Unspeakably offensive!But, sadly, it’s also not surprising. It’s like a replay of how Jesse Helms tried to bring down the Americans with Disabilities Act in 1990 by using LGBT people as pawns. Sadly, he succeeded in denying transgender people protection under that law. Although that was nearly two decades ago, this strikes me as a serious threat, given how horribly spineless moderate Democrats are.

I’d just make one amendment:“… for patients under the age of 12″.
Intersexed babies are being surgically mutilated all the time so they don’t look “different”. Even though this may sterilise them. Even though this may make them sexually dysfunctional, insensate. Even though this may make them transsexual, boy brain in girl body.
Just so as not to disturb society’s expectations. Just so their appearance is “normal”.
It’s one thing to do a minimalist reconstruction to give urinary continence, or relieve pain, as is necessary in some cases. It’s another to mutilate babies just to stop others from feeling uncomfortable, knowing that people like myself exist, and then to prevent reversal of the damage later, when they can give informed consent.

Nice point!

shopping around for a sponsorHow disgusting. No post-op treatments is unspeakably cruel. I take this to mean that if you get an infection after reconstruction surgery, you’re told, “Sorry, not covered.”
And what about intersex kids? Are they going to add an amendment to their amendment to allow intersex kids to get hormones? I’m no expert on the subject, but I’ve known a person or two born intersex who was put on hormones. I’m assuming at puberty, but I wasn’t nosy enough to ask exactly when. I just remember him telling me that he took them, legally prescribed by an MD.
I don’t know why I’m so pissed off about this particular amendment when there have been so many things about the whole health care reform that have not been to my liking. The idea that we have a majority in the House, should have a filibuster-proof majority in the Senate, and they are being as obstructionist as possible annoys me, and choosing to pick on (a subset of) queers one more time just angers me.
We have what? All of three openly gay/lesbian members of Congress and zero transsexual ones. No senators. I am so sick of straight people, either voters or elected officials, deciding whether LGBT people get to have our families recognized or get appropriate health care.  

Counter AmendmentWhat we need is someone to insert language into the bill like this of “there shall be nothing in this bill that prohibits treatment of any disease or disorder that has been determined by the American Medical Association to be medically necessary”
Now run again and justify your voting against that.

Ooh, I like that idea!Maybe we should be in the DSM-IV-TR and maybe we shouldn’t be, but while we’re there we can at least use that against the transphobes.
Honestly, though, it wouldn’t surprise me if this does pass… transphobia can be awfully widespread (I’ve certainly heard plenty of so-called liberals use “transsexual” as an insult against Ann Coulter). Too, as far as I know very few private insurance companies don’t cover surgery or even hormones (I know mine doesn’t).

Also…Should have put it in the previous post, but didn’t: I read the Politico article in full and found that the comment thread (which I always read on that sort of thing, I think it tells you more than the story half the time) was something like 75% transphobic “ooh, the government shouldn’t pay for elective surgery for freaks” talk (with several honorable exceptions, including Zoe’s!). I don’t know what Politico’s record on trans issues is, but this is sort of depressing regardless.

I think something more sinister is happeningIf the Dems/real health care reformers fight against this amendment, they will be seen as reckless with tax money. That’s why I think if it’s put forward they will most likely allow it to be attached to the bill.
Both sides know this is a “gotcha” ploy and the Dems won’t allow the threat of “Trannycare” jeopardizing the whole bill.
Don’t laugh, the “death panel” lie almost did.        

We Should…add an amendment to prohibit coverage for all Ex-Gay treatment programs

How typicalWhat could the conservatives possibly be thinking?  That people who aren’t really trans are out there undergoing physically and emotionally taxing sex-change operations, frivolously?  For the sole purpose of pissing off the other side of the Culture War(TM)?
Reminds me of the social conservatives’ take on abortion, with all the paranoia about its supposed use as a form of birth control.  It’s as if these fundie freakoids seriously believe that women go around having abortions cavalierly, with just a flip of the hand, because gosh it’s just so EASY… rather than the truth, that anyone willing to undergo something that physically and emotionally difficult probably has a damn good reason to do so.  Same thing for a sex-change op… anyone willing to endure something that difficult is only doing so because they really need it to harmonize who they are… because they’re an honest-to-goodness trans person and one who won’t feel at home in their body until they transition.
It stuns me that moral conservatives apparently can’t grasp these essential facts.

Jackasses…When I first heard this it pissed me off immediately.  I would freak out for a bit should my current insurance just decide to stop covering my HRT.  Not because of the money, but because its a necessity (and the money).

I agree, but…I think that if anything you’re giving the conservatives too much credit. I don’t think that they would change their position if a regiment of trans folk marched into their offices and proved beyond a doubt that we DO feel that deep-seated need to have SRS. As far as I can tell, this isn’t about stopping people from leeching off the state to get spurious operations — this is about denying genuine trans folk the right to bring our bodies into accord with our identities.

