May 31st, 2014

Medicare ban on transgender surgery coverage lifted

I’ve noted that now that the battle for gay marriage has all but ended, transgender rights seem to be next on the agenda.

You know, I’ve got nothing against transgendered people. Based on the fairly extensive research I’ve read, both pro and con, I think the evidence indicates that transgenderism is a real issue that causes real suffering for a relatively small percentage of the population, and that for many of those it is probably something they were born with, perhaps having to do with hormonal glitches affecting fetal brain development in utero.

But having Medicare pay for sex reassignment surgery in a 74-year-old seems preposterous. If a person’s gotten that far in that particular body, why not go the distance? Practically speaking it really doesn’t come up very often. But, as the article indicated, Medicare rulings such as this often pave the way for private insurance, too. Will the Obamacare powers-that-be insist that transgender reassignment surgery coverage, like birth control, be something every health insurance policy must have? And what about Medicaid, which so far doesn’t cover it? It seems to me that if Medicare pays for it then Medicaid can’t be far behind.


Administration officials originally sought to overturn the ban in 2013, but the attempt prompted a backlash among social conservatives and religious groups who oppose taxpayer funding for such procedures.

What’s different about 2014, I wonder? Is it just that we are so preoccupied with so much that our attention is diverted? Is it that people feel powerless to stop this administration in its administrative rulings?

24 Responses to “Medicare ban on transgender surgery coverage lifted”

  1. Geoffrey Britain Says:

    Enough money for having Medicare pay for sex reassignment surgery on a 74-year-old but not enough for our veterans. The societal priorities are clear and… suicidal.

  2. vanderleun Says:

    Hixs Nix Dix Chix

  3. Lizzy Says:

    This makes no sense to me, I guess I’m stuck in a pre-2009 worldview.

    This is a perfect example of how having he government so heavily involved in heath care leads to the prioritization/rationing of care expenditures based on politics. They will be cutting back on some other treatment in order to pay for this, right?

  4. Ann Says:

    What’s different about 2014, I wonder?

    Perhaps because we’re deep into this November’s elections and don’t want to walk into yet another Democratic trap laid for social conservatives. Also maybe because social conservatives seem to have thrown in the towel on same-sex marriage and figure, why bother to put up yet another hopeless fight. It’s bigger than just feeling powerless under Obama.

  5. Oldflyer Says:

    Life in this country is becoming too bizarre. Sometimes I wish there were a viable alternative. But, as so many blow hard Hollywood types decided, there really isn’t.

    I know this can be a wrenching issue. Some very dear friends went through it with a daughter. I believe they actually paid for the surgery after the issue nearly split the family apart. By all accounts it worked out ok. The Mother and Father since died (Was that coincidental?) and we lost track, so can’t say over the longer term.

    But, it seems that it is the now the surgery of the week. I remember when it was nose jobs, then boob jobs. What next?

    And how in the world did it become an entitlement?
    Will recipients be entitled to reversal surgery if they find out they were mistaken in their original “feelings”?
    And who decided that God, or nature if you wish, got it wrong in so many cases? It sounds a lot like good old fashioned brain washing at work.

  6. Cornhead Says:

    That’s exactly the plan. We will all be paying for the ultimate elective surgery.

    If Chastity Bono wants to become Charles, she can pay for it.

  7. parker Says:

    I am willing to accept the concept that some exceedingly small percentage of the population actually feel/believe that they are not the gender their chromosomes say they should be. Asking the rest of society to pay for their desire to appear, on the surface, as the other gender is plain wrong. We are either XX or XY, with a vanishingly small percentage who are XXY. This is on par with the EPA ruling about arsenic exposure where the limit the bureaucrats have set is in the neighborhood of spending 5 billion dollars for every theoretical life lost.

    Logic and proportion have indeed fallen sloppy dead and the white knight is talking backwards and the red queen has offed her head. Priorities apparently have been turned upside down.

