It's any wonder that healthcare costs are spiraling out of control...

[DermViser]

http://www.nytimes.com/2014/05/31/u...age-of-sex-change-surgery-is-lifted.html?_r=0

Any wonder that premiums are skyrocketing.

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[Kaputt]

This is a good thing.

Hormone treatment is still not covered and that's what probably costs more long-term.

 

[Psai]

No one needs gender reassignment. If you think you're a boy and you want to be a boy you can pay for it yourself.

 

[DermViser]

This is a good thing.

Hormone treatment is still not covered and that's what probably costs more long-term.

Is hormone treatment lifelong? Not too familiar with this. I thought it was only for a specified period of time for endocrine suppression. Also there is no need for govt. health insurance to pay for it. You want it? Pay for it yourself.

 

[DermViser]

No one needs gender reassignment. If you think you're a boy and you want to be a boy you can pay for it yourself.

Apparently it falls under the diagnosis of gender dysphoria.

 

[Kaputt]

Is hormone treatment lifelong? Not too familiar with this. I thought it was only for a specified period of time for endocrine suppression. Also there is no need for govt. health insurance to pay for it. You want it? Pay for it yourself.

I don't know if it's lifelong. Honestly don't know much about how much it costs.

It's not a matter of "want". I would say your line of reasoning is akin to "you want treatment for depression? Pay for it yourself." Dysphoria is rough enough without also adding the nightmare that comes with transphobia being a norm in our society. Insurance covering gender reassignment surgery is as ethical as insurance covering treatment for any psychiatric condition, in my opinion.

 

[DermViser]

I don't know if it's lifelong. Honestly don't know much about how much it costs.

It's not a matter of "want". I would say your line of reasoning is akin to "you want treatment for depression? Pay for it yourself." Dysphoria is rough enough without also adding the nightmare that comes with transphobia being a norm in our society. Insurance covering gender reassignment surgery is as ethical as insurance covering treatment for any psychiatric condition, in my opinion.

No, then buy a specific plan that covers gender reassignment surgery. Don't foist the costs on everyone else, esp. on a GOVERNMENT funded plan. I can't believe you are equating treatment of gender dysphoria thru gender reassignment surgery to the treatment of depression as if they are on the same plane.

 

[Kaputt]

No, then buy a specific plan that covers gender reassignment surgery. Don't foist the costs on everyone else, esp. on a GOVERNMENT funded plan. I can't believe you are equating treatment of gender dysphoria thru gender reassignment surgery to the treatment of depression as if they are on the same plane.

How are they not on the same plane? They are two conditions that the patient has no control over. Transgendered individuals can't help being transgendered. The treatment for dysphoria is determined by what the patient wants...most of the time, that means helping the person's body match their identity. Saying this stuff should be elective and paid out of pocket isn't right in my opinion. People who get sex reassignment surgery aren't doing it on a whim or because they choose to be transgendered.

 

[WaylonS]

Just to throw this out there

Some private companies have mandated that the insurance policies they negotiate for their employees cover gender reassignment surgery.

MediCal--California's MediCaid program--will cover gender reassignment surgery, but the reimbursement rate is too low, and consequently, no surgeon will accept it.

It's interesting to see where Medicare will fall between these two examples.

 

[DermViser]

Just to throw this out there

Some private companies have mandated that the insurance policies they negotiate for their employees cover gender reassignment surgery.

MediCal--California's MediCaid program--will cover gender reassignment surgery, but the reimbursement rate is too low, and consequently, no surgeon will accept it.

It's interesting to see where Medicare will fall between these two examples.

Yes, key word here being PRIVATE. The same way a company can choose to give women paid (vs. unpaid) maternity leave.

 

[DermViser]

How are they not on the same plane? They are two conditions that the patient has no control over. Transgendered individuals can't help being transgendered. The treatment for dysphoria is determined by what the patient wants...most of the time, that means helping the person's body match their identity. Saying this stuff should be elective and paid out of pocket isn't right in my opinion. People who get sex reassignment surgery aren't doing it on a whim or because they choose to be transgendered.

Forget paying out of pocket. Pay for a PRIVATE insurance plan or supplement plan that covers it, if you so choose.

 

[Kaputt]

Forget paying out of pocket. Pay for a PRIVATE insurance plan or supplement plan that covers it, if you so choose.

