Economic Principles Applied to Circumcision

I’m a huge fan of economics because it provides useful, widely-applicable lessons. Economist David Henderson created a list of The Ten Pillars of Economic Wisdom that is quite useful. Several of the principles apply directly to the issue of genital integrity. The principles obviously connected to the basic human right of genital integrity, from the current version (originally published in The Joy of Freedom: An Economist’s Odyssey):

1. TANSTAAFL: There ain’t no such thing as a free lunch.

Circumcision is commonly sold in the U.S. with a long list of benefits and a tiny list of supposedly rare risks. The challenge is that the former is only potential and the latter is incomplete. There is no such thing as a free lunch. Circumcision is more than a bunch of benefits in exchange for “a useless flap of skin”. In addition to the inherent risks of surgery, circumcision has permanent costs that last long beyond the surgery itself. This is what’s ignored. Most advocates of non-therapeutic child circumcision omit this. (Brian Morris is probably the most egregious offender on this point.) They treat the surgery as a free lunch. “Look at the potential benefits” they say. Even this, which is better than most lists, omits the full range of costs. There is no discussion of the mechanical change. There is no discussion of the foreskin as a normal anatomical structure or what’s lost. It’s just ignored, as if it’s not a cost. This omission is incorrect. (This is related to another economic principle.)

2. Incentives matter; incentives affect behavior.

The most obvious example is the third-party payment system within the United States that generally pays for non-therapeutic circumcision of children. Parents don’t see the full financial cost because it’s spread out among the full range of insured Americans. It’s as if it’s a free lunch because the direct cost is hidden.

This is also seen with Medicaid. Where it’s not funded by the state, fewer low-income parents impose non-therapeutic circumcision on their sons. (I reject the nonsense offered by advocates like Dr. Edgar Schoen¹ and Colorado State Senator Joyce Foster – for reasons related to several of these economic principles – when they say Medicaid funding is a matter of social justice.)

As an aside, I do not accept the argument that a single-payer government insurance system in America would automatically result in the near-extinction of non-therapeutic circumcision in America, as it has in a country like England, by removing the financial incentive. I’ve long voiced a level of skepticism on this for reasons influenced by this economic principle. Incentives matter. The hidden financial cost of circumcision is not the only incentive in America. The idea that circumcision is “patriotic” (to cite Schoen, among several) rests on a non-financial incentive. The fear that family, classmates, and/or future sexual partners will shun an intact male is an incentive. These are cultural and will not disappear if the only change in society is that parents will carry the full financial cost of imposing circumcision on their (male only) children. I’ve encountered too many examples of parents complaining that they “have” to pay for their son’s unnecessary circumcision because their insurance plan won’t cover it to think otherwise.

6. Every action has unintended consequences; you can never do only one thing.

This is related to the no free lunch principle. Parents and medical professionals think that allowing proxy consent on this involves doing what’s best for their son. Parents who circumcise are assumed to achieve this – and only this – outcome. However, the action eliminates the child’s personal choice. That is not generally intended, on the “parents are well-intentioned” fallacy that ignores the act of circumcision. But circumcision is not just reducing risk X or whatever argument parents use. It’s also whatever the child decides about circumcision. Perhaps his opinion will align with his parents’. Perhaps not. Either way, his choice is gone.

Also, the funds and labor used for circumcision are no longer available for therapeutic treatments or other pursuits. This is an unintended consequence.

7. The value of a good or a service is subjective.

This is the key point here. This applies to all circumcisions, but with non-therapeutic circumcision, it’s especially true. There is no objective need, no reason to impose this on someone who can’t consent. The value of the intervention rests with the recipient. Again, perhaps his opinion will align with his parents’, but perhaps not. Society permits (and often encourages) parental proxy consent. The value is placed exclusively on the parents’ subjective valuation of the potential benefits and (often ignored) costs of non-therapeutic circumcision. The child’s possible objection is ignored in favor of his parents’ preferences about his body. In my case, my parents paid for a circumcision that I wouldn’t choose to accept if I were paid an enormous amount of money to undergo the procedure. Their valuation doesn’t match mine for the service.

These principles help make the ethical case. A permanent, non-therapeutic alteration should never be imposed on someone who does not consent.

¹ Dr. Schoen, especially, since he writes “[t]his means that many poor families are unable to choose to receive a circumcision…”. The family doesn’t receive the circumcision. The child does. Dr. Schoen’s position on the ethics of non-therapeutic circumcision is idiotic and untethered from anything other than is subjective valuation. As economic principle number seven shows, the valuation of everyone other than the patient is irrelevant in the imposition of circumcision.