View source for Financial incentive

{{Citation
 |Title=The Merchant's Conflict of Interest
 |Text=It's hard to get a man to understand something, when his livelihood depends on his not understanding it.
 |Author=Upton Sinclair
 |Source=
}}
[[Image:Money.jpg|right|thumb|]]

'''Financial incentive''' in the United States to perform medically-unnecessary, non-therapeutic [[circumcision]] is very large. Non-therapeutic circumcision is a multi-billion dollar industry. Profit is reaped not only from the practice of circumcision itself, and associated hospital charges, but also from the sale of harvested foreskins, the sale of products derived from harvested foreskins, the sale of circumcision specific tools and utensils, and the treatment of oomplications and botched circumcisions.

== The procedure itself ==
Mansfield et al. (1995) reported there are no medical indications for non-therapeutic infant circumcision.<ref name="mansfield1995">{{REFjournal
 |last=Mansfield
 |first=Christopher J
 |init=CJ
 |author-link=
 |last2=Hueston
 |first2=William J
 |init2=WJ
 |author2-link=
 |last3=Rudy
 |first3=Mary
 |init3=M
 |author3-link=
 |etal=no
 |title=Neonatal circumcision: associated factors and length of hospital stay
 |trans-title=
 |language=English
 |journal=J Fam Pract
 |location=
 |date=1995-10
 |volume=41
 |issue=4
 |pages=370-6
 |url=http://www.cirp.org/library/procedure/mansfield/
 |archived=
 |quote=
 |pubmedID=7561711
 |pubmedCID=
 |DOI=
 |accessdate=2020-08-04
}}</ref>

1.2 million baby boys are circumcised a year in the United States alone. At a dollar per procedure, that is already $1,200,000 a year. The going rate for a circumcision procedure is approximately $1,700 when hospital charges are included, multiplied by 1.2 million, that is approximately $2,040,000,000 a year that circumcision brings in based on the procedure alone.

When a baby boy is to be circumcised, mother and baby remain in hospital for about one-fourth of a day longer,<ref name="mansfield1995" /> so that increases the profit to the hospital.

Bollinger (2012) estimates that the total cost of non-therapeutic male circumcision, including hospital costs, repair of botched circumcisions, treatment of complications, and so on is more than $3 billion per year.<ref name="bollinger2012">{{REFweb
 |url=https://www.academia.edu/6442587/High_Cost_of_Circumcision_3.6_Billion_Annually
 |title=High Cost of Circumcision: $3.6 Billion Annually
 |last=Bollinger
 |first=Dan
 |author-link=Dan Bollinger
 |publisher=Academia
 |website=https://www.academia.edu
 |date=2012
 |accessdate=2020-11-25
 |format=
 |quote=As they saying goes, follow the money. Now you know why neither the [[American Academy of Pediatrics]], American Medical Association, [[American Academy of Family Physicians]], or the [[American Congress of Obstetricians and Gynecologists| American College of Obstetricians and Gynecologists]] haven’t condemned this unnecessary surgery, and why their physician members are quick to recommend the procedure to expectant parents.
}}</ref> [[Third-party payment]] is a major support to the performance of this medically-unnecessary surgery.

The now expired and  discredited AAP 2012 ''Circumcision Policy Statement'' stated that "Although health benefits are not great enough to recommend routine (i.e. non-therapeutic) circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it and to '''warrant third-party payment''' for circumcision of male newborns. It is important that clinicians routinely inform parents of the health benefits and risks of male newborn circumcision in an unbiased and accurate manner." and "The American College of Obstetricians and Gynecologists has endorsed this statement."<ref>{{REFweb
 |last=
 |first=
 |date=2012-08-27
 |title=Circumcision Policy Statement
 |url=http://pediatrics.aappublications.org/content/130/3/585
 |publisher=''Pediatrics''
 |accessdate=2012-11-24
}}</ref> Many new born circumcisions are performed by obstetricians.

==Solicitation for circumcision surgery==

[[Intact America]] commissioned a survey by [https://www.qualtrics.com/ Qualtrics] of the number of times that parents are solicited for a consent for non-therapeutic infant circumcision. The average was 8 times, which resulted in a 143 percent increase in the number of non-therapeutic, medically-unnecessary circumcisions carried out.<ref name="intactamerica2020">{{REFweb
 |url=https://www.prweb.com/releases/having_a_baby_boy_intact_america_warns_get_ready_for_the_circumcision_sellers/prweb17552844.htm
 |archived=
 |title=Having a Baby Boy? Intact America Warns, ‘Get Ready for the Circumcision Sellers!'
 |trans-title=
 |language=English
 |last=Chapin
 |first=Georganne
 |author-link=Georganne Chapin
 |publisher=Intact America
 |website=prweb
 |date=2019-11-18
 |accessdate=2020-12-15
 |format=
 |quote=Each year, an estimated 1.5 million baby boys are circumcised in American medical settings. Intact America estimates that if circumcision solicitations were to cease, 600,000 boys—and the men they will become—would be spared every year from the trauma and lifelong consequences of the procedure.
}} </ref> Giving in to the constant solicitation means that two charges will be incurred:

# A hospital service charge or facility fee.
# A physician's fee.

Parents are reminded that neonatal [[circumcision]] has no medical indication, does not provide treat disease, is non-therapeutic, unnecessary, and causes life-long irreversible harm because of the loss of the [[https://en.intactiwiki.org/index.php/Foreskin#Physiological_functions multi-functional foreskin]].