I Don’t Think It’s About ThatFirst: You can always tell when people don’t want to touch a topic because they disagree with a post because of the lack of comments.  Even now, I’m tempted to just join the vast majority of the 5,000 or 8,000+ readers (whatever the latest numbers are) and silently duck off into the night, keeping my opinion to myself for fear of being attacked.  But, I love Pam’s House Blend, and I love what it does for the community, even though I’m fearful that this won’t be a nice conversation over coffee, but rather turn into an attack because a very, very small group of people on the site don’t seem to believe others can disagree with them without it being motivated by hate.  Still, cowardice isn’t a virtue, so I’m going to go ahead and post this in good faith.
I think you’re over thinking it.  It’s about the money and individual property rights.  The logic goes like this.  
The United States current has a population of 308,000,000.  If you take the HRC’s smallest estimate of the transgendered population of 1/4th of 1%, this works out to 770,000 transgendered people in the country.  
As many on the site have stated, not everyone has “the operation”, nor does every transgendered person desire to do so.  Let’s assume for the sake of argument and conservatism, then, that fully 50% of transgendered people do NOT want the surgery, meaning that 385,000 do.  In theory, the actual number may be higher than historically suggested because we don’t know how many people aren’t getting the procedure because it is financially impossible under the current system.
The cost of reassignment surgery according to some sites online can range from $7,000 to more than $50,000 for a female-to-male operation.  Let’s err on the lower side and say $25,000 on average for the operations, post operative treatments, etc.
The total cost of providing all of these procedures over the first few years would therefore be $9,625,000,000.  You would of course have to make adjustment for those who have already paid for their operation out of pocket, new transgendered people being born and growing into adulthood every day, etc.  But that seems like a reasonable guess as to the total systematic cost because we are assuming the lowest percentage estimate for total transgendered people in the nation, as well as a full 50% non-reassignment surgery rate and the mid to lower end of the cost spectrum.
According to the 2007 estimate figure, there are 111,162,259 households in the United States.
In effect, assuming 50% of transgendered people do not want the operation, you are looking at every household in the country needing to pay $86.59 to cover the initial health care costs of reassignment surgery.
For those who believe in limited government, as many libertarians do, the question would best be posed as follows:
You wouldn’t believe you have the right to break into your neighbor’s house and steal $86.59 out of their purse or wallet to pay for reassignment surgery.  What makes you think you have the right to steal it through the ballot box?  The consequence for them and their family is effectively the same.  You are taking from their resources to pay for something you want, but that is not a matter of life or death such as a bone marrow transplant.
I fully support health care reform because I believe it is a basic, fundamental, human right that you should not die because you are poor or due to the circumstances into which you are born.  This requires some level of taxation (and a significant one, if we are to be honest about it.)  That’s fine.  
I have a real problem with the Government covering anything not directly related to life, death, physical pain, or disability.  Given that reassignment surgery is by its very nature elective by what many of the transgendered people on the site have said in the past (I’m not transgendered, so I have to take the word of those who are on the site that say it is a personal decision that must be made for oneself and someone is no more or less transgendered due to “the operation”, it merely another step in a personal journey), I don’t think opposition to it is based in hate, I think it’s philosophically consistent with that world view.  For sexually active men who have lost their ability to have an erection due to age or other factors, Viagra would drastically improve their quality of life and intimacy.  I don’t think it should be covered, however, because it shouldn’t be born by the population as a whole.  The same can be said of women who suffer from horrific breast cancer and are forced to undergo a mastectomy, as my grandmother was.  Cosmetic surgery to make her feel more attractive should not be paid for by you, or me, or anyone else.  It’s a private expense.
I don’t think everyone who disagrees with members of the LGBT community is motivated by hate.  Frankly, it requires a certain sense of arrogance to believe that (we’re important but I don’t think everyone walks around thinking about us all day unless you happen to work at Focus on the Family).  
Some people just have a fundamental, philosophical world view difference that is just as valid and rational.  The Government itself cannot produce anything; it must take from one party and give to another.  Our job is to do so in a way that protects individual liberty as much as possible.  In my own case, as a member of the LGBT community, I’m fully supportive of the rights of transgendered people in employment, benefits, opportunity, and protection under the law.  
This, however, is a different question: You are asking whether or not I would support taking money from one party for something that is non-life threatening.  I’m philosophically opposed to that, period.  I believe for anything that is not a matter of life and death, the cost should be born by those who benefit from it.  
This is not a conservative vs. liberal issue.  If you need proof of that, look at the near total lack of comments on the thread relative to other postings.  A much smaller percentage of the reader base seems willing to engage on the topic because there is nothing to gain and something to lose (no one likes being accused of acting in bad faith or being motivated by hate, even when it’s done by complete strangers).  It may not be popular, but I would bet that a significant portion of the LGBT would oppose being taxed to pay for gender reassignment surgery.  Unless you press them on the issue, you aren’t going to get an answer.  It’s a topic best left avoided and sidestepped to avoid confrontation.
In other words, if you were to run a poll that posed the question: “Do you believe that all American households should be subject to a one-time tax of $86.59 to raise $9.625 billion to pay for gender reassignment surgery for 50% of the transgendered people in the United States?”, I think even a vast majority of LGBT people would vote it down because there are more pressing uses for the funds right now.  What frustrates me about politicians is that the question, as framed, is really what we’re asking.  Cowards want to sugar coat it by asking, “Should reassignment surgery be covered?” without including the factual data on the sacrifice required by each household.  Economics is the study of allocation decisions and capital is not infinite.  
 

Point(s) takenI may very well be overthinking it, and I would agree that there are much more pressing things to do with $9.625 billion than finance SRS (my view might be different for hormones, but that’s neither here nor there).
I should also note that I don’t, at all, think that people who disagree with me are motivated by hate (in general). When I said “the conservatives”, I was referring specifically to the ones cited in the Politico article (the ones who want to get this ban put in place); I certainly didn’t mean to imply that everyone who identifies as conservative is motivated by hate, or even that most opposition to this measure is. It is the “people who work at Focus on the Family”, though, who I think may be, and they are definitely the ones described in the article (I can’t remember if it’s FotF specifically or similar groups, but it’s their ilk.)
I most certainly don’t “believe others [cannot] disagree with [me]without it being motivated by hate”. I simply think that, whatever one may think of the rightness or wrongness of taxpayer-funded SRS, the proposal as described in Politico is a horrifying overreach in that it would ban funds for any plan that would cover not only surgery and hormones, but also pre- and post-op care. As I read that, it says that public funds may not be used to treat, for instance, complications arising from surgery. I understand where you’re coming from as far as not wanting to  subsidize non-essential procedures (which I’m using here as shorthand for your description above), but I think we could probably agree that this measure would be a serious overreach.
Finally, I would hope that this could be a pleasant conversation over coffee (well, metaphorical coffee anyhow). I wasn’t trying to provoke argument or to attack people, and I regret that it came off that way — I need to be more careful with the way I say things, I think.

