ACLU Joins Lawsuit to Force Medicare to Pay for Sex Change Surgery

I’m going to get roasted and toasted for this post. It would be hard to say anything more politically incorrect that what my typing fingers are about to type here on this blog.

Let me begin with a vignette from my daily life. A few days ago, I was in a committee meeting in which we were discussing amendments to Oklahoma’s advanced directive laws. Several doctors testified about this legislation. During questions and answers, one of them remarked, “A patient can’t come to a medical practitioner and ask him or her to cut off their healthy legs and have them do it.”

No one on the committee reacted to this statement because it is so obviously true. If I went to a plastic surgeon and asked them to cut off my nose, they would call for a psych evaluation. If I went to a orthopedist and asked him to cut off my hands, he or she would do exactly the same thing.


Because a persistent  compulsion to mutilate myself would be an indication of mental illness. 

However, if I went to a doctor and asked him or her to cut off my genital organs and then re-shape the stubby leftovers into the appearance of the genital organs of a man, and if I further demanded that I be given massive doses of hormones to force my body to mimic secondary male characteristics such as a deeper voice and a beard, the doctor and everyone else in our society would be forced under threat of being called a bigot to pretend that this was not a mental health problem, but “normal” behavior on my part.

I could change my name to Regis, dress in a pinstripe suit, use the men’s bathroom and probably go on to demand the right to farm other women’s bodies for eggs in order to create a designer baby for me to raise, if I wanted.

Of course, what I wouldn’t be is an actual man. I would be a surgically and chemically mutilated woman with a serious mental health problem that was going untreated, but whose delusions were being played into socially and medically due to political correctness.


I have all the sympathy in the world for people who suffer from this problem, which is called “severe gender dyphoria.” It must be hell for them. I have witnessed it up close in the person of a member of the clergy at a church I once attended who “came out” as someone who had the body of one sex but felt a compulsion to live as the opposite sex and went through all these grisly procedures to achieve this.

I also am adamantly opposed to any violence or unjust discrimination against transexual people. I don’t want to harm them, but I don’t think that subjecting people to mutilating surgeries and hormone overdoses is treatment. I think it is yielding to social and political pressure to collude with them in the delusions which are a symptom of their real — mental — illness.

I don’t want to muddy the waters here with the small number of people who, through what I regard as birth defects, possess mixed chromosomes that are both male and female and who often also have mixed genitalia. That is something entirely different from what I’m talking about.

What I am referring to are those who are born with normal bodies of one sex, and for whatever reason, develop the belief that they are really the opposite sex and who also feel a compulsion to be surgically and hormonally mutilated to live their lives in accordance with this delusion.

I am also not going to weigh in on whether or not doctors should “treat” them by honoring their delusions and performing surgeries and administering the concomitant hormonal overdoses necessary for the person to look like the sex they are not. I will leave that to the physician and patient, as well as the hospital and insurance company.

What I want to address specifically on this blog is how far society and government should be compelled to go in this politically-correct assumption that this mental illness, is, in fact normal. The question for this particular post is, should medicare pay for sex change operations?


The ACLU has joined a lawsuit demanding that Medicare pay for sex change operations. I don’t know how much these surgeries cost, but I do know that there is talk of Medicare going broke. It seems evil to me that we have public officials, such as the former governor of Colorado, talking about how elderly people have a “duty to die” because they take up too many resources and put too much strain on our health care system and at the same time are being forced to consider funding what is an entirely elective and mutilating surgery to mistreat a mental illness.

The cost of these unnecessary surgeries and treatments would be enormous. Claims that these procedures are “safe and effective” are nonsense. No surgery is “safe.” Every surgery is a risk. This surgery is elective and it is massive. I do not doubt that there are many serious potential complications and that these would be magnified when the surgery is performed on elderly people. I also cannot imagine what years of hormone overdoses would do to a person’s health, but “safe” is not a word that comes to mind.

Claims based on what various associations of medical practitioners have voted to say about things like gender dysphoria have become meaningless, at least to me. I do not think these positions are based on science. I think they are based on politics and are a response to pressure from interest groups. I don’t think they mean much more than if the members of my book club had voted to take these positions.

I don’t know how the ACLU manages to shoe-horn this concern under the Bill of Rights. But from what I’ve seen, they can twist any trendy social experiment they are pushing to fit if they want to. At least, they can do it to their own satisfaction.