  8. OldFert Says:

    How about Medicare and/or TRICARE For Life paying for my fat removal? I don’t mean bariatric stomach bypass or stapling or that sort of thing, I mean do a physical reduction of my fat belly. Some liposuction would be OK, too.

    After all, I’m really a skinny person crying to get out of this fat body.

  9. Steve57 Says:

    I have nothing against transgendered people, either. What I do object to is the contention that the extremely high suicide rate among people with gender identity disorder has much to do with prejudice.

    Occam’s razor. If people who have a disorder have a high suicide rate, then why isn’t the high suicide rate attributed to the disorder, as opposed to the “prejudice” of those who won’t accept the disorder as if it were normal?

    I raise this because I’m not entirely convinced that surgery is the solution. Given the fact that people with gender identity disorder aren’t entirely cured by the surgery. And the ongoing hormone therapy. They continue to have problems.

    I was being somewhat flippant, but entirely serious, when I asked why a man who is convinced he is a woman can be cured by surgery, but a man who is convinced he is Napoleon can’t.

  10. Molly NH Says:

    Where’s a good Death Panel when you need one ?
    Oh I get it all the medical restraint applies to your average person, but any loon of any persuasion or age gets anything they want ! Guess thats the way the Obama admin will deal with *Normal People Privilege*

  11. J.J. Says:

    Well, now that the precedent has been set, I think I’ll just request a complete face lift. My self esteem and sense of who I am is hindered mightily by those wrinkles and age spots. In my mind there is not a shred of doubt that I’m still 39. Yet, I keep seeing this old codger in the mirror. Jest ain’t right! Gotta start campaigning for this immediately.

  12. Beverly Says:

    Transgender = extreme drag + self loathing

    Here’s the former psychiatrist-in-chief of Johns Hopkins University Hospital on the subject:

    “We saw the results [follow-up studies of post-op transsexuals] as demonstrating that just as these men enjoyed cross-dressing as women before the operation so they enjoyed cross-living after it. But they were no better in their psychological integration or any easier to live with.

    With these facts in hand I concluded that Hopkins was fundamentally cooperating with a mental illness. We psychiatrists, I thought, would do better to concentrate on trying to fix their minds and not their genitalia.

    Thanks to this research, Dr. Meyer was able to make some sense of the mental disorders that were driving this request for unusual and radical treatment. Most of the cases fell into one of two quite different groups.

    One group consisted of conflicted and guilt-ridden homosexual men who saw a sex-change as a way to resolve their conflicts over homosexuality by allowing them to behave sexually as females with men.

    The other group, mostly older men, consisted of heterosexual (and some bisexual) males who found intense sexual arousal in cross-dressing as females. As they had grown older, they had become eager to add more verisimilitude to their costumes and either sought or had suggested to them a surgical transformation that would include breast implants, penile amputation, and pelvic reconstruction to resemble a woman.

    Further study of similar subjects in the psychiatric services of the Clark Institute in Toronto identified these men by the auto-arousal they experienced in imitating sexually seductive females. Many of them imagined that their displays might be sexually arousing to onlookers, especially to females.

    This idea, a form of “sex in the head” (D. H. Lawrence), was what provoked their first adventure in dressing up in women’s undergarments and had eventually led them toward the surgical option. Because most of them found women to be the objects of their interest, they identified themselves to the psychiatrists as lesbians.

    The name eventually coined in Toronto to describe this form of sexual misdirection was “autogynephilia.” Once again, I concluded that to provide a surgical alteration to the body of these unfortunate people was to collaborate with a mental disorder rather than to treat it.

    This information and the improved understanding of what we had been doing led us to stop prescribing sex-change operations for adults at Hopkins, much, I’m glad to say, to the relief of several of our plastic surgeons who had previously been commandeered to carry out the procedures.”

    [Read the whole article here: food for thought —

  13. Beverly Says:

    A woman I know (a very butch lesbian) who’s had her breasts amputated and is hovering on the brink of getting her uterus, vagina, ovaries amputated and an ersatz penis constructed, confided that she has been having nightmares that she’s a little girl again, and the little girl is screaming.