Since you are not transgenderI do not think you have the right to decide ones motivation why they have surgery or not. Just because 100% do not op for GRS doesn’t make in any less important to the ones that do. I’m sure there are medical procedures you consider vital in you own life (and in your family) that I could care less if you (or them) are able to access. The thing is, I do not have the “right” (or should I) to vote whether you or anyone else receives them.
Do you want to tell the families of the men and women who killed themselves “tough shit” because they could not afford surgery? That their medical condition was not directly related to “life, death, physical pain, or disability”? Go for it but be ready for the consequences.
You have a lot of nerve.
BTW, if you want to talk to someone about things related to transition and surgery, talk to me. I’m biased but I will tell the truth.
I am a (proud) Trans Woman.
Dena.

Typo(nor should I)

Thank youDena, thank you for saying what you did; it was what I was sort of trying to circumlocute around to in my post above (I didn’t quite manage it, though). I think your argument is kind of the central one in this whole issue/debate, and I’m very glad that it’s been made.
(I’m assuming here that the “you” in your heading refers to GoldTopHat; I in fact am transgender/transsexual and I don’t recall making the points that you’re rightly opposing.)
Anne
PS: Regarding your signature line — does that indicate that you’ve read Serano?

Anne, you’re welcomeMy comments were directed toward GoldTopHat. I can never get over why some make judgments of others, especially something they have never gone through. Something so life and death.  
On the signature line. I really can’t take credit for it. A 25 year-old friend coined something similar (and gave me permission to play with). Young folks, they are so clever.
Anywho, she wrote in her online journal of her first experience going to our local gender support group.
I forgot people used “genetic girls.” Seems so 2006!
lol
Concerning Julia Serano. I’m a big fan of her book Whipping Girl.
Dena
 

I think you’ve misunderstoodI don’t believe anyone has the right to tell someone whether or not to have reassignment surgery.  It’s none of my business, or anyone’s business, because that is a very personal decision.  (And, for the record, I absolutely believe that there are hateful, bigoted nutcases out there that oppose anything and everything that has to do with LGBT rights, or even the hint that we may be treated fairly.)
But we’re not talking about private decisions.  We’re talking about public funding.  Just as the Supreme Court ruled in the case of publicly funded art Christians found offensive, whoever pays the bill gets a say in how the money is spent.  Lawmakers who oppose gender reassignment surgery are not seeking to ban the procedure, they are seeking to avoid their money going to pay for it.
That leads to my point: This conversation regards specific budget allocation questions.  I think that a lot of people who are against this come at it from the position that it’s fundamentally unfair to tax every American household $86+ to raise the $9.2+ billion necessary to cover the procedure, especially if we aren’t going to cover reconstruction surgery for breast cancer survivors or cosmetic surgery burn victims.  
My hypothesis is that the total absence of comments or engagement on the topic from the broader gay, lesbian and bisexual component of the LGBT community probably stems from the idea that a lot of people, even within the community, would rather put such a massive amount of money to work in education or other social programs so you encounter a Bradley effect – you are not going to get most gays or lesbians to admit that if there is a transgendered person within earshot.  They will quietly duck out and not say a word because it’s just not worth the possible social consequences or hurt feelings.
In my case, this isn’t an arbitrary philosophy.  My grandmother had to pay for her own reconstruction surgery because having her breasts removed following the cancer made her feel unattractive and “not like” a woman, in her words.  This was a very, very important issue to her.  Yet, it was our family‘s job to come up with the money. I would never sneak into your purse and have stolen a pro-rata share of the cost of the operation.  Yet, if it’s built into the tax code, that’s effectively what I would have been doing.  I have a deep, philosophical problem with that because it is inherently theft.  It is no different than walking up to the cash register of a small business owner and grabbing the cash in the change drawer.  That cash represents their time, energy, and the risks they have taken for their own family.
Money is not infinite.  The United States is drowning in debt and faces a fiscal crisis that could virtually end entitlement programs twenty years from now if we don’t do something about it.  I was equally as frustrated with my fellow gay activists when they protested AIDs funding getting cut in California when the budget collapsed because I don’t think most of them realize how utterly broke the state is.  We cannot keep pretending like we don’t have a spending problem in this nation because China and Japan aren’t going to indefinitely lend us money to feed our deficits.  If we don’t do something about it sooner rather than later, the shock to the nation’s standard of living will be severe and horrific.  If it gets that point, we will be losing the companies that make the drugs in the first place, causing far more ultimate death and suffering.
Opposing blanket public funding of gender reassignment surgery or other procedures that are equally as important (such as breast reconstruction following breast cancer or cosmetic surgery following burn accidents) does not mean people don’t realize they are important.  It means that, like any family on a budget facing layoffs and tough times, we’re not exactly flush right now.  Decisions have to be made that are not pleasant.  Our fiscal reality is very different than when we were running surpluses.  When the debt has been reduced as a percentage of GDP and our budget outlook appears strong again, the public will be much more sympathetic.  
I just don’t think people understand it’s about the money.  It’s almost always about the money.  Someone who votes in favor of restricting non-life or death procedures is not inherently bigoted if they are acting on a deep, philosophical belief that it is immoral and unethical to steal from their neighbors.  This is one of those cases.  It, like the other equally important surgeries that are vital to a full, happy life, should remain private expenses because the alternative is common thuggery executed through the tax code.