The ACLU press release regarding the lawsuit they’ve joined says in part:


LGBT Groups Challenge

Medicare’s Refusal to Provide

Healthcare to Transgender


April 1, 2013


WASHINGTON – Several national LGBT groups filed an administrative challenge last week to Medicare’s ban on medically necessary healthcare for transgender patients. Medicare currently prohibits all forms of gender reassignment surgeries regardless of the individual patient’s diagnosis or serious medical needs.

The National Center for Lesbian Rights, the American Civil Liberties Union, Gay & Lesbian Advocates & Defenders, and civil rights attorney Mary Lou Boelcke initiated the challenge on behalf of Denee Mallon, a transgender woman whose doctors have recommended surgery to alleviate her severe gender dysphoria.

“Medicare’s categorical exclusion of this care lacks any scientific basis,” said Shannon Minter, legal director at NCLR. “Study after study has shown that these surgeries are the only effective treatment for many patients suffering from severe gender dysphoria.”

Mallon joined the United States Army when she was 17 years old and worked as a forensics investigator for a city police department after she was honorably discharged from the Army. She was later diagnosed with gender identity disorder, a serious medical condition that is characterized by intense and persistent discomfort with one’s birth sex.

“The American Medical Association, the Endocrine Society, and the American Psychological Association all support these treatments for transgender patients,” said Joshua Block, a staff attorney with the ACLU Lesbian Gay Bisexual Transgender Project. “These procedures have been performed for decades and are proven to be safe and effective.”

Medicare adopted the ban more than 30 years ago. Decades of extensive scientific and clinical research since that time have established that these surgeries are safe and effective. (Read the rest here.)

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  • Brandi

    First, allow me to say that this is an interesting analogy – cutting off someone nose, hands, legs, etc verses “mutilating” their sex organs. At face value, it seems a sound comparison. And, I can believe that most doctors, politicians, insurance companies, etc. are making decisions based on “popularity” rather than what is in the best interest of the patient and our law.

    However, I can say with 100% certainty that I don’t have a clue how the human brain and chemical makeup works. And, I’m 95% certain you don’t, either… nor does anyone other than God. It is entirely possible that it is NOT a mental illness, but is, indeed, a combination of biological and psychological “mistakes” in the chemical makeup of those who are born physically one gender, but otherwise believe they are the other.

    The problem with this issue is that all we see are sex organs. Like you said… if someone is born with both, that’s a different story. Why? Because we can SEE there is something wrong. With a person born with female parts, all we see are the female parts, and therefore any belief on “her” part that “she” is a male must obviously be a mental illness.

    This is a serious trap of logic we must be careful to avoid. Just because you don’t SEE me in church, doesn’t mean I’m not a Christian. Just because you don’t SEE a degree hanging on my wall, doesn’t mean I’m uneducated. Just because we can’t SEE God, doesn’t mean he doesn’t exist. Just because we can’t SEE this person is truly a male, doesn’t mean he isn’t.

    • Rebecca Hamilton

      That may be true. But none of the politically-motivated “opinions” I’ve seen come from science of any sort. They are just responses to political pressure.

      If we discover real reasons why this is a physical and not a mental problem, then hopefully we will also discover ways to treat it that are not mutilating. If, on the other hand, it proves to be a mental health problem, hopefully we will discover ways to treat that.

      What we are doing now treats nothing.

      “However, I can say with 100% certainty that I don’t have a clue how the human brain and chemical makeup works. And, I’m 95% certain you don’t, either… nor does anyone other than God. It is entirely possible that it is NOT a mental illness, but is, indeed, a combination of biological and psychological “mistakes” in the chemical makeup of those who are born physically one gender, but otherwise believe they are the other.”

    • Theodore Seeber

      “It is entirely possible that it is NOT a mental illness, but is, indeed, a combination of biological and psychological “mistakes” in the chemical makeup of those who are born physically one gender, but otherwise believe they are the other.”

      I’d *still* call that a mental illness. Just because the mental illness has a biochemical cause, doesn’t make it less of an illness.

  • Mike

    If a little black boy says he is white and wants to bleach his skin he is told he is suffering from internalized racism.

    What more is there to say about this subject? It’s all politics, the politics of division; of dividing good people for political gain. And it works.

  • neenergyobserver

    What you said here is correct, in my opinion, Rebecca, as is Mike above. It is not a pleasant subject but I suspect if we did the research that there is a human reason for these cases. I could be wrong also, but I think we need to do a lot of OBJECTIVE research before committing money to such schemes. To me this is another one of those things (and most of them involve sex, at some point) where PC seems to contradict everything ever learned by human beings. Maybe, but if so, prove it objectively.

  • pagansister

    I thought Medicare was for those of us over 65—so how many 65 year old people will need/want a sex change?