    But she doesn’t make the connection: the part of her that is dominant is allied with whatever/whoever made her hate her femaleness, and is driving right over her female self. It’s actually horrifying. I haven’t expressed this to her, but I feel sorry for this woman. And no matter what surgery she has, she’ll still have XX chromosomes.

    There’s more to being a man than having an appendage; there’s more to being a woman than having breasts. And I can’t help noticing that most “transsexuals” stop short of actual castration. One called Rush Limbaugh on Thursday, a deep-voiced guy calling himself “Tina,” which launched a pretty funny conversation.

    But at one point, this fellow said that men get mad if they’ve been “fooled” by a tranny, “like if the plumbing is different,” he breezily averred. Oh, I thought, he’s admitting he’s only had the boob job done.


  14. CV Says:

    This article by Dr. Paul McHugh, the former chief of psychiatry at Johns Hopkins, is well-worth reading. He maintains that sex-reassignment surgery generally doesn’t resolve the underlying psychological problems and is basically a misdirection of psychiatry. Needless to say, trans-gender advocates are not pleased with him:

  15. CV Says:

    Oops, sorry, just noticed that Beverly posted the very same thing.

  16. Molly NH Says:

    Interesting reads Bev & CV, people following things have noted THAT these people have much more going on than just *thinking* they are the wrong sex.
    I have commented before but this medical facet to give people utopia will mushroom into the *fertility* industry.
    Anyone will be given the reproductive option, like Cali sans marriage or not, ala Octomom, who achieved her
    *dream* of multiple children (not kittens buy HUMAN lives) courtesy of the Cali taxpayer. Then I imagine the taxpayer will be on the hook when a gay couple needs to find a surrogate to have the laboratory induced pregnancy that their marriage requires.
    Providing Utopia will not be cheap ! Meanwhile try to get a hip replacement if you are under 65 ! Regardless if you are so crippled up that you are immobile.

  17. waitforit Says:

    Cakes and surgery must be provided
    So the civil rights march can go on
    But there are those who think unimpeded
    Civil rights won’t mean much for long.

    To wit, the city of San Francisco
    Which outlaws even innuendo
    Find its hands tied against the insane
    Rats, disease, and all that is inane.

    SAN FRANCISCO — While authorities are trying to keep track of a San Francisco woman who was breeding rats in her room at a residential hotel and releasing them in public parks, they say their hands are tied as far as trying to stop her.

  18. lacune Says:

    It’s sobering to think that if I live to 74 years old and developed cancer, Government Insurance’s Death Panels would not pay for my chemotherapy, but WOULD pay for an operation to remove my genitals.

  19. Liberty Wolf Says:

    Interestingly Neo, this ban was put in place at least partly — by radical feminists in the 80’s — one called Janis Raymond. She wrote a book called _The Transsexual Empire_ where she claimed that trans women (MTFs) were merely men who were “raping” women by attempting to become women and were part of a larger patriarchal plot to destroy natal women and create a bionic Barbie race to satisfy all of those nasty male chauvinist desires. Raymond worked with the Reagan administration, convincing them to make this ban with Medicare. The religious right may also have been involved but I really think the impetus came from Raymond and her very far left, radical feminist group. Transsexuals have always been suspect by both the left and the right – and this continues to today. Obviously from comments here… While many feminists are on the “side” of transsexuals, many are not and radical feminists remain one of our greatest threats. They are called “TERFs” or “trans exclusionary radical feminists”. They are among the most vicious of anti-transsexual people around and devote large chunks of time to ranting about transsexuals, particularly trans women (male to females) on the internet. The religious right has its issues with us as well, but it is not quite so vocal. Though possibly that may change as trans people become more visible as we are doing.