Thank YouDena,
I just responded to your earlier message.  I’m not making a value judgment at all (and if it sounded as if I were, I apologize.)  I also appreciate your offer to answer any questions I have.
My goal was to explain that a lot of us would love to pay for much better and robust services in everything from health care to education.  But my background is business.  That’s what I do and when the checking account is empty, and the situation looks worse a few years in the future than it does now, decisions have to be made.  
People like me will always be fine.  If the nation’s balance sheet continues to deteriorate, we’ll likely buy foreign-denominated assets and effectively short the dollar.  In fact, it will probably end up being profitable for us.  But as a citizen, it is not good for the country and I hate to see it happen.  Right now, I think there are a lot of people that have a problem paying for anything not absolutely a matter of immediate life or death when we are printing trillions of dollars a year, and borrowing nearly all of it from China, effectively becoming their servant.  
Right now, for instance, the interest we pay on the national debt is almost equal to what we distribute in social security each year.  Interest rates are at historic lows; when they recover following the recession, we will likely be paying more on the interest on the national debt than we send to seniors, widows, disabled people, and orphans who rely on social security payments.  If the debt didn’t exist, we could effectively double their monthly checks.  (If you’re curious, you can see more at: http://www.usdebtclock.org)
That’s what I mean when I say that economics is, in many cases, a zero sum game.  Even I would have a difficult time voting in favor of any expenditure right now given the state of nation’s finances.  It has nothing to do with what I’d like to cover or offer the public.  It has everything to do with recognizing the horrible mess we’re in at this present moment in time.  If we don’t do something about it, our children and grand children are effectively screwed and we’ll be relegated to a second world nation.  

Corrected URLFor some reason, it picked up the text in the URL.  The correct address I referenced is:
http://www.usdebtclock.org/

Uh huh

Do you believe that all American households should be subject to a one-time tax of $86.59 to raise $9.625 billion to pay for gender reassignment surgery for 50% of the transgendered people in the United States?

I find this assertion to be highly dishonest. Putting it as a one time cost makes it seem far larger an amount.
By your own words you say this is a one-time cost to cover surgery for ALL transexual people who want it in the entire US. Not all will get SRS at the same time (even if covered), and it would only cover those of the current generation of people, but not the next. How long is a generation? 25 to 30 years?
Your $86.59 per household divided over a generational timeline equals what? 3 to 4 dollars per household per year? 25 to 40 cents per household per month? Even less if you divide it per adult person.
Hardly the bank-breaker you make it out to be.

Not Exactly – You Aren’t Factoring in the Deficit FinancingThe total cost is $9.625 billion one-time for the “adjustment” year (we could expect the costs would be born largely in the first few years as the treatment was made available).  Since we are running deficits right now, it would have to be paid for by borrowing the money.  The Treasury department would have to issue bonds at auction in New York City.
Going forward, assuming a 5% Treasury rate, there are two additional costs to the nation’s balance sheet:
1.) The $481,250,000 interest expense on the one-time $9.625 billion initial year costs.  This will be due each and every year the debt remains outstanding and if we are still running deficits, it will get added to the debt itself, compounding the problem further.
2.) The additional costs of each new generation of transgendered people as they gently roll into the system and reach adulthood.  This would be much lower, and much more affordable, as you already mentioned, because the costs would be staggered.  
To be fair, you’d need to discount the cost of those procedures back using the 30-year United States Treasury because of the time value of money (e.g., if the “on-going” cost was, say, $100 million per year over ten years for the new generation of transgendered people, the cost would not be $1 billion ($100 million x 10 years) but instead $772 million assuming a 5% Treasury rate, which would be reasonable given that rates cannot maintain themselves this low for very long.  Yet, since we are running deficits, this would have to put on the nation’s credit card, so you’d have to factor back in the 5% interested that would be forever owed on the principal that was borrowed.
To recap, our costs are:
1.) $9,625,000,000 initial startup +
2.) $481,250,000 subsequent annual interest due to the inability to pay for the startup costs now, forcing us to finance by issuing Treasury bonds.  The interest cost will itself be paid by issuing more debt until Congress balances the budget, meaning that we will start paying interest on interest as early as year two of the program.
3.) $(Insert Figure) Much smaller figure for the new generations of transgendered people who reach adulthood and are able to make that choice for themselves.
The cumulative cost to the tax payer is massive.  When you factor in the other things that we discussed that must be covered if we were to cover this (breast cancer reconstruction surgery for survivors and burn victim surgeries), it’s easy to see why the nation’s budget is spiraling out of control.
We must get back to balanced budgets and begin paying down the debt as a percentage of the GDP.  The fastest way to do this would be:
1.) Immediately suspend the wars overseas and lower the defense budget using the same “peace dividend” technique Clinton did in the 1990′s
2.) Lower personal payroll tax rates (not income tax) for the bottom 30% of the income ladder – the people who are shopping at Wal-Mart and can’t afford to feed their kid.  The single most effective government “tax break” is actually the food stamps program because the money immediately stimulates the economy.  If you give a tax break to people like me, we’re going to invest it or save it.  If you give it to someone who has to choose between milk and bread, their going to spend it on their families.  It improves their standard of living and tax revenues increase as the velocity of money increases through the economy.  (Compared to if you cut capital gains taxes, for instance, like Bush did.  Those tax cuts do nothing for government revenues.  Of course, Bush had no incentive to lower taxes for poverty level workers because they don’t have a rich lobby in Washington.)  
3.) Require Congress to balance the budget.  Over time, a slow rate of inflation, say 3%, would cause the percentage of the debt relative to GDP to decrease.  Canada has effectively paid off 50% of their national debt over the past 15 years by using this technique; the actual balance has not decreased, but the real cost in purchasing power terms has been slashed by half.
Once those things are done, we could easily afford programs such as reassignment surgery or better educational funding because we’d be paying for them as we go.  The problem with debt financing is the interest expense begins to eat up a bigger and bigger part of the budget.
I mean, we spent nearly $328 billion on INTEREST on the national debt last year alone.  How many programs would that have funded?  If the previous generation had been responsible and paid as they went, that money would be available for us now to pay for things like this.
If we don’t address the problem now, the consequences in a decade or two will be severe for anyone making less than $100,000 a year.  My guess is we’d see the total decimation of the middle class with the rich on one side and the full-time working poor on the other.

