Should Medicare be Forced to Pay for Sex Change Surgery?

UPDATE: I first published this post in 2013. I am publishing it again today because the concerns it raises are still valid. Should Medicare pay for sex change surgery? I don’t think so. The Obama Administration’s Department of Health and Human Services ruled in 2014 that Medicare would pay for sex change surgeries. Meanwhile, agitation to reduce coverage for Medicare payments for elderly health care, and agitation to euthanize the frail elderly continues. 

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. Why? 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

Patients

April 1, 2013

FOR IMMEDIATE RELEASE CONTACT: (212) 549-2666; media@aclu.org 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.)