The use of Medicaid tax money to pay for amputating an integral part of individual's normal
body without his permission is a disgrace, and in North Dakota it is
also insurance fraud because tax dollars are still spent on infant
circumcisions despite regulations prohibiting its use. Using any health
insurance money to pay for disfiguring operations on nonconsenting
individuals is not only a waste, it is unethical, and likely a violation
of the state charters under which insurance companies legally operate
(see below, for example, BlueCrossBlueShield's Articles
of Incorporation). The law proposed in 1995
(see below) must be passed to prevent such misuse of funds until boys
are given the same protection from enforcement agencies as girls.
This page contains:
1992 Letter to Earl Pomeroy, State Insurance Commissioner.
BlueCrossBlueShield's Articles of Incorporation.
Blue CrossBlueShield's Mission Statement.
Open letter to BlueCrossBlueShield, November
Medicaid's policy statement and
1995 Proposal for new legislation to discontinue
September 24, 1992
State Insurance Commissioner
State Capital Bldg.
RE: Misuse of medical
Dear Mr. Pomeroy:
I saw Nightline last
night and your campaign ad on the Blue Cross Hawaii board meetings.
That is small stuff compared to what BlueCrossBlueShield plans across
the country spend on unnecessary operations that mutilate infant
genitals, namely, circumcision.
There is no medical
reason for this operation which costs the country millions a year plus
additional millions to repair "botched jobs." Then there is
the cost to us in higher medical bills because doctors must pay higher
insurance premiums to protect themselves from malpractice.
Estimates are as high
as 200 people a year in the US die from circumcision complications;
one in 500, according to the American Academy of Pediatrics (AAP),
have major complications like loss of penis, and there is always the
loss of the foreskin and its sensitivity. The operation is still
generally done with no anesthesia and can cause life-long trauma [the
AAP, in 1999, finally suggested that anesthesia be used, even though
no safe and truly effective means is available, and even if there
were, protecting the infant from immediate pain does not protect the
cutters from ethical malfeasance].
Many like Dr. Robert Wentz, Chief North
Dakota Health Officer, and Gladys
Cairns, Director Child Protection Services, think this
"routine" operation should not continue.
North Dakota may not
have any laws on the books yet (some will be introduced next year),
but ... your office could be proactive and ask for legislation to
prevent wasting money on circumcisions and thereby the cost of their
A legislator has asked
Attorney General Spaeth to rule on whether or not the ND Board of
Medical Examiners and Commission on Medical Competency must consider
circumcision as unnecessary surgery. Law suits claiming no one has the
right to mutilate a healthy organ of another without his consent have
been filed in other states and may be here. Some laws are being
challenged because the laws are sexist in their enforcement, unless,
of course, we allow parents and doctors to remove healthy genital
tissue from females (common in Moslem countries, and U.S. and Canadian
doctors have been asked to do it).
Duane Voskuil, Ph.D.
[No response to this
The BlueCrossBlueShield of North Dakota's (BCBS) Articles of
Incorporation which follow can be found in the archives of the
North Dakota Secretary of State. Is
BCBS legally in agreement with Article III in reimbursing for routine
infant circumcision which BCBS itself, Medicaid and the American Academy of Pediatrics say is not a healthcare service? Italicized words are added emphasis to point
out that BCBS is in the healthcare business, not a support for a social
ritual that has no health justification.
AMENDED ARTICLES OF
BLUE CROSS AND BLUE SHIELD OF NORTH DAKOTA
The name of the
Corporation shall be:
BLUE CROSS AND BLUE
SHIELD OF NORTH DAKOTA
The period of its
duration is perpetual.
The purpose for which
this Corporation is organized shall be:
A. To establish,
operate and maintain Health Service Plans whereby one or more
kinds of health service is provided to Subscribers under a Prepaid Health
Service Contract entitling each Subscriber to certain specified
health services. In connection therewith, the Corporation shall have
1. Enter into
contracts for the rendering of hospital service to any of its
Subscribers with hospitals maintained and operated by the state
or any of its political subdivisions, or by any corporation,
association, or individual. The Hospital Service Plan operated
by the Corporation may provide for hospital service and other
related health services as advancements in health care
and treatment warrant the extension and providing of such
services and in case of emergency or expediency.