This will likely put pressure on other insurers to cover it as well

What's your beef with Medicare specifically paying for it? You have some moral objection to taxpayer money being used for this purpose?

Also, the cost issue is not a big one -- not all trans individuals want the surgery, and trans individuals make up 0.3% of the adult population.

 

[DermViser]

This will likely put pressure on other insurers to cover it as well

What's your beef with Medicare specifically paying for it? You have some moral objection to taxpayer money being used for this purpose?

Also, the cost issue is not a big one -- not all trans individuals want the surgery, and trans individuals make up 0.3% of the adult population.

When your insurance is paid by the taxpayer then yes, it falls under a different set of rules. And no, it WON'T put pressure on other insurers to cover it if it's only 0.3% of the population. Has nothing at all to do with a "moral objection" - nice non sequitur.

The same way insurance shouldn't have to cover birth control (for non-medical reasons), maternity care, etc. When you keep adding mandates, the price of insurance premiums is jacked up for EVERYONE. It stops becoming actual insurance.

 

[Kaputt]

When your insurance is paid by the taxpayer then yes, it falls under a different set of rules. And no, it WON'T put pressure on other insurers to cover it if it's only 0.3% of the population. Has nothing at all to do with a "moral objection" - nice non sequitur.

The same way insurance shouldn't have to cover birth control (for non-medical reasons), maternity care, etc. When you keep adding mandates, the price of insurance premiums is jacked up for EVERYONE. It stops becoming actual insurance.

But people with gender dysphoria have a MEDICAL reason for sex reassignment surgery. Do you deny that?

 

[DermViser]

But people with gender dysphoria have a MEDICAL reason for sex reassignment surgery. Do you deny that?

No. And it's a treatment they themselves can pay for by buying a specific health insurance plan that covers it or an insurance supplement. Do you get that?

 

[Kaputt]

No. And it's a treatment they themselves can pay for by buying a specific health insurance plan that covers it or an insurance supplement. Do you get that?

You're making absolutely no sense. Why shouldn't Medicare cover the treatment for a medical condition? The ban on these surgeries before was largely because they were experimental in the 80s, and they aren't now.

Look, this is a largely symbolic act. It only applies to people on Medicare (and not Medicaid), which is people 65 and up, and it requires justification for it to be approved. It's part of an overall increase in access to care for transgendered individuals. Private insurers are increasing coverage as well.

Here's a better article, in my opinion:
http://www.washingtonpost.com/natio...bcd122-e818-11e3-a86b-362fd5443d19_story.html

The only people opposed to this are people who don't think gender dysphoria is a medical condition, or think that the only way we should be treating it is why forcing transgender individuals to accept their birth sex as their gender.

 

[Psai]

Because it's stupid. If someone has body dysmorphic disorder and wants to have a hundred rhinoplasties, why should anyone else pay for that? If you can afford it, go for it. Don't expect the government to pick up the tab. Psychiatric medical diagnoses tend to be soft with many arbitrary designations. No ones forcing anyone into anything. It's that if they want an elective procedure, they can pay for it themselves. Learn the difference between positive and negative freedom.

 

[pdxhopeful]

Kaputt, just want to show my support. The level of ignorance around trans issues is pretty staggering, and we as physicians or future physicians should be doing better.

 

[pdxhopeful]

Because it's stupid. If someone has body dysmorphic disorder and wants to have a hundred rhinoplasties, why should anyone else pay for that? If you can afford it, go for it. Don't expect the government to pick up the tab. Psychiatric medical diagnoses tend to be soft with many arbitrary designations. No ones forcing anyone into anything. It's that if they want an elective procedure, they can pay for it themselves.

For someone with BDD, no amount of surgery will make them feel better about themselves. Covering it would be pointless.

For someone who is trans, hormonal treatment and/or surgery actually do treat the condition.

 

[Psai]

And that's why medicare covers dialysis right? Because it treats chronic renal failure oh wait

 

[Kaputt]

And that's why medicare covers dialysis right? Because it treats chronic renal failure oh wait

Worst analogy ever.

 

[pdxhopeful]

And that's why medicare covers dialysis right? Because it treats chronic renal failure oh wait

Cure it? No. Does it treat it in the sense of slowing damage, improving the patient's ability to live their life, and extending longevity to up the odds of getting a transplant? Yup.