P.S.All of that is to say that I would have framed the argument as you put it if we were paying cash today.  Because we are putting it on the credit card, however, the cumulative cost is exceedingly larger by an order of several magnitudes to the point the total interest on the program will be more expensive than the program itself.  You cannot use a straight line depreciation method and get an accurate picture of the total damage to the balance sheet when the interest expense exceed the annual depreciation charge.
Also: To be fair, you would have to recap the total additional income tax generated by the doctors that performed the procedures and reduce that from the end of the terminal year’s program costs.  The additional velocity of money would result in slightly higher tax revenues.  It would still be a rounding error, though, so it wasn’t worth mentioning in the first response.

Should it be covered at all?Many seem to think that SRS should have a lower priority than other procedures when it comes to whether or not it should be covered at all. They usually ask something like “why should SRS, which a person can live fine without, be covered when (other much needed treatment) isn’t covered?”.
I’d like to answer, if I may, by copying a forum post I read a few years back that said it much better than I could.

Posted: Fri May 05, 2006 1:56 am
xxxxxxxxxx- your most recent argument is quite reasonable and a world away from your earlier statements along the lines of SRS being the rough equivalent of Breast Augmentation. If this had been your position at the beginning, I doubt our exchange would have become nearly as heated as it did.
Let me address some of your points. However, let me preface all of my arguments by saying that there is far more wrong with the American health care system than just the exclusion of certain beneficial treatments from insurance coverage. I expect an argument could be made on public policy grounds for the inclusion of any of the common insurance exclusions, however for the purpose of this debate my aim is to distinguish SRS from the other excluded conditions, and explain why it should be included in both insurance coverage and government-provided health care. I may, in fact, agree that certain other conditions should be covered, but that is not the focus of this thread, or my argument.
Quote:
I will agree with you that comparing breast augmentation with gender reassignment is debating apples to oranges. But give me an instance where we could be debating apples to apples in this discussion?
—–
This comparison is a particular flash point for me because it suggests a number of highly inaccurate ideas with respect to an individual’s motivation for seeking SRS, as well as suggesting that a transsexual denied the ability to transition (if that is the medically appropriate treatment for that transsexual) is no worse off than a woman who is denied breast implants. The difference, in my view, (and I expect in the view of the majority of the psychological community) is at least one or two orders of magnitude more antithetical to quality of life. It isn’t apples to oranges, it’s apples to elephants.
Quote:
Many procedures and services are denied because they are not medically necessary. That doesn’t mean that they aren’t medically valid.
—–
OK, let’s take a look at the most common exclusions on health insurance policies:
1. Routine, Convenience, and Comfort Items: humidifiers, cough syrup…
2. Band-Aids, telephones, TV’s, extra pillow’s…
3. Reconstructive/Cosmetic and/or Sex Change Surgery (Breast reconstruction is usually an exception and circumcision is commonly being considered cosmetic therefore may no longer be covered)
4. Home Care or Private Nursing
5. Dental Care, Hearing and/or Vision Aids
6. Elective Abortions
7. Reversals of Vasectomies or Sterilization (Tubes Tied)
8. Learning and/or Behavioral Problems
9. Experimental Treatments or Drugs and Non-Prescription Drugs
Of these exclusions:
Two can be covered by supplemental insurance policies (#4 and #5, Long Term Care, Dental and Vision policies, respectively). It is not that there is no insurance available for the treatment, it just isn’t included in a standard policy. The traditional argument against policy coverage of medical appliances (glasses, hearing aids, etc) is that they are too common. The greater the frequency of a particular insurable need, the more money the insurance company has to charge to cover it. Take eyeglasses. If roughly 25% of the population requires glasses, and glasses cost $200 each, then an insurance company would have to charge policyholders $50 extra in order to provide that coverage. By way of contrast, to provide coverage for a $100,000 surgical procedure that only occurs in one out of every 10,000 people, they would only have to charge policyholders $10.
Routine convenience items (#1 and #2) are excluded because the cost outweighs the incremental health benefit, and many such expenses are not medical expenses per se.
Elective abortion (#6) I’m not going to touch with a ten foot pole. That’s a subject for another thread.
Sterilization reversal (#7) is a treatment for a voluntary medical condition. Most insurance companies will pay for the sterilization procedure itself. No one is forced to get a vasectomy or tubal ligation (absent certain other conditions that would make pregnancy life-threatening). There is no naturally occurring medical disorder that “causes” a person to undergo elective sterilization.
Learning and behavior problems (#8 ) are only covered if there is a concurrent medical condition. Absent a medical condition, the treatment for learning and behavioral problems is not provided by the health care system, but rather the school system. These conditions do not go untreated if they are sufficiently severe so as to cause interference with a child’s success at school. They are treated. They are treated by the school in the context of an IEP (individualized education program), as required by state law. If a medical condition contributes to the learning and behavioral problem, the treatment for that condition usually is covered by insurance. Ritalin for ADHD, for example, is covered by many insurance policies that contain prescription drug benefits.
Experimental treatments (#9) are not covered because the benefit of the procedure has not been established.