    I am obviously alone on this comment page, and am in fact — a trans man or as I prefer, a man of transsexual history (born female became male through hormones and surgery and living my life over a period of 25 years from my transition in 1989) and I won’t go into defending my very existence here. Too exhausting and I have a million things to do today. I will say this: Many of the studies cited by other commenters, including John Hopkins, are outdated. Certainly this is a serious decision and not one to be taken lightly and it is not for everyone. Oh and estrogen treatment does not change a person’s voice… but it will “chemically castrate” a person. The vocal cords change from male puberty (testosterone) and they do not change back. For someone like myself, my female voice changed since I take testosterone, and so my vocal cords did change — listen to my Audible Book and see! The point is not merely to advertise a book though, but that this process is complex, and — I think many commenters know less than they realize about it. Any way… I wrote a book about this… which many feminists loathe, although some also love it — and though I was not yet a libertarian/classic liberal when I wrote it – I think it has the beginnings of that arc in my political development. That amazing transformation, in some ways more profound, is for another memoir! I refer people to the book for a more positive view… and nuanced. And, to find out more about how the process works. I focus a lot on the hormones and what I learned about the very real differences between men and women, since the testosterone changed me so profoundly. Hence, the vitriol from some feminists, though not all. They would prefer that hormones do not make such a difference…

    As for Medicare, I do disagree that it is too late to change, why not – if you finally can, and die happier? However, should it be paid for? I have a lot of thoughts about this… and I guess some confusion… I also think why not, if other conditions are. This procedure is still relatively rare and won’t break tax payers. I do think Medicare is fine and it will be rare that anyone undergoes this as they move into being elderly. However… I am also conflicted to some degree, as any classic liberal might be, and feel that when government starts to pay for these procedures that we automatically tend to have less choice. In countries where say, the NHS pays for surgery and everything — trans people wait for YEARS and YEARS before seeing even a therapist. I don’t want that to happen. Competition has kept costs down for trans surgery, though it is certainly not cheap. But doctors compete and keep innovating and I wouldn’t want government interference to make that stop. I worry about the effect of insurance coverage because of cost inflation as well, but I also think it is nice to have it covered. My understanding was that these new “Obamacare” plans did cover surgery, HOWEVER — the deductibles are so HIGH, that you may as well be paying for it out of pocket. Or, at least, much of it out of pocket. I guess, your mileage may vary. So since Medicare is an established program – fine, but as to more government coverage – I am less enthused. However, this is where we are – Obamacare.

    I tend to be more for the free market setting prices and having various ways to finance- and I don’t pretend I have figured it out. However, this is not the direction we are going in – obviously. And, so — I guess we should be included. I guess we can all sink together… (!) But then again, I have some conflict on this to be honest. Insurance plans covering it, in that a la carte fashion, where if it pertains to you, you choose that plan, and if you have no interest in such a thing, you do not – would be the most fair. I don’t ride motorcycles so why be insured for that, and I do not smoke, so why should I pay for insurance as though I did. So, people who are not transsexual should not have to pay in a private plan for me and so on. However, this is not the way Obamacare works, which is — of course, wrong.

    My book, for those who are interested:

    I add that many trans people tell me that the right “hates people like you” so why did you change your politics? I always protest. I have to admit that some of these comments make me wonder, but I also know that many on the far left are even worse… or at least, the same… so really, one has to not look for comfort but do what one believes in. In this case, it means being a classic liberal since really I believe in individualism and in individual rights- and my own right, to pursue my happiness.

  20. Charles Says:

    Liberty Wolf – while not a transsexual I do want to point out that you are NOT the lone commenter on this site with your beliefs. I wasn’t going to weigh in on this topic because, despite our generous and graceful host, there are some commenters who don’t realize just how hateful they can be. But, since you spoke up, so will I.

    Not everyone on the right is religious, nor is everyone on the right a hater as far too often many on the left claim. Most folks on the right are, I find anyway, more tolerant than most folks on the left.

    Sadly, the most radical and vocal on the right get the media attention while the most radical on the left are not shown as being a huge part of the left; even though their influence is greater than the news media leads us to believe.