 

[pdxhopeful]

When your insurance is paid by the taxpayer then yes, it falls under a different set of rules. And no, it WON'T put pressure on other insurers to cover it if it's only 0.3% of the population. Has nothing at all to do with a "moral objection" - nice non sequitur.

The same way insurance shouldn't have to cover birth control (for non-medical reasons), maternity care, etc. When you keep adding mandates, the price of insurance premiums is jacked up for EVERYONE. It stops becoming actual insurance.

You ought to do your research. Covering BC lowers insurance costs almost 20%, because insurers aren't paying for as many pregnancies, births, and resulting children covered on their parents' plan.

 

[BobbyB]

having a penis or vagina doesn't determine your gender
the gender you identify as can change

"do no harm"

should we be doing major surgery and subject our patient to risk for a cosmetic change that doesn't affect their gender?

 

[Kaputt]

having a penis or vagina doesn't determine your gender
the gender you identify as can change

"do no harm"

should we be doing major surgery and subject our patient to risk for a cosmetic change that doesn't affect their gender?

Not sure what your point is. Are you arguing that because there are inherent risks to sex reassignment surgery, that they shouldn't be done? Well, the whole point of Medicare reversing the ban from the 1980s is that the procedures are not experimental anymore. For many people the risks of the procedures are outweighed by the benefits.

 

[DermViser]

You ought to do your research. Covering BC lowers insurance costs almost 20%, because insurers aren't paying for as many pregnancies, births, and resulting children covered on their parents' plan.

Please link to peer-reviewed journal research showing this. I want to see it.

 

[KinasePro]

How are they not on the same plane? They are two conditions that the patient has no control over. Transgendered individuals can't help being transgendered. The treatment for dysphoria is determined by what the patient wants...most of the time, that means helping the person's body match their identity. Saying this stuff should be elective and paid out of pocket isn't right in my opinion. People who get sex reassignment surgery aren't doing it on a whim or because they choose to be transgendered.

Depression has legions of evidence supporting pharmacotherapy as highly efficacious and is one of the most prevalent diseases in the modern US.

Gender dysphoria is relatively rare, and the only treatment with decent evidence is hormone therapy. Reassignment surgery has tiny, chitty trials without impressive numbers.

I'd support medicare funding the hormones, but would need to see some quality evidence demonstrating safety and efficacy of reassignment surgery in actually TREATING gender dysphoria.

 

[el_duderino]

Yeah, sex-change operations are CLEARLY a significant driver of cost in the insurance industry.

CLEARLY.

 

[Psai]

No one rain drop thinks they caused the flood.

Seriously a sex change operation for a 74 year old? What a waste of money.

 

[pdxhopeful]

Please link to peer-reviewed journal research showing this. I want to see it.

It's easily Google-able, and I've had my SDN time for the day.

 

[DermViser]

It's easily Google-able, and I've had my SDN time for the day.

Yeah, I'll take that as you're talking out of your ***, bc I was asking for something that's Pubmedable, not Googleable. Thanks.

 

[DermViser]

Yeah, sex-change operations are CLEARLY a significant driver of cost in the insurance industry.

CLEARLY.

Every single person believes that the treatment they want doesn't contribute to increasing other people's premiums. Nice to know you still live in your little utopia, Medical Student (Accepted), where everyone can get the care they want, at any cost, no matter what.

 

[el_duderino]

Every single person believes that the treatment they want doesn't contribute to increasing other people's premiums. Nice to know you still live in your little utopia, Medical Student (Accepted).

Yawn. You all but directly stated in the OP that sex reassignment surgery is a reason for health care costs "spiraling out of control."

That is nonsense.

 

[DermViser]

Yawn. You all but directly stated in the OP that sex reassignment surgery is a reason for health care costs "spiraling out of control."

That is nonsense.

I said, "It's any wonder that healthcare costs are spiraling out of control." When you add more insurance mandates, premiums continue to skyrocket. This is known fact, Medical Student (accepted).

 

[Kaputt]

Every single person believes that the treatment they want doesn't contribute to increasing other people's premiums. Nice to know you still live in your little utopia, Medical Student (Accepted), where everyone can get the care they want, at any cost, no matter what.

People don't get sex reassignment surgery just because they want it. The standards of care most surgeons adhere to are pretty strict about eligibility.