That leaves #3, reconstructive/cosmetic and sex change surgery. Cosmetic surgery is not covered because demand for it is price elastic and if it were available at a low cost, too many people would use it (same as the eyeglasses problem). Eventually the policy price for providing that coverage would approach the price of the surgery and there would be no point in buying insurance.
Let’s talk about SRS, in particular, though.
Gender Identity Disorder (GID) is the underlying diagnosis for which Sex Reassignment Surgery (SRS) is sometimes indicated as the medically appropriate treatment. GID is an Axis 1 disorder in the DSM IV. One of the best ways to explain what GID is to explain some of the things it is NOT.
GID is not transvestism (crossdressing for sexual pleasure).
-GID is not effeminate homosexuality.
-GID is not merely preferring to present in an androgynous style.
-GID is not a temporary or transient desire to live as the opposite sex.
-GID is not a desire to change sex primarily for the purpose of obtaining presumed cultural advantages of the target sex.
One of the mandatory diagnostic criteria for GID is that “The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.” If someone is somewhat uncomfortable with their gender, but is generally experiencing little or no distress or impairment as a result, then they don’t have GID. To be diagnosed with GID, the patient must have a strong and persistent cross-gender identification. They must have persistent discomfort with his or her own sex and a sense of inappropriateness in the gender role of that sex.
To get an idea of how serious a problem GID is for a person, let’s take a look at other Axis 1 disorders in adults:
-Dementia
-Amnestic disorder
-Schizophrenia
-Schizoaffective Disorder
-Major Depressive Disorder
-Bipolar Disorder
-Panic Disorder with or without agoraphobia
-Obsessive Compulsive Disorder
-Post Traumatic Stress Disorder
-Dissociative amnesia
-Dissociative personality disorder
-Anorexia Nervosa
-Bulimia Nervosa
-Nacrolepsy
GID is often co-morbid with depression. A transsexual has to spend three months in therapy before they can receive a prescription for hormone replacement therapy (HRT). They have to live as their desired gender for a year before they can obtain the two letters from different psychologists required for SRS.
Are any other Axis 1 mental health conditions commonly specifically excluded from treatment?
There’s the argument that the surgery is elective, and that the transsexual could just “deal with the hand they’re dealt”. I have mentioned other ‘elective’ surgeries already in this thread. Many of these ‘elective’ surgeries are entirely related to life choices, non-life threatening conditions, quality of life and pain management. Sure, transsexuals could just suck it up and deal. Then again:
-Women could just give birth in their homes.
-Elderly people with broken hips could just learn to live with a lack of mobility.
-Cataract sufferers could just learn to read braille.
-People with Arthritis, Lupus, Crohn’s disease, Urinary Tract infections, chronic back pain, Parkinson disease, epilepsy… they could all just learn to live with their conditions.
I guess my point here is that lots of people could live with an untreated medical condition if they had to. In third world countries, a lot of people do live with these untreated conditions.
I don’t have a problem with the idea “insurance shouldn’t cover and taxpayers shouldn’t pay for medical treatment that is not designed to treat life threatening conditions.” I DO have a problem with “insurance should cover and the government should pay for ‘quality of life’ procedures, EXCEPT treatment for transsexualism.” I repeat my position that there is no medically sound reason to single out transsexuals for denial of treatment. I will add to that that given the cost of treating GID and its extreme rarity in the general population, there is no economically sound reason to single out transsexuals for denial of insurance coverage or treatment under Badgercare.
You identified a number of other arguably important treatments that are not covered by insurance. The arguments for or against each of them could take up a thread on their own. Rather than hit each one individually, I think I can reply to them all with the following:
You’re including them as examples either because you feel that it is right that they’ve been excluded, or because you feel that it’s wrong that they’ve been excluded. If you feel it is right that they were excluded, then I’d invite you to state your reasons why you think it’s ok, and we can discuss whether or not those reasons should apply to GID. If you feel it is wrong that those conditions were excluded, then I don’t see how the existence of other unjustifiably excluded conditions makes it any more ethical to exclude GID. The fact that I’ve burglarized 5 other houses on my block doesn’t make it any less immoral for me to burglarize the 6th.
Quote:
I think that it is invalid and ignorant to make the assertion that gender reassignment is a cure.
—–
It is a medically appropriate treatment in many cases. Post-operative regret is quite rare, with most transsexuals being highly satisfied with their surgery. Your step-cousin was the exception, not the rule. SRS does not cure all life problems, but it is a critical step towards mitigating severe GID. Once that issue is under control, the transsexual can make meaningful progress on other problems. In a survey of 232 post-op transsexuals between 1994 and 2001, the average overall satisfaction with their surgical results was 8.7 on a 10 point scale.
Quote:
Sex Reassignment is Effective and Medically Indicated in Severe GID. In persons diagnosed with transsexualism or profound GID, sex reassignment surgery, along with hormone therapy and real-life experience, is a treatment that has proven to be effective. Such a therapeutic regimen, when prescribed or recommended by qualified practitioners, is medically indicated and medically necessary. Sex reassignment is not “experimental,” “investigational,” “elective,” “cosmetic,” or optional in any meaningful sense. It constitutes very effective and appropriate treatment for transsexualism or profound GID.
—–
The Harry Benjamin SOC represents the professional consensus about the psychiatric, psychological, medical, and surgical management of gender identity disorders.