==Government support ==

Although the foreskin has [[Immunological and protective function of the foreskin| immunological and protective functions]], Government medical insurance in the United States still holds the notion, which originated in the late 19th century, that the [[foreskin]] is a cesspool of disease, and circumcision improves hygiene and prevents sexually transmitted diseases (STDs), therefore it is best cut off and insurance should pay for it without any proof of medical indication or necessity, so there are no effective controls in force to see that only medically necessary services are covered.<ref name="hodges1997">{{REFbook
 |last=Hodges
 |first=Frederick
 |author-link=Frederick M. Hodges
 |last2=
 |first2=
 |author2-link=
 |year=1997
 |title=A Short History of the Institutionalization of Involuntary Sexual Mutilation in the United States
 |url=https://link.springer.com/chapter/10.1007/978-1-4757-2679-4_2
 |work=Sexual Mutilations: A Human Tragedy
 |editor=George C. Denniston, Marilyn Fayre Milos, Frederick Mansfield Hodges
 |edition=
 |volume=
 |chapter=
 |pages=17-40
 |location=
 |publisher=Plenum Press
 |isbn=
 |quote=
 |accessdate=2020-08-04
 |note=
}}</ref> This view is not supported by current medical evidence.

===Medicaid===
[https://www.medicaid.gov/ Medicaid] is a medical insurance program for people whose income is below the federal poverty level (FPL}. However, in most states, pregnant women are covered to a variable amount above the FPL.

The medical expenses of many births are borne by Medicaid. The percentage of births covered by Medicaid varies by state. It ranges from a low of 20 percent in Vermont to 71 percent in New Mexico.<ref>{{REFweb
 |url=https://www.kff.org/medicaid/state-indicator/births-financed-by-medicaid/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
 |title=Births financed by Medicaid
 |last=
 |first=
 |accessdate=2020-08-05
}}</ref> Medicaid financed 45 percent of all births in 2010.<ref>{{REFweb
 |url=https://publichealth.gwu.edu/content/medicaid-pays-nearly-half-all-births-united-states
 |title=Medicaid Pays For Nearly Half of All Births in the United States
 |last=
 |first=
 |date=2013-09-05
 |accessdate=2020-08-05
}}</ref> Circumcision is frequently included as part of the birth package of covered expenses, so third-party payment is provided.

While 18 states have stopped paying for non-therapeutic [[circumcision]], 32 states still pay for it. Doctors may be driven to promote non-therapeutic circumcision if they get a free stipend from the state. Adler (2011) has argued that such payments are contrary to law.<ref>{{REFjournal
 |last=Adler
 |first=Peter W.
 |init=PW
 |author-link=Peter W. Adler
 |title=It is lawful to use Medicaid to pay for circumcision?
 |journal=Journal of Law and Medicine
 |date=2011
 |volume=19
 |issue=
 |pages=335-353
 |url=https://www.arclaw.org/wp-content/uploads/2019/04/is-it-lawful-to-use-medicaid-to-pay-for-circumcision.pdf
 |quote=
 |pubmedID=
 |pubmedCID=
 |DOI=
 |accessdate=2020-08-05
}}</ref>

===Indian Health Service===

The [https://www.ihs.gov/ Indian Health Service] provides non-therapeutic circumcision to native Americans, even though circumcision is not part of the culture of native Americans.

===Tricare===

[https://www.tricare.mil/ Tricare] is the government medical insurance for military dependents. Tricare covers non-therapeutic circumcision of the newborn male infant.<ref>[https://www.tricare.mil/SearchResults?search=circumcision Circumcision (Newborn)]</ref>

===Civil servants===

There are about 2 million United States government employees in the United States whose health insurance covers non-therapeutic circumcision.

===Medicare===

The [https://www.medicare.gov/ United States Medicare Program] provides health insurance for persons who have reached the age of 65 years. It assumes that any man with a [[foreskin]] needs a [[circumcision]]. It does not require proof of medical necessity to provide third-party payment.

===State and local government===

There are approximately 7,000,000 employees of state and local government. The great majority of these have health insurance that provides [[third-party payment]] for non-therapeutic circumcision.