 

[DermViser]

People don't get sex reassignment surgery just because they want it. The standards of care most surgeons adhere to are pretty strict about eligibility.

Sex reassignment surgery is not the only treatment for gender dysphoria, and you know that.

 

[Kaputt]

Depression has legions of evidence supporting pharmacotherapy as highly efficacious and is one of the most prevalent diseases in the modern US.

Gender dysphoria is relatively rare, and the only treatment with decent evidence is hormone therapy. Reassignment surgery has tiny, chitty trials without impressive numbers.

I'd support medicare funding the hormones, but would need to see some quality evidence demonstrating safety and efficacy of reassignment surgery in actually TREATING gender dysphoria.

Trials assessing efficacy are indeed lacking, largely due to small numbers. The standard of care though is a unified approach between psychotherapy, hormonal treatment, and surgery.

A problem also arises in that many states require sexual reassignment surgery before changing someone's sex on their birth certificate.

 

[dadaddadaBATMAN]

Yeah, I'll take that as you're talking out of your ***, bc I was asking for something that's Pubmedable, not Googleable. Thanks.

I'm off for the summer, aside from some easy research I'm doing.

Here's an article on the cost savings of providing tubal ligations after a woman has an abortion.
http://www.ncbi.nlm.nih.gov/pubmed/24799310

It took me around 30 seconds to find, and I won't pretend like I read the article past the abstract, but I'm not exactly surprised. Even if only one in ten women prevent a pregnancy by being on the pill, it makes sense that this would save money to me.

Birth is expensive, child care is expensive, the medical expenses during childhood are expensive, food for a kid is expensive, productive time lost by raising a child is expensive, etc. Assuming many of these costs would end up covered by the state in poor families doesn't seem like a huge stretch to me.

 

[Kaputt]

Sex reassignment surgery is not the only treatment for gender dysphoria, and you know that.

Duh, who said it was? But hormones and therapy alone don't help every patient. An individualized approach is needed for every patient, and surgery is one option which helps a lot of people.

I know you never back down from any position you take, so maybe it's just time to agree to disagree.

 

[DermViser]

Duh, who said it was? But hormones and therapy alone don't help every patient. An individualized approach is needed for every patient, and surgery is one option which helps a lot of people.

I know you never back down from any position you take, so maybe it's just time to agree to disagree.

No one said you can't have the surgery. It's a problem when other people pay for it on a government program. Like I said Medicare people are free to get Medicare supplementals that cover it. Notice that Medicare is now covering it, while Medicaid does not.

 

[dadaddadaBATMAN]

Duh, who said it was? But hormones and therapy alone don't help every patient. An individualized approach is needed for every patient, and surgery is one option which helps a lot of people.

I know you never back down from any position you take, so maybe it's just time to agree to disagree.

I guess my main concern is about how the money is being used, and on the utility of it. Assuming a finite spending limit for healthcare, is the money for treating this disorder worth more than if it were spent on leukemia patients?

I know it's somewhat of a false dichotomy (increasing spending on one does not preclude increased spending on the other), but I guess it bothers me that this idea is totally ignored. At some level, we are making the decision of forgoing using that money on something else.

If it were better studied, and could show a clearer benefit, I would have less of a problem with it. Perhaps the money they're planning on throwing it would be better spent on generating a real clinical trial.

 

[DermViser]

I'm off for the summer, aside from some easy research I'm doing.

Here's an article on the cost savings of providing tubal ligations after a woman has an abortion.
http://www.ncbi.nlm.nih.gov/pubmed/24799310

It took me around 30 seconds to find, and I won't pretend like I read the article past the abstract, but I'm not exactly surprised. Even if only one in ten women prevent a pregnancy by being on the pill, it makes sense that this would save money to me.

Birth is expensive, child care is expensive, the medical expenses during childhood are expensive, food for a kid is expensive, productive time lost by raising a child is expensive, etc. Assuming many of these costs would end up covered by the state in poor families doesn't seem like a huge stretch to me.

I'm not all surprised that the American Journal of Obstetrics and Gynecology (who would be doing the tubal ligations) would put out an article that...wait for it....supports tubal ligations. Also your article has nothing to do with the issue at hand.

 

[DermViser]

I guess my main concern is about how the money is being used, and on the utility of it. Assuming a finite spending limit for healthcare, is the money for treating this disorder worth more than if it were spent on leukemia patients?