Very Well Said

I don’t have a problem with the idea “insurance shouldn’t cover and taxpayers shouldn’t pay for medical treatment that is not designed to treat life threatening conditions.” I DO have a problem with “insurance should cover and the government should pay for ‘quality of life’ procedures, EXCEPT treatment for transsexualism.”

That is precisely my argument.  I would absolutely agree that if everything else is covered EXCEPT transsexualism, it would be abhorrent because there would be no reason for it except ignorance (or, in some cases, bigotry).
Right now, I think a lot of people feel that we are in a position that we simply cannot afford anything other than the basic necessities until we get our financial house in order as a country (then we can have the discussion).  If I were in Congress, though, I’d be voting against everything that wasn’t fully funded, even though it would probably make me get booted out of office.  
I think what scares me is that based on the current imbalances in our trade and budget figures, the Federal Reserve is going to be forced to get into the double-digit interest rate levels within the next decade short of a huge boost in productivity and real GDP growth.  I don’t see that happening (unless we open the borders to immigrants to drastically increase the proportion of working class tax payers or their is another baby boom).  When that happens, most of the budget will consist of payment on the debt interest, leaving no money for social security, medicare, defense, or other vital programs.
 

A few things…that you aren’t factoring in yourself.
You still insist on putting the entire cost for the current generation up front as if every single TS person will get SRS in the very first year.
First, a signifigant number of those that want the procedure have already had it done.
Second, many of those in this generation who will want it done haven’t decided on it yet (not everyone is the same age or at the same point in their lives).
Third, those who want it right now will still have to wait even if it were available tomorrow. There are many many hoops that must be jumped to qualify for a procedure to be covered (whether it be by gov’t single payer, or private health coverage) and only so many can go through the system at a time. On top of that there are only so many doctors who do this surgery and they can only work so fast.
Yes, there is a large backlog of people who need these treatments (that’s what happens when coverage is denied), but there is also a large number of other people who need other medial care because they didn’t have, or were denied coverage by their insurers.
Should they wait for help too? Or are Trans people’s needs of a lower priority? Is there a hierarchy of necesary medical procdures?
About start up costs:
Yes, there will be signifigant start up costs associated with the public option (stemming largely from the fact that so many have gone without proper medical care for so long), of which care for trans peeps is a miniscule drop in the bucket. Many (and I do mean MANY) see us as easy targets to deny care.
And, speaking of Canada (I live there), despite the debt situation being much better than in the US, many of us are still being denied coverage, or even had it taken away just recently in Manitoba and Alberta (where they had paid off their debt completely until “The great recession” came along). Alberta de-listing SRS cut a whole 0.005% off the total health budget ($700,000 CAD annually). Yes, that’s how small a drop covering our health needs is.
To not be totally negative with my reply, your well worn thoughts on how best to reduce the deficit; ending the wars, lessening regressive flat taxes on the poor (who spend any extra money they have, increasing demand, rather than investing it, increasing supply) are good, even if I’ve heard them many times before.
But to suggest that denying coverage for TS peeps (easy targets that we are) will make a real differance in total federal spending is nowhere near accurate.
You saying “Wait until we lower the debt some” sounds a lot like “We’ll come back for you”.

Um, I think you missed the pointThat’s the exact arguement that many make. That there are many treatments that aren’t covered so we’ll just have to wait in line behind others, whose needs are more important than ours. Only after all of those are covered will we be included.
Or are you saying (and I think you are) that medically needed treatments should not be done, and even removed from the list of approved treatments in order to save money? Even if a treatment will save lives, will make a person a contributing, tax-paying, member of society, it shouldn’t be done to save money in the short term, so therefore not including treatment for trans peeps is no big deal?
Wow, just… wow.
Are you one of those “All taxes are outright theft!”, “Everyone should have to cover their own needs, and if they can’t, suck it”, “Money is more important than people” libertarians?