==Private insurance==

The United States has an unusual system, which originated during World War II, of having employers provide a non-taxable benefit of medical insurance to employees. The system is not universal so many employers do not provide insurance. Of those who do, many provide [[third-party payment]] to support non-therapeutic circumcision.

== Auxiliary tools ==
Industries that depend on the practice of circumcision, particularly infant circumcision include makers of the [[circumstraint]] (the board to which a baby is strapped down to for the procedure), makers of circumcision clamps, manufacturers of circumcision kits, and other utensils used for circumcision.

Clamp manufacturers:
* [[Gomco]]
* [[Mogen]] (out of business)

Makers of other circumcision tools:
* [[AccuCirc]]
* [[TaraKlamp]]
* [[Plastibell]]

Makers of circumcision kits:
* [[Priontex Products & Services]]

Makers of restraints:
* [[Circumstraint]]

Other costs:
* Anaesthetic (rarely used)
* Nerve blocks

== Profit from harvested foreskins ==
Foreskins are sold to pharmaceutical companies for stem-cell research, the creation of synthetic skin, and the creation of consumer products. Since the 1980s, private hospitals have been involved in the business of supplying discarded foreskins to private bio-research laboratories and pharmaceutical companies who require human flesh as raw research material.<ref name="hodges1997" /> They also supply foreskins to transnational corporations. Dr. Tania Phillips, professor of dermatology at [http://www.bumc.bu.edu/ Boston University School of Medicine], insisting foreskin gathering and cultivating is scientifically and technologically "very promising." <ref>Ronald Rosenberg. 19 October 1992: 22-23.</ref>

=== Corporate benefactors ===
The following transnational corporations reap corporate profits from the sale of marketable products made from harvested human foreskins:

* [[Advanced Tissue Sciences]] (ATS) <ref>Forget pork bellies, now it's foreskins. Manson B. ''San Diego Reader'' (May 4, 1995): 12, 14 passim.</ref>
* [[Organogenesis]]<ref>New skin twin life- and look-save. Brewer S. ''Longevity'' (September 1992): 18.</ref>
* BioSurface Technology<ref>Companies see $1.5b market in replacement skin products. Rosenberg R. ''Boston Globe'' (October 19, 1992): 22-23.</ref>
* Genzyme
* Ortec International
* [[LifeCell Corporation]] (Nasdaq:LIFC)
* [[SkinMedica]]

=== FDA approved products ===
The following products fashioned from harvested foreskins were approved by the FDA for marketing:

* [[Dermagraft-TC]]
* [[Apligraf]]
* [[AlloDerm]]
* [[TNS Recovery Complex]]

== Grants from pro-circumcision interest groups ==
There are pro-circumcision interest groups that give grants to doctors and researchers to "study" and promote circumcision. Organizations that do this include the [[Bill & Melinda Gates Foundation]]. In 2009, [[Schusterman Family Foundation]] gave a grant to mohel and professional infant circumcisor [[Neil Pollock]] to promote infant circumcision in Rwanda,<ref name='marketwire 2009-02-24'>{{REFnews
 |last=Millman
 |first=N. Michael
 |url=http://www.marketwire.com/press-release/BC-Surgeon-Joins-Fight-Against-Sub-Saharan-Aids-953409.htm
 |title=BC Surgeon Joins Fight Against Sub-Saharan AIDS
 |date=2009-02-24
 |publisher=marketwire
 |quote=...much of the trip's cost was covered by grant money from Canadian Institutes of Health Research and funding from the Shusterman Foundation...
 |accessdate=2011-04-10
}}</ref> particularly the [[Mogen]] technique, in the name of HIV prevention.

==Total annual costs of American circumcision==

Bollinger (2012) estimated that the total cost of non-therapeutic circumcision to Americans is $3,647,000,000.<ref name="bollinger2012" />
{{SEEALSO}}

* [[Third-party payment]]
* [[PEPFAR]]

{{LINKS}}

* {{REFweb
 |url=http://acroposthion.com/the-foreskin-industry/
 |title=The Foreskin Industry
 |website=Acroposthion
 |last=
 |first=
 |accessdate=2020-03-02
}}

* {{REFweb
 |url=https://thehappyhospitalist.blogspot.com/2008/01/get-yer-snips-at-12-price.html
 |archived=
 |title=How Much Does a Circumcision Cost? Detailed Analysis! 
 |trans-title=
 |language=English
 |last=
 |first=
 |author-link=
 |publisher=Happy Hospitalist
 |website=
 |date=
 |accessdate=2020-08-25
 |format=
 |quote=
}}

{{REF}}

[[Category:Motives]]
[[Category:Financial gain]]
[[Category:USA]]

[[Category:From CircLeaks]]
[[Category:From IntactWiki]]

[[de:Finanzieller Anreiz]]