    I for one, don’t care if Medicare pays for this or not. If it is a real condition (and there isn’t evidence to suggest otherwise in my opinion) then it should be covered. I do agree that when the government starts to take care of something other options disappear and that will lead to shortages. Which doesn’t help anyone.

    And lastly, yes, never bother to defend your existence to anyone but yourself and to God – all others can go to you know where!

    May you have your American dream and pursue YOUR happiness.

  21. Liberty Wolf Says:

    Thank you so much Charles — I tend to agree that the most vocal are not always the majority. Thank you for extending yourself and making your own more supportive opinion on this known. I do appreciate it!

  22. Ymarsakar Says:

    You can either have your treatments paid for by the government, which means the government and its factions get to dictate how you live. Or you can pay for it yourself and it won’t be a concern of society any more.

    There is no “middle ground” where people can sit on the fence, going along with the flow because the government pays for it with confiscated money, while talking about their “liberty”.

    Statistics are tools to control weak minds, as usual. They don’t really matter, even if they were accurate and true. The Left, instead of snorting crack cocaine, snorts statistics instead.

  23. JuliB Says:

    I don’t mean to insult anyone’s existence but I’ve changed my mind about trans-sexualism. I truly believe it is a mental illness. As a woman, one thing that irks me beyond belief is that any person born male can say with certainty that he thinks like a woman thinks and knows he is a woman inside.

    If one is not a woman, then there is no way one can know how a woman feels or thinks. It is merely projection.

    What really changed my mind was the fact that there is a subculture of people who believe that they should only have one leg (or any other appendage) and want the other one removed.

    When I realized that my reaction was ‘mental illness’ I started comparing it to changing one’s genitalia. More of that thinking and I changed my mind on the trans issue.

    Now – did it make Liberty Wolf happier? Perhaps. Do I think it’s “right” to change? No. Do I really care one way or the other? No. Would I argue to make it illegal? No. Do I want the gov to pay for it? No. Could I be completely wrong in my thoughts? Yes.

    There’s one group of people I really feel bad for – intersexuals. One popped up on bemoaning the fact that the Church had issued no guidance in this situation. When I learned more about it, I felt awful for that person. But the percentage in the population must be darn low.

  24. Mayan Says:

    I’m late into this, but …

    I had sex reassignment surgery quite a few years ago and it led to a distinct improvement to my life.

    The most recent studies show that it is overwhelmingly beneficial to those who need it. There are more chromosomal irregularities than xxy: indeed there is quite a wide range of obvious intersex conditions. Having had my own experience (my mother admitted that there was something ‘not quite right’ at my birth) and witnessed the experiences of others, this is a real thing. Some of us, not many, are just this way.

    Now for the view that is more in accordance with the view expressed here. There are increasingly many people who are being given hormone therapy and approved for therapy on somewhat flimsy grounds, and that worries me. Similarly, when two year olds are being transitioned by their parents, I worry. To be clear, I knew my situation when I was 5 or 6, but the actions being taken on behalf of pre-teens by some parents worries me. Finally, there is a huge difference between people like me who need this intervention and the many people who ‘play with gender’. The two things are very different.

    Finally, I must ask whether the comments against this are “I don’t want to pay for that, but please pay for my medical bills” or, perhaps less likely, a principled “your health is your concern, pay for it yourself”. People who are life-long smokers asking for heart bypasses while campaigning against SRS are not credible. Principled positions, however, are.

    For the record, I do not live in the USA, nor was my treatment covered by the public system in my country (Australia). That said, having seen the treatment given to others for all manner of conditions and being able to compare it with the treatment I sought out and paid for, I have concluded that there is much truth in the old adage that those ‘who pay the piper, call the tunes’. Or, in more simple terms, should I require a hip replacement or such in my old age, i’ll take myself and some money to Thailand to get the job done right and to be treated with dignity rather than suffer the poor excuse for medicine found in too many western countries, with their government-run systems.

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