No – Taxes *Can* Be GoodTaxes are necessary to have a functioning society.  I think that the goal of a fair tax system should be to provide a level playing field so that everyone gets access to the same opportunities as his or her neighbor, no matter the circumstances into which he or she is born.  This means decent nutrition, adequate public services such as fire, police, postal, protection of property and individual rights, and access to affordable higher education or trade schools.  In other words, Locke’s ideas about a “just society” being designed to reflect a world that you would want to live in, even if you were born at the bottom of the economic heap, are exactly right, in my opinion.
Anything beyond that requires that we take from one person and redistribute to another by the first party telling the second what their priorities should be.  I have a problem when Christians tell gays how they should be living.  I have a problem when schools tell boys or girls how they should be dressed.  I have just as big of a problem with the majority, through the ballot box, telling individual people how they should be spending their money.
That conversation would be interesting at another time but it isn’t what I’m positing in our discussion on health care so it’s not relevant at all.  
What I’m saying is that right now, at this moment in time, we are facing a financial crisis that no one wants to talk about because the average person simply doesn’t understand, or doesn’t care to study, the implications of massive trade and budget imbalances.  Until we return to fiscal stability like we had under Clinton in the 1990′s, the only way it is physically possible to cover these expenses is to print money.  Inflation cannot be contained once the paper cash in circulation begins to exceed that which was lost in the M2 and M3 money multipliers as part of the banking crisis.  When that happens, interest rates will have to rise.  In short, we are maybe only 10 or 15 years away from the interest on the debt consuming most, if not all, of the Federal budget.  
The only alternative left to the government if it wants to still send out social security checks will be to print currency.  Social security will then lose purchasing power, most likely a great deal, resulting in a massive and horrific standard of living drop for everyone who relies on it.  The cost of groceries, energy, clothing, and housing will go through the roof not because they’ve changed in value but because we’re paying for them with less valuable dollars.
Given that we are in that situation right now, and the only way anyone has proposed to pay for this is by charging it to the nation’s credit card (which would be like a 400 pound man eating a triple cheeseburger when he already has heart problems), I worry about my friends, family, and fellow citizens.  As I said earlier, people like me will be fine.  Hell, I will most likely short the dollar by purchasing foreign real estate or buying equities with most of the earnings generated in Europe or Asia.  My wealth in real terms will actually increase if it were to happen.  But the average American, the men and women who go to work each day, or live off social security, or get a pension check, would be totally and completely screwed on a scale that we haven’t seen in a very long time.  That angers me.  Somehow, as Americans, we are so arrogant as to think we’re immune to this.  Latin America is familiar with this precise cycle (hence the phrase in finance, “He lied like the finance minister on the eve of a devaluation.”)  The closest thing we’ve seen is when Mexico had to devalue its Peso years ago.  
My point is this: Every penny we spend covering health expenses as it stands now, will be borrowed from China because they are the biggest purchaser of our debt.  Most people don’t have exposure to the realities of economics so they don’t understand that their decision would literally transfer yet another chunk of the United States to the Chinese government, citizens, and corporations.  In this case, $9.6+ billion plus another nearly $500 million per year in interest payments plus the annual cost of surgeries as teenagers became adults.
In answer to your question: I don’t think it’s unreasonable to expect people to pay for things that are important to them.  The average high school graduate (think someone who leaves school and goes and works at Wal-Mart or the grocery store) in the United States will earn just shy of $1,000,000 over the course of their lifetime.  For someone with a bachelor’s degree, that figure is $1,800,000.  As I explained in an earlier post, I believe it would be wrong to ask anyone other than our family to raise the money to pay for my grandmother’s breast reconstruction surgery following cancer.  For someone who never went to college, paying only 1% to 5% of earnings for a surgery that is extremely important to living a happy, fulfilled life is not a small sacrifice.  
This leaves only a tiny, minuscule population that could not afford the surgery.  In this case, you have what economist call opportunity cost and an allocation decision in its most brutal, primitive form: Are those handful of people (maybe a few thousand at most), worth tens of billions of dollars in additional debt, plus nearly half a billion in annual interest?  The fact that this money will go to China, giving her greater control over the nation and far more political influence in our decisions, should factor into that decision as well.  In that case, the needs of the many outweigh the needs of the few.  I could not screw over every American a decade or two from now for the sake a few thousand today.  (The decision may be different if we were paying for the bill with cash through balanced budgets.  That’s the key point you’re missing.)
To pretend that this is simply a case of someone not wanting to part with money is disingenuous at best.  We cannot continue to act like a junkie with a credit card.  Families have to make hard decisions when the money runs out and the government should be forced to the do same.  Otherwise, our children and grandchildren will be spending (literally) almost the entire tax base of the United States paying interest on debt owed to foreign governments and investors.  That means that all of the money they send in to Washington isn’t going to fellow Americans; it’s getting shipped back to Beijing and being used to grow their society.  
P.S. (On a side note: We also have to differentiate between infrastructure investments (capital investments) and expenditures.  In certain limited circumstances, it’s possible to “spend your way” out of a debt problem if you are a government through economic infrastructure building.  For instance, if the United States Government were to spend $100 billion on a high speed bullet train network that connected every major city in the nation, making freight far more affordable to deliver and reducing shipping times, the gain in productivity should result in far higher tax revenues as the velocity of money increases.  In this case, by spending the cash, you have a long-lived asset that will result in more money going back to the Treasury each year.  Europe has shown that a rail system like that can drive economic growth through the roof.  Not to mention the social benefits: Can you imagine if someone in Nebraska could be in L.A. or New York in a few hours by just going down to the local train station?  It would change everything.)

You’re Absolutely Correct

“But to suggest that denying coverage for TS peeps (easy targets that we are) will make a real differance in total federal spending is nowhere near accurate. “

You’re absolutely correct.  In terms of the total problem we are facing as a nation, adding reassignment surgery would be a drop in the bucket.  In fact, I’d love to be able to offer it on a personal level because I’ve heard how important it is to people on this site.  Maybe I should have said that upfront.
And, in truth, my comments aren’t even really about whether or not reassignment surgeries are offered.  I think I’m just reaching a level of exasperation because in my position as a business owner and investor, I see this massive crisis coming.  Most people, though, are busy going about their lives and don’t understand how or what causes it.  We are now walking the same path that many Latin American countries did and if something doesn’t change, or we don’t slash costs quickly, I fear we’re going to end up in a society with only two classes – the super rich on one side and the extremely poor on the other.
Even though I’d be fortune enough to be in the former, I don’t want to live in a nation like that.  (I also don’t want to have to worry about “let them eat cake” comments!)  
So many of my friends and family members are “regular” in the sense that they teach elementary school or work as nurses in hospitals.  When I think that years from now, all the taxes they pay will go to China, Japan, and Europe just to cover the interest on our debt, it makes me angry.  I was fortune enough to have been born here and live in a society that let me go from lower middle class to rich within ten years of graduating from college.  I don’t want that opportunity to be taken away from the next generation.  

P.S.I responded to your comment up above after I wrote this one.  
You’re absolutely correct – the whole debate about reassignment surgery is just a drop in the bucket.  Every time I hear that Congress is printing more money, though, for anything, I just want to bang my head against a wall.  It’s more about fear for the average citizen where we’ll be if we don’t get it under control now.