2. Make and
enter into mutual agreements with hospitals or groups of
hospitals, nursing homes, and other vendors and furnishers of health
care services and other related facilities.
3. Make and
enter into mutual agreements with state, federal, or other
governmental agencies to provide hospital services, nursing home
care, and other related health services, including health
care services for the needy and other persons.
4. Make and
enter into mutual agreements with any other health care
corporation or with any state or local government or agency
thereof to provide health care administrative services,
to act as administrator of any other health care service plan,
or to act as a marketing agency or as a fiscal intermediary of
any health care plan or of any other health care
organization or of any federal, state or local government or
5. Enter into
contracts with other corporations or other entities in this
state or in other states or possessions of the United States, or
of the Dominion of Canada or other foreign countries so that:
Reciprocity of benefits may be provided to Subscribers.
of Subscribers from one entity to another may be effected to
conform to the Subscriber's place of residence.
benefits may be provided for all employees and dependents of
such employees of entities and other organizations
transacting business in this state and elsewhere and a rate
representing the composite experience of the areas involved
may be charged for such employees and their dependents.
services may be provided for Subscribers of this or
other corporations or entities for the purpose of ceding or
accepting reinsurance of of [sic] jointly providing
benefits, underwriting, pooling, mutualization,
equalization, and other joint undertakings which the
governing board may from time to time approve.
6. Enter into
contracts with physicians for the rendering of medical service
to Subscribers in accordance with the terms of the Subscriber
7. Enter into
contracts with laboratories and vendors of health
appliances and prostheses to provide material and services
pursuant to contracts with Subscribers.
8. To do
everything necessary and proper for accomplishing any of the
purposes or attaining any one or more or the objects herein
enumerated or which, at any time, appear to be convenient,
conducive to, or expedient for the protection or benefit of this
Corporation or any of the Subscribers and Health Care
BlueCross BlueShield of
North Dakota Mission Statement
[link may be dead]
It is the mission of Blue Cross Blue
Shield of North Dakota to provide the best value in health insurance to
our customers. [Yet BCBS pays
for contra-indicated surgeries]
We apply our corporate values to exceed
our customers' expectations in providing health insurance, government
program administration, and related employee benefits by:
- Responding to our customers in all
- Offering products and services that
provide financial security to our customers.
- Maintaining effective and professional
- Collaborating with our health care
providers for cost-effective, healthy outcomes.
- Operating the company efficiently and
effectively while maintaining financial stability.
- Empowering our customers to make
informed health care decisions by providing them with informational
opportunities and resources. [Requests
that they help educate the public on the circumcision issue are
- Supporting and contributing to
economic development within North Dakota.
Our Shared Business Values
We are committed to understand our customers' needs and proactively
deliver products and services to meet those needs.
A Dynamic Workplace
Working together, we encourage an environment where every employee can
pursue and be recognized for outstanding individual and team performance
with diverse opportunities for personal growth.
Excellence is an expectation. We continually improve and remain open to
being compared to the best.
We are trustworthy, ethical, honest, and accountable for our actions. [Is it honest and ethical to pay people to
amputate valuable, normal, healthy tissue from those who have no say in
letter to BlueCrossBlueShield of N.D.
November 17, 1993
RE: One Unnecessary Surgery Covered by most ND Blue Cross plans
(except state employees).
Routine infant circumcision has no medical justification. It is a
surgery looking for a medical rationalization. In 1891 James Hutchinson
of the Royal College of Surgeons in England proposed it as a
"treatment" for masturbation which supposedly caused insanity.
He went so far as to say that "if public opinion permitted their
adoption—measures more radical than circumcision would be a true
kindness." Today we are told it helps prevent urinary tract
infections, cervical and penile cancer and even HIV infections.
Even if any of these claims were true (and none are to any
statistically significant degree and others are actually the opposite of
the claim), still the actual known risks to the surgery far outweigh the
purported advantages, namely, infection, significant pain, penises with
physical distortions (in addition to their loss of the natural
foreskin,) total loss of the penis, and death (not to mention some
possible long-range psychological problems and loss of significant
sexual nerve tissue). Robert Wentz,
MD, former State Health Officer agrees "that the purported medical
indications are outweighed by risks and disadvantages and that
circumcisions represent an unnecessary health care cost" (Letter to
The financial cost to Blue Cross and the public is high. Estimates
range from $300,000 to half a million dollars for the operation and
follow-up care for North Dakotans alone. This does not even cover the
cost of paying for the multimillion dollar law suits that follow when
one ends up with a badly damaged or lost penis. Just what these costs
are no one seems to know since no one is keeping records and making this
information public. We are aware of at least one case of a Glendive, MT,
who has lost his penis and several other cases reported by James Snyder,
MD, former chairman of the Virginia Urological society.
