And while it is true that three randomized trials in Africa found that circumcision more than halved the risk of men getting HIV, it is harder to justify a prophylactic procedure in a place with considerably less HIV risk. In South Africa, for example, almost a quarter of the adult population is already infected, whereas in America, a little over one third of 1% (.37%) have HIV.
This helped entrench an elective medical practice, creating generations of foreskinless fathers and doctors who were inclined to believe it was best for their sons, too. It is a trend that America’s unwieldy fee-for-service health-care handily reinforces, as doctors and hospitals have incentives for offering interventions deemed unnecessary most everywhere else.
Johnson, the University of Michigan professor of obstetrics and gynecology, observes that the procedure is “highly remunerative” for the pediatricians at his hospital.
“I think the professional charge in our state is somewhere between $150-200,” he says. “That’s real money if you can do four or five circumcisions in an hour.” In states where Medicaid does not cover the practice, rates have fallen fast.