I dunno about that. Perhaps counseling would be a better alternative than sex re-assignment, certainly less expensive and cost efficient. I can't really justify that this procedure be covered by insurance...you know, with little kids dying of cancer and all. But that's just my opinion.
Really? I am disappointed to hear such thoughts but I suppose you are not alone in thinking this way. As an adament supporter of funding for SRS, I am eager to reply.
Let me address each of the major reasons given for not covering these procedures in turn.
SRS is expensive: SRS is expensive, but not more so than other surgeries in the US. The cost of surgery for transwomen is approximately 15-20 K, and usually much higher for transmen. SRS saves money for the state in the long term by allowing workers to become more productive and citizens who could not otherwise work to find stable jobs for the first time. In fact, utilization rates of SRS are low, but for those who seek the procedure, they can get life-changing care for the first time. What exactly is the cost? San Francisco is the only municipality currently funding SRS for its employees. To pay for the new program, they charged everyone insured by the city an extra $1.70 per month. Over four years, $183,000 dollars were paid out and the city took in an extra 5.6 million dollars; the surcharge was soon dropped as unnecessary. Alternatively, not providing surgery also leads to social costs, such as caring for things like depression, drug abuse, and providing welfare over long periods of time. Counseling itself is expensive. Preop women require larger and more expensive hormone doses.
SRS is experimental: Actually, this is blatantly false. SRS has been performed for over seventy years! In contrast, drug eluding stents were approved in America for use very quickly and before other countries such as the UK did so; clearly, an unfair standard has been applied here. SRS has been performed hundreds of thousands of times around the world by dozens of surgeons since the 1950s, and the first surgeries were done in the early 30s. SRS is consistently found to be extremely beneficial for patients. For many, SRS has been the only effective means of treating their transsexualism. The entire notion that SRS is experimental probably stemmed from two pharmacologists working for Medicaid who arbitrarily made that claim as a basis for excluding coverage.
SRS is too risky: Ironically, SRS is one of the most successful procedures in the world in terms of patient satisfacation. Patients express satisfaction rates as high as 98% after surgery. One study measured patient satisfaction using a 1-10 Likert scale and 86% of respondants gave a score of 8 or higher. I don't have the data on hand, but I suspect these figures are much higher than for other more common procedures, such as joint replacement. I can say that in a 1998 paper from Clinical Orthopaedics, only 61% of patients undergoing hip revision were satisfied. I don't see many people railing against funding for hip revision work. I for one would rather have my gender surgery than hip revision were I in the position to choose. Complications for SRS are also rare. In one study I recently reviewed, approximately 95% of patients had one or fewer complications, again a much lower rate than most other procedures. Incidentally, hip replacement cost an average of $51,290 -$34,328 per person, depending on the complexity of the procedure, in one 1999 study from the same journal, and is also considered elective.
SRS is cosmetic: SRS produces major improvements in the lives of patients. In another study, before and after surgery, gender dysphoria, body dissatisfaction, negativism, shyness, neroticism, depression, and feelings of inadequacy all declined at a p value of <.001. Anecodatally, many persons I know report they could not live their lives without this procedure. Gender dysphoria itself is a real condition that does not go away, a fact substantiated by brain studies and observational studies of young children. The only way to prevent many such individuals from killing themselves or leading lives of severe depression is by undergoing this procedure.
SRS has better alternatives: First of all, without surgery, it is impossible to obtain recognition as the real gender. Surgery itself may not be sufficient, but is necessary at a minimum according to all court cases I have reviewed. Therefore, it is the only way to be recognized a real female (or male), which may be necessary for employment, marriage, and so forth. Beyond this practical need, surgery itself is the only way to treat dysphoria in many patients. Counseling does not work. The necessity of counseling itself stems from a desire to deny surgery; the gatekeepers must be appeased before care can be given. I think it is worthwhile to make sure those requesting surgery are not crazy or delusional, but beyond this, some sort of long, drawn out therapy program is not necessary. It just represents another large financial burden. HRT is also necessary but often not sufficient.
My view: Denying coverage for SRS is pure politics. Gender dysphoria is as serious a concern for some patients as a broken bone and should be treated. SRS is the only way such persons can contribute effectively to society and flourish as productive citizens. Therapy is not a sufficient alternative. Just like you can't make gays straight, you can't make transsexuals non-transsexuals. Moreover, as a future doctor, it is not your job to arbitrarily deny surgery based on cost. In other words, if a person were in the ER and there was a 1% chance of saving her life at a 100 million dollar cost, you should still try to save her life. You should be focused on improving lives or saving lives instead of deciding which conditions deserve treatment and which do not.
The notion that providing coverage for these surgeries somehow hurts children with cancer is a gross distortion and red herring. SRS is not covered today in the vast majority of cases and our health care system is still the most expensive in the world. If you really have concerns over cost, which you should, I suggest you not scapegoat transsexuals and instead look at inflation, provision of unnecessary care, unhealthy lifestyle choices, and provision of end-of-life care.
For many of us, obtaining SRS on our own is an impossibility. Some of us are able to find well-paying, professional jobs, typically if we come from supportive backgrounds, are fortunate enough to pass well, or delay transition until reaching financial stability. In these cases, we could eventually pay for SRS. I say, how is it ethical to force us to wait until we are 30 and 40 when we have saved enough money? Should we effectively be robbed of half our lives, our most vital years, while saving this money?
Many of us cannot even answer this question, because we can never afford the procedure. Most trans people face severe economic discrimination and hardships that result in poverty and unstable housing. Many are predisposed to street lifestyles and drug addiction. Try getting a job when you look like a woman but your social security info gives a male name and shows the wrong gender. Again, this is not some internal flaw associated with being transsexual but a direct result of prejudice and discrimination in society. Therefore, there is literally no opportunity to save this much money.
Thus, surgery should be funded early (ideally pre-18 in qualified cases) and doctors should administer hormones so patients can live more readily in their real gender. Therapists should determine appropriateness of surgery; parental consent should be disregarded. At a minimum, androgen blockers should be given before puberty. Insurance providers, employers, and Medicaid should be committed to paying for at least some of this procedure. Many successful companies already do so, such as Kodak and IBM. Until these changes are implemented, gender should be a malleable category on our IDs, school, government, health, and financial records, if it is recorded at all.
Ultimately, society will gain a clear net benefit by recognizing these procedures as legitimate and necessary. This is also the only humane course of action undertaken with much success in other countries.
I am writing hurridly before class, so I apologize for any typos or anything I did not explain adequately. I would love to develop this response further and do some editing, but, alas, I must be going now...
Hope this helps!