    • Fabio P.Barbieri

      Oddly enough, it happens.

    • Fabio P.Barbieri

      Having had a lot to do, purely by chance, with male-to-female transsexuals, I know that I am less sure of anything than when I had not been the close friend of one, the collaborator of another, and the passionate admirer of a third. The fact is that, while in one occasion the female identity seemed so obvious as to suggest some fundamental genetic mistake, in another case I could have said with just as much certainty that the male features, not just in body but in behaviour, were so dominant as to make it seem obvious that, in this case, the gender disphoria was evidence of a mental illness. This “Case B” would never have looked – did never look – or sound – or act – like anything except a man with lipstick and long hair. And yet it was case B, not case A, of which I know for a fact that mixed sexual features, not quite to the point of hermaphroditism, but marked and impossible to conceal, existed from birth. (As I said, these are people with whom I have been as close over the years as friends can get, and I have discussed their cases with both as intimately as any therapist.) Then there was case C, which was very public – Jeffrey “Catherine” Jones, one of the greatest painters and illustrators America ever produced. (Most of the illustrations here are his: .) In his case, it seems very clear – though I would not dare say it in any other forum but here – that his sex-change operation was part of a horrifying collapse, physical as well as mental, which began with a mental breakdown that put an end to his creativity and ended with his death – the death of an American genius on a par, as far as I am concerned, with Thomas Eakins and Edward Hopper. By contrast, my friend “Case A” has never been more happy and well-adjusted than since she (I can’t help think of her as female) has been operated. And we aren’t talking of a flash in the pan, but a matter of some twenty years ago.

      Britain’s NHS offers “sex-change” operations, but under tremendously difficult conditions, and only a few dozen a year, I believe, are carried out. This seems to me, though you will not agree, the best that can be done at this stage of our knowledge. Above all, it roots out a danger you did not mention but which I think is serious – that of immature persons with exaggerated notions of their own “specialness” and “difference” demanding operations which they then would regret. I heard of a possibly apochryphal case in which one such person, obviously with more money than was good for him, had himself altered five times over.

      However, while I regard the British NHS compromise as sensible, I would not recommend it to America. It would not work there, because of a specific American predator, – Lawyerus Americanus Devastatorus. If once the very idea of publicly funded sex-change operations had been allowed in any way, black clouds of lawyers would set over every court of the land, and not move away till it had been made available, by legal hook or crook, to anyone who bothered asking for it.

  • SteveP

    “Gender reassignment surgery” does not contribute to the common good. I’d anticipate the argument to develop from the basis of an equal-protection rights violation if there are currently benefits for genital reconstruction due to injury or, more importantly, birth defect.

    • Guest

      I don’t think that logic holds. People have body parts removed all the time due to disease or injury but that’s not the same as messing with healthy body parts that function as they were designed to do. The closest that sex reassignment comes to anything else is cosmetic surgery and extreme body modification – neither of which anyone is even remotely suggesting should be publically funded. Not even gov issued breast implants for insecure AA cup women who suffer tremendous psychological and actual discrimination in the pursuit of men in our EE cup world aesthetic – sarc of course.

  • FW Ken

    Medicare also comes with Social Security Disability payments, which can come anytime after 10 years of paying into the system. Medicaid comes with SSI, which is for disabled persons or older folks who didn’t pay into the system.

    • Rebecca Hamilton

      Ken you’re correct. However, this particular court case is based on the request for a sex-change which was requested by a 75 year old person and denied by Medicare.

      • pagansister

        75? Wow! That person certainly waited a long time to attempt to “solve” their situation. In this case, I’m glad Medicare denied his/her request.

        • Theodore Seeber

          For once I agree with PS. I wonder if male menopause (the end of the body producing testosterone) had anything to do with this decision.

          • pagansister

            “For once I agree with PS. ” Theodore, I think this rare event calls for a smiley face!! :-)

  • FW Ken

    That’s a hoot. Teach me to go read the fine print. :-)

  • Bill S

    We have a case in Massachusetts where a judge has ruled that the state must pay for a prisoners sex change because it is cruel and unusual punishment to keep him as a man in a men’s prison when he is really a woman. He is serving time for killing his wife.

    I hope that people don’t oppose gay rights because of extreme transsexuals abusing the system. I hope they can see the difference and say yes to one and no to the other.

    • Rebecca Hamilton

      Did the state appeal this ruling?

      • Dale

        I think Bill is referring to the case of Michelle Kosilek. There have been a long running saga of repeated court cases, going back years, to obtain resources for Kosilek to complete her transition from male to female.

