Alex Blaze

Socialized, heavily regulated, or single-payer: A health care system is as good as the people running it

Filed By Alex Blaze | October 09, 2009 12:30 PM | comments

Filed in: Living, Living, Politics, Transgender & Intersex
Tags: America, britain, government, GRS, health care reform, international, paris, system, transgender, underground

It seems like it's the universe's goal to simultaneously lower my expectations for my fellow humans and to surprise me with their generosity. Today I schlepped myself across town to do visa paperwork and found out, when I got to the huge bureaucratic building, that the one woman who handles visa paperwork for folks on my visa was out, and no one else in the city is trained to, literally, take a folder from me and put it on her desk. I then dragged myself to work, borrowed crutches and all, and climbed up to the third floor of an elementary school, only to find out that I didn't have to work today.

I was in too much pain at that point, and, well, let's just say that I got some health care access on the down-low here in Paris. At least I know I didn't fracture anything and I'm not allowed to walk for a week (so if I owe you an email, now's the time. I have no excuse). I just can't believe how generous people can be sometimes.

Anyway, this morning I came across this story from PinkNews about a trans woman who's suing the government to cover her breast augmentation surgery, saying that she's been on hormones for 10 years and that breasts are integral to her identity as a woman:

According to the Daily Telegraph, she argues that she will suffer great distress if Berkshire Primary Care Trust will not provide the surgery, saying it is essential to her identity as a woman.

Her case will be heard at the High Court on October 20th.

Berkshire PCT will only fund breast enlargement in "exceptional circumstances" and has only funded one such procedure in the past three years, for a woman who was deeply distressed at the size of her breasts.

It decided that C's case was not exceptional.

Stephanie Harrison, C's barrister, told a preliminary hearing that the patient had been discriminated against because she had been treated exactly in the same way a biological woman without gender dysphoria would have been treated.

She argued: "Breast augmentation is not cosmetic surgery, it is a treatment for gender dysphoria. This is a treatment for a recognised medical condition.

"The fact that someone is transsexual is treated as irrelevant by the PCT. It is a legal error to say that you must treat transsexual females and natal females the same".

Not every trans woman gets top surgery since hormone therapy will sometimes result in breast development. But not always, and I'd imagine being a woman, especially a woman who can, for a number of other reasons, be read as male, without breasts leads you to doubt your own identity and be mistreated by others.

According to a British court ruling in 1999, their national health care system isn't allowed to discriminate:

The Court of Appeal ruled in 1999 that it is unlawful for NHS organisations to operate anything amounting to a blanket ban on the funding of gender treatment.

But even the Department of Health says that not all procedures needed for gender reassignment are guaranteed:

Generally, you will be able to obtain funding for specialist psychiatric assessment and for hormonal medication. In addition, a few PCTs will fund hair removal, especially on skin from a donor site that is to be used in later surgery. Speech therapy may also be included in the package of care provided by a gender identity clinic (GIC) or a private gender specialist, and some PCTs are willing to fund this treatment. However, when you are considering surgery, you may find that the PCT limits this, in line with the view that there are 'core procedures' - which would usually be funded - and 'non-core procedures' that may be deemed 'cosmetic' or 'aesthetic'. In the case of trans women, this is likely to mean that facial feminising surgery, for instance, will not be covered. Even breast augmentation may be deemed aesthetic, and therefore not funded, despite the fact that this surgery may be essential to the success of the transition to the new gender role. The exclusions of such types of surgery are in line with local policies, and apply to anyone, whether or not they are a transsexual person. Chest reconstruction for a trans man, however, is likely to be regarded as 'core' surgery.

As Mercedes Allen pointed out, spread out across a population, the price of GRS is about 19 cents a year per person. It's negligible enough to recognize that the reason this procedure isn't covered isn't because of the money (as some British pols say), but about some people's discomfort with the idea.

I hope her lawyer does a good job with this case, because it's just silly. The Department of Health is going to pay more for lawyers to fight this case than if they just paid for the surgery to begin with. But I suppose they don't want people faking gender dysphoria and rushing to get GRS, thus draining the system's resources, so they just deny necessary care to everyone.

All this is to say that any health care system is as good as the government that runs it. France still has a strong single-payer system, but the conservative government is chipping away at its benefits and I got caught in a new loophole that started just this past year.

This is a big reason I just don't trust health care reform that doesn't include a strong public option - I simply don't believe that the US federal government is going to enforce the regulations proposed in various compromise bills. But I do trust the US government to put together its own program, since if it does a bad job, if it produces poor results for its clients, Americans will feel ripped off and complain. Really, feeling cheated is one of the primary ways to get Americans going, and it works because being a smart consumer is central to our identity. No wonder Democrats fall over one another to prove that they're not "spendthrifts."

So God bless Americans, but we can't let our politicians get away with "We're going to ban huge corporations from doing X." Because that never works.

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So a cisgender woman who is "deeply distressed" by the size of her breasts can get them enlarged, but a trans woman can't? That's nice.

"But I suppose they don't want people faking gender dysphoria and rushing to get GRS"

Who does that? Seriously? That just plays in to the notion that trans people are deluded or confused.

"I'd imagine being a woman, especially a woman who can, for a number of other reasons, be read as male, without breasts leads you to doubt your own identity and be mistreated by others."

It depends on several factors. I've known girls who were very self-conscious about their breasts, others who weren't. I've been blessed in that area myself, so I don't know first-hand.

One thing I do know is that a trans woman with a very masculinized face is more likely to be worried about that than her breasts. So I find it a bit odd that they're ranking breast augmentation as less cosmetic than FFS. For many trans women, FFS isn't about looking beautiful, it's about looking female. Undoing the damage of testosterone is hardly "cosmetic".

I think it's also pretty ridiculous that they're more willing to fund hair removal for GRS than removal of facial hair. Again that irrational bias trumping GRS above all else, as if it's the most important thing a trans woman can do.