I know it's somewhat of a false dichotomy (increasing spending on one does not preclude increased spending on the other), but I guess it bothers me that this idea is totally ignored. At some level, we are making the decision of forgoing using that money on something else.

If it were better studied, and could show a clearer benefit, I would have less of a problem with it. Perhaps the money they're planning on throwing it would be better spent on generating a real clinical trial.

Exactly.

 

[dadaddadaBATMAN]

I'm not all surprised that the American Journal of Obstetrics and Gynecology (who would be doing the tubal ligations) would put out an article that...wait for it....supports tubal ligations. Also your article has nothing to do with the issue at hand.

You asked for peer reviewed research, specifically from pub med, describing cost savings from elective methods of contraception. It was relevant to another poster, who you claimed was full of it (they may still be). You're the op, and in my books you control where the conversation goes.

I agree that they have a financial stake in it, but I'm not sure that necessarily means it's all tainted. If a oncological society was promoting a procedure for cancer prevention as cost saving, I think I would still give it credence.

If in either case the results were not reproducible, then I would start to speculate about ulterior motives.

 

[DermViser]

You asked for peer reviewed research, specifically from pub med, describing cost savings from elective methods of contraception. It was relevant to another poster, who you claimed was full of it (they may still be). You're the op, and in my books you control where the conversation goes.

I agree that they have a financial stake in it, but I'm not sure that necessarily means it's all tainted. If a oncological society was promoting a procedure for cancer prevention as cost saving, I think I would still give it credence.

If in either case the results were not reproducible, then I would start to speculate about ulterior motives.

I asked for a peer-reviewed journal article in which it supports what he was claiming that "Covering BC lowers insurance costs almost 20%, because insurers aren't paying for as many pregnancies, births, and resulting children covered on their parents' plan."

 

[dadaddadaBATMAN]

I asked for a peer-reviewed journal article in which it supports what he was claiming that "Covering BC lowers insurance costs almost 20%, because insurers aren't paying for as many pregnancies, births, and resulting children covered on their parents' plan."

Gotchya, if you want a specific article to back a specific claim then my post was irrelevant.
Sorry for the distraction

 

[Wordead]

Duh, who said it was? But hormones and therapy alone don't help every patient. An individualized approach is needed for every patient, and surgery is one option which helps a lot of people.

I know you never back down from any position you take, so maybe it's just time to agree to disagree.

How do you know it helps a lot of people? I don't see anything in the literature about efficacy of gender reassignment surgery. If a treatment is unproven, how can you advocate society paying for it?

 

[mimelim]

Honestly, this is a relatively minor thing. The number of people and cost is minimal from a population standpoint. And insurance isn't about covering only things that are strictly absolutely necessary. I can see a strong medical argument for performing these surgeries from an improving the health and well being of an individual. I'm also not really understanding the differentiation between private and publicly supplied health insurance. Also, somehow bringing dialysis into this discussion is just plain ignorant.

On the other hand, food for thought... Viagra and Cialis are covered by most private insurance. Vacuum erection devices, vasectomies, circumcision and penile implants are covered by Medicare. Much higher numbers in terms of people affected.

And on my imaginary 3rd hand, none of this pales in comparison to my 5 patients on ECMO who cost our system 7k / day of whom only one has a chance of meaningful recovery and two of whom will live like this 'forever' until something terrible happens because they are wards of the state and we live in a pro-life state.

And that's why medicare covers dialysis right? Because it treats chronic renal failure oh wait

 

[Kaputt]

How do you know it helps a lot of people? I don't see anything in the literature about efficacy of gender reassignment surgery. If a treatment is unproven, how can you advocate society paying for it?

If you don't see anything, you haven't been looking hard enough. There is evidence, but it is modest and from very small studies.

Feel free to read the AMA's position on it, which includes many references. In their view, there is enough evidence out there for the benefit of treating gender dysphoria (with surgery as one option).

http://www.tgender.net/taw/ama_resolutions.pdf

 

[DermViser]

How do you know it helps a lot of people? I don't see anything in the literature about efficacy of gender reassignment surgery. If a treatment is unproven, how can you advocate society paying for it?

Bc it makes him feel all warm and fuzzy inside bc he thinks it solves the problem.