        A federal appeals court is currently reviewing the requirement the state pay for sexual reassignment surgery. A decision is expected within three months.

        • Guest

          Looks like he got life instead of the death penalty. The only thing more insane than giving this guy a sex-change operation (so he can go to a women’s prison and kill more women perhaps?) would be to do it before he had a lethal injection. I guess we can be thankful for some small bits of rationality, hmmm?

          btw, he looks like a Case B from Fabio’s classification.

    • SteveP

      BillS: The lawsuit subject of the article and “gay rights” are both abuses of the system. The latter also abuses the meaning of the word gay and the meaning of the word right.
      If it is inappropriate for the public to pay for a set of surgeries to outwardly change a man to a “woman,” how can the public paying a man survivor benefits because his “husband” died be different? How can it be justified that a woman not pay the estate tax on her deceased “wife’s” property?

  • Bill S
  • Guest

    It’s mind blowingly illogical and irrational. The same set of gender reformers who tell us that ‘healthy’ gender identity can be wholly unrelated to the genitals one carries around from birth also tell us that being able to live a ‘healthy’ life with one’s gender identity is totally dependent on having the right set even if you have to get the right set by mutilating your body. Seems to me one or the other has to be an unhealthy coping strategy, no?

  • Patty

    The problem I see is that if some are saying it is a “Mistake” of nature, then you are saying God made a mistake. God created MAN and WOMAN – period. God does not make mistakes, this is another attempt for humans to try to be better than God. But for those that do not know God, then they will believe the mistake in nature bit, but what amazes me is the fact that men and women of God are buying into this “mistake”. Rebecca, you said it better than I could, it is a mental illness or someone who has no morals or lost their way. One thing I do know (I am not a theologian – but I am a faithful child of God) is that God created beauty, He created love, and everything He created is perfect. It is simple and direct. I seen no gray areas here. I do not hate these people but I do have compassion for them because they are so lost they may never find redemption. It is just wrong to try and “better” God. I know some of your commentators can be mean spirited so to those who are…be mean, but I know the truth – the true word of God is more important to me than you trying to bully me or anyone else to agree with you. This is wrong in the eyes of our creator.

    • pagansister

      Patty: I find it hard to agree with your belief that everything that God creates is perfect. How is a child born with horrible defects, sometimes painful and sometimes causes early, painful death, perfection? Unless someone has experienced being a person who can’t mentally identify with their body’s looks, ie their sex organs, I think it is hard to say it is not possible and against their creator’s wishes, if you will.

      • Rebecca Hamilton

        If I may interject, every person is made in the image and likeness of God, which means that they are inherently beautiful and, yes, perfect. At the same time, we are born into a world which is blighted by original sin, which explain many things. As to birth defects, we all have them. It is simply a matter of degree. I was born with a predilection to allergies and have asthma. My husband is color blind. I realize that both of these things are within the range of normal inheritable things, but they are also less than the perfect human body. Someone who is born with a more disabling birth defect, such as one arm or spina bifida or down’s syndrome certainly suffers a greater disability, but that in no way diminishes their perfection as human beings made in God’s image. I believe (I have no idea if this is Church teaching; it’s just what I think) that this perfection is only partially realized in this life, even though it is present.

        A person with a disability is fully human, and their humanity is totally perfect. God’s love for them is enormous. One reason people miss the reality of God is that they try to judge him by themselves and their understanding which is finite and thus limited.

  • pagansister

    Honestly, Rebecca, I have a very hard time with the concept of “original sin”. Correct me if I’m wrong, but wasn’t that , according to the Bible or someone, because Eve had Adam eat the apple after God said don’t mess with that tree(of knowledge)? Thus all who are born are born in sin? That is taken care of by Baptism as an infant? Obviously I may have that all wrong—raised Methodist, and we weren’t taught “original sin”. Please correct me if I have that all wrong. (or someone else who is educated in that area). Whatever the religious reason, I can’t understand how an innocent infant can be born “sinful”. You mentioned having allergies, and you husband is color blind. Chances are as annoying as those things are, they probably won’t kill you. Yes, people with disabilities are human. I understand that. What I don’t understand is the concept that God created those people with those problems/disabilities ? Why would He/She do that? He/She intentionally causes those things to happen ie creates those folks? Does that go back to the tree? I’m not trying to be disrespectful of the Church here—I’m just trying to understand the thinking/teaching of the Church. Birth defects happen, IMO, due to many factors—to numerous to name, and can in some cases make that infant have a horrible and sometimes short life—-as medicine can’t solve everything. Those people who do live—depending on the disability—live long, happy lives. I taught with a teacher who was born with Spinal Bifida, and she got around on crutches and was an excellent teacher. However she finally had to stop teaching because she could no longer stand for long periods of time. Have lost touch with her, but I expect she ended up in a wheel chair. Had a now over 50 year old Downs Syndrome neighbor who was able to work in a sheltered situation and made a little money. He was fortunate that his parents could afford the things he needed to keep him healthy. He was the 5th of 5 children. The others had no problems. Yes, those with defects can and do live with their situations. What I want to know is how it is believed that God created those folks as well as “normal” folks, if God makes no mistakes, as the poster above wrote. I appreciate your input and most certainly it wasn’t an intrusion. I thought awhile before I answered your post—and I’m not sure what I wrote makes sense—–