Circumcision, the only male surgery done by those specializing in
female care (gynecologists), is the only surgery still permitted to
remove healthy tissue from a non-consenting individual (though some
argue that abortion falls into this category). Much is made of the
so-called parental right to decide whether to cut off a infant’s
foreskin, but few consider what the child might want. Since this is an
irreversible operation, and one that is not medically indicated and one
that can be done at anytime with no more, and probably fewer, problems
than when it is done as an infant, reason should dictate that the
decision to cut this sexually sensitive tissue away be left to the one
who must live with it.
The legal aspects of circumcision are just beginning to be explored
as they are with the female genital operations of circumcision,
clitoridectomy and infibulation, common in many parts of the world and
re-occurring in the US and Canada because of new African immigrations.
Even as late as 1977 some Blue Cross plans covered clitoridectomies
according to Constance A. Bean, coordinator of health education at MIT
and author of Methods of Childbirth (p.227).
Over and above the discussion of circumcision as unnecessary surgery,
there is an increasing awareness that circumcision is abusive. Since it
has been a common social practice for 100 years (in the US but not in
Europe where the incidence is less than 1% compared to our 60%
nationally and probably 90% in many North Dakota hospitals), to say
circumcisers and parents who put their sons through the operation are
legally culpable of child abuse is still an unsettled legal and moral
issue. Most who do not want to call it child abuse do not, however,
hesitate to call female genital mutilations what they are, namely,
"mutilations" and the ones who do it culpable of criminal
Psychologists, especially those who specialize in the effects of
neonatal experiences on adult thinking and behavior, stress that the
placing of pain in the region of the brain/mind that is designed for
pleasure produces neurotic people. Also, the distrust the infant comes
to feel towards the world ("mother" who betrayed him) can
never be completely erased.
Summary: There are no health reasons to circumcise. There are reasons
not to. Stop paying for it.
Duane Voskuil, Ph.D.
P.O. Box 209
Minot, ND 58702
Addendum: North Dakota BCBS did
stopped paying for routine circumcisions for a while in the '80s upon
the urging of Ron Miller, MD, but
reinstated payments because they thought they might be losing
subscribers. This would not be a concern if all policies were the same,
this is why we need a prohibition on any insurance coverage such as the
following bill suggested in 1995:
for an Amendment
to the N.D. Century Code
An Amendment to create and enact a new
section to chapter 26.136 of the North Dakota Century Code, relating
to a restriction on health insurance coverage of infant circumcision
A new section to chapter 26.1-36 of the
North Dakota Century Code is [to be] created and enacted as follows:
coverage. No health insurance policy, health service contract, or
evidence of coverage may be issued, delivered, executed, or renewed
unless the policy, contracts or evidence of coverage restricts coverage
for infant circumcision to cases in which the patient has a
life-threatening or health-threatening condition requiring immediate
In support of this amendment we would have the legislators
consider the following quotations:
policy statement: “Effective for services provided on or after
November 1, 1986, the North Dakota Medical Assistance Program will
provide payment for circumcisions only when there is documented evidence
that the circumcision was performed due to medical necessity. Routine
circumcisions that are not medically indicated will no longer be
reimbursable through the Medical Assistance Program.”
Employees Retirement System Group Health Plan (PERS), July 1, 1993,
underwritten and administered by BlueCross BlueShield of North Dakota:
“You [North Dakota Public Employees] are not covered for: nonmedically
necessary circumcision for newborns.” PERS handbook.
circumcisions–We [the Contract Administration Committee of BlueCross BlueShield of ND]
consulted with other Plans and The American Academy of Pediatrics. The
majority of these entities do not have an established policy regarding
circumcision.... There is recognition by these parties that this [i.e., routine infant
prepuce amputation] is an
elective service." Letter to Jody
McLaughlin from BCBS, 11/23/92.