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The ACA and the Future of Infant Circumcision

I've made the argument that a government-run single-payer health care system in America would not automatically result in non-therapeutic infant circumcision rates comparable to other Western nations (e.g. United Kingdom), probably most directly here. I stand by that for the reasons I've stated. But now that the Affordable Care Act has been upheld by the Supreme Court, I want to explore a possible (though unlikely) unintended consequence of encouraging the government to control more health care.

As I understand it, the government has now been given what amounts to unlimited power to incentivize (i.e. compel) activity to achieve a public policy goal where some (or many) may prefer inactivity. Congress merely needs to establish a "Do X or Pay T" regulatory scheme. Many, although not a majority of Americans, approve of this for health care. This is presumably a statement on the value of the goal rather than an explicit endorsement of the means. But the means matter.

Extending this thinking, what now prevents the Congress from implementing "Circumcise your newborn son or Pay a Tax"? It now has that power. And the logic is no different. Congressman Brad Sherman endorsed the political thinking that would encourage such a policy during last year's discussion of the San Francisco ballot initiative. He declared that "Congress has a legitimate interest in making sure that a practice that appears to reduce disease and health care costs remains available to parents".

I do not believe this is politically likely. With any extension of this newly-expanded power, Congress will need the political cover to pass a new tax. They swore the ACA wasn't a tax, though, so lying is an option. They're politicians, after all. It would still face challenges. But it is possible, and we've seen the lengths to which politicians will fall over themselves to avoid offending the status quo on non-therapeutic infant circumcision.

I think my argument holds up. If nothing else, the ACA almost certainly slows future progress on ending this violation of male children. Cultural circumcision has a new god in the perceived¹ reduction in future health care costs. There are means available within government control to pursue that. If we get further "reform", it's likely to offer even more control to the government. That is a problem. This seems obvious to me. As long as the government has a power and a willingness to ignore facts, the possibility of consequences exists, both intended and unintended. We should be careful which methods we endorse.

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¹ The time value of money must be included. A dollar spent today on health care is not the same as a dollar that might be spent twenty, thirty, or more years from today. The number of adult circumcisions needed would have to be greater than it is to justify this public purse argument. It still wouldn’t be ethical to circumcise healthy infants, of course.

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