  • Manny

    You are right on. Wanting to mutuilate part of your body is a mental health issue. Thinking that you are in the body of the wrong gender is also a mental health issue. Both are delusions. It’s time we stopped this nonsense. Sex changes should be prohibited. There is no reason for them, and certainly the general public shouldn’t have to pay for it. The modern world has sunk into insanity.

    Ed Koch, the former Liberal mayor of NYC, once famously said (I’m paraphrasing from memory) that if the ACLU is for something, it almost a given the right position to be is on the opposite side.

  • Dale

    Rebecca, did you mean to update this article?

    I remember reading this article, and almost all of the comments, last month. But I see now that the article has today’s date on it, and its at the top of the blog. Am I missing the update?

    • hamiltonr

      I just put it up here because I’m posting another article that fits with it today and I wanted them both up front where readers who wanted to could reference the older one. I do that sometimes. It’s my feeble attempt at continuity. :-)

      • aimes

        Perhaps you should gather more facts on this matter before posting things that aren’t true. One f as ct that you fail to realize is that many of these people are born with other defects that cause them to feel the way they do. Example.. Some are born with the brain of the opposite gender. And these defects aren’t seen, so that person is considered “normal” at birth.

  • Dave

    Bingo, Ted…in fact, I believe most, if not all, “mental illness” does have a biochemical cause. Mental illness, or “insanity”, is a condition where an individual is not dealing with objective reality and truth.

    As secularization now encourages people to think that there is no such thing as “objective truth” in many areas, ESPECIALLY those with anything to do with sex, that means that more and more mental illness is going to go undiagnosed, and even be encouraged.

    That explains why someone wanting to mutilate and “replace” their sexual organs is treated as normal, while someone who wanted to mutilate and replace another part of their body would be considered insane.

  • pagansister

    Medicare paying for sex-change surgery? NO. As often as I usually agree with the ACLU, I totally disagree with their efforts in this case.

  • EMS

    A few days ago, I read of a man who had his part of his healthy leg cut off (midthigh, I think) because he felt he didn’t have a leg that went beyond that point. I can’t decide who is more mentally ill – him or the doctor that went along with it.

  • TheodoreSeeber
    • pagansister

      Well, in my years as a Methodist, approximately 17, age birth to 17 that is, I never heard about the UMC holding the belief of original sin. Since I disagree with that concept, maybe it is even better I left at 17. :-)

      • TheodoreSeeber

        I heard it from my Methodist grandmother before I ever heard it from a Catholic priest, back in the 1970s.

        I can think of no theological concept that has more anthropological evidence than Original Sin. It is easily the most scientifically proven concept in all of Catholicism.

        • pagansister

          Guess I missed that concept in my Methodist upbringing. But as I said above in a couple of places, I do not believe in it at all—and if I was taught that as a Methodist (not from my parents, as I feel they would have disagreed with the church too) by some Sunday School teacher or other, I totally forgot it which means—it wasn’t important.

  • TheodoreSeeber

    I can’t. It either has to be no to both- and no to moral relativism- or yes to both- and yes to moral relativism.

    If moral relativism is true, then we can’t discriminate against those who live in alternative mental worlds.

  • TheodoreSeeber

    Here’s a real trip- this comment says it was made “a month ago” on an article that was posted today. Same with the rest in this commenting system.

    I have grave doubts about the medical research surrounding this. Like Dr. George Weinberg’s research on homosexuality in the 1970s, I suspect a great hidden bias, or maybe even bribery is involved.

  • TheodoreSeeber

    And now here’s a comment of mine that I barely remember making from a month ago. What’s going on Disqus?

  • Maria Reynard

    SRS is the only treatment for people such as myself. You cannot change the way a person’s brain is structured (since the “illness” starts in utero), but you can change (not “mutilate”) your body. Consider talking to some transgender people and what they go through on a daily basis before deciding their lives for them.