Minnesota faces lawsuit over transgender surgery policy

[K_Z]

The high suicide rate -- is that linked solely to body image, or is it more likely to be linked to transphobic behavior and attitudes from society at large?

I have really mixed feelings about this. I have a disfiguring, debillitating disease that has no cure and precious few treatments. One of the most successful treatments is a special type of surgery, which is offered in Germany (and a few other European countries) for women who have the earliest stages of this disease, which means that they will likely NEVER progress to the later disabling stages. Meanwhile, in the United States, insurance sees the surgery as cosmetic-only, and they flatly refuse to cover it in most cases. Needless to say, many women with this condition struggle with deep depression and anxiety.

Basically, I feel a little sour-grapes-y at the idea that someone can have a so-called elective surgery on the taxpayers' dime while I can't get the surgery I need to live an active, healthy life using my paid insurance. But at the same time, I feel like none of us should have to fight so hard to get treatments that are needed. It all comes down to defining need, though, and clearly, the insurance companies don't think I "need" my surgery. And that's not fair. Nor is it fair for insurance companies (or the government) to define need for transgendered people. These things really should be between a doctor and patient. The biggest problem with that is weeding out the unethical doctors.

BBM for focus.

The National Transgender Discrimination Survey, the largest study of transgender people’s experiences, found that 41 percent of transgender and gender non-conforming people have attempted suicide, a rate far higher than the national average of 4.6 percent. Now, an in-depth study of that result reveals how various aspects of anti-trans discrimination and stigma might be contributing to that high rate.

Here’s a look at some of the study’s results about what stressors may be putting transgender people at greater risk for suicide attempts:

Racial Stigma: Transgender people of color were more likely to have attempted suicide, particularly those who identified as multiracial (54 percent) or American Indian or Alaska Native (56 percent). White respondents reported the lowest rates (38 percent).

Poverty: The more financially stable respondents were, the less likely they were to attempt suicide. For those with an annual income less than $10,000, the suicide rate attempt was the highest (54 percent), with those making up to $20,000 close behind (53 percent). For those making over $100,000, the suicide attempt rate was half that (26 percent).

Unemployment: Inability to secure a job was also a significant factor. Transgender individuals who were unemployed but still trying to find work had the highest suicide attempt rates (50 percent), while those with jobs had a much lower rate (37 percent).

Education: Trans individuals who had more education were less likely to have attempted suicide, particularly those who completed college degrees. Those with a graduate degree reported a suicide attempt rate of 31 percent and those with a bachelor’s degree reported a rate of 33 percent. For those who had only graduated high school, the rate was 49 percent.

Outness: Suicide attempt rates were lowest among trans people who felt others could not perceive their identity (36 percent) and who didn’t tell others that they were trans (33 percent). Being totally out as trans (50 percent) or feeling like people perceived them as trans most of the time (45 percent) contributed to higher rates of suicide attempts.

Homelessness: Being denied housing for being transgender had a big impact on the likelihood of a suicide attempt. Those who experienced this kind of discrimination but found another place to live had a fairly high attempt rate (54 percent), but those who wound up homeless had an even higher rate (69 percent).

Bullying and Violence: Consistently across educational experiences (elementary school through college), harassment of various kinds contributed to higher suicide attempt rates. Individuals who reported having been physically assaulted or sexually assaulted reported extremely high rates, including 78 percent of individuals who were sexually assaulted while in college.

Family Rejection: The suicide attempt rates among those whose families supported them after coming out as trans was 33 percent, while those who experienced rejection from friends or family faced higher rates. For example, among those whose parents or other family members stopped speaking with them, the attempt rate was 57 percent.

Health Care Discrimination: Suicide attempt rates were higher among those who had a doctor that refused to treat them because of their gender identity (60 percent).

It’s important to note that nothing about being transgender or gender non-conforming causes suicidal thinking, nor do any of the above stigmatizing experiences. Still, the research suggests that anti-transgender rejection, discrimination, victimization, and violence are considerable risk factors, particularly when serious mental health conditions may already be present.

http://thinkprogress.org/lgbt/2014/01/28/3214581/transgender-suicide-attempts/

To be fair, I want to re-iterate that I do not oppose surgery for transgendered individuals. My issue is that I strongly believe it should not be paid for by Medicaid. This isn’t a debate on whether or not the surgeries transgendered people want “are” or “could be” beneficial. Sure they “can be” beneficial. The bigger issue is that transgendered people have a uniquely complex constellation of issues, of which things like cosmetic breast removal are only one small piece. It’s not like if you do a surgery, like breast removal, their multifaceted situation is “fixed”.

In this kind of case, the surgeons creed “to cut is to cure” is not relevant. Surgery doesn’t “fix” the emotional, social, and psychological problems they face, nor does it remove the social stigma. It “may” make them more emotionally and psychologically content, but not always.

The reasons that the suicide rate is so high among transgendered people are multifaceted—it’s not just because they have, or don’t have, the surgeries to change their outside appearance. Transgender people have a huge raft of difficulties under the best of circumstances. And in some cases, the surgeries may add to that raft of difficulties.

Here's a 2011 study done in Sweden. It's a good study, but has one glaring hole-- the population of surgical transgendered patients were compared to the general normal population in Sweden-- not compared to the non-surgical transgender population. Hopefully someone else will do that kind of study.

Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden

Results

The overall mortality for sex-reassigned persons was higher during follow-up (aHR 2.8; 95% CI 1.8–4.3) than for controls of the same birth sex, particularly death from suicide (aHR 19.1; 95% CI 5.8–62.9). Sex-reassigned persons also had an increased risk for suicide attempts (aHR 4.9; 95% CI 2.9–8.5) and psychiatric inpatient care (aHR 2.8; 95% CI 2.0–3.9). Comparisons with controls matched on reassigned sex yielded similar results. Female-to-males, but not male-to-females, had a higher risk for criminal convictions than their respective birth sex controls.

Conclusions

Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group.

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0016885

 

[K_Z]

I’d like to address the comment above about a single payer system. Some believe that single payer will somehow improve access to elective surgical procedures, but absolutely nothing could be further from the truth.

A single payer system IN THIS COUNTRY will only progressively REDUCE access to all services, and REDUCE access to all elective procedures (including things like tubal ligations, hip replacements, joint surgeries, carpal tunnel releases, colonoscopies, etc.) This is exactly where we are now with the ACA/ Obamacare. Premiums are going up, access is reduced, costs are increasing, and services are being geographically restricted.

Payer-mix is the life blood of any health care practice, whether it’s a small clinic, or a large health system. (Payer mix refers to how many patients are private pay, how many are private insurance, how many are Medicaid, how many are medicare, etc.) Medicare/ medicaid, for example reimburses about $16 per unit of care, versus $45+ per unit for private insurance.

A single payer system in this country will decimate the medical system we have in under 10 years, IMO. This is an entire separate discussion in and of itself—but my point is that a single payer system will NEVER increase access to elective surgery. Never. Single payer systems always seek to limit and restrict access to elective surgical procedures, particularly non-medically necessary cosmetic elective procedures. (Rationing of care.) Evan Thomas would have substantially more difficulty getting elective surgery approved under a single payer system, not less. IMO.

That said, I'd also like to touch on the phrase "medically necessary", versus “cosmetic/ elective” terminology.

I do see these procedures (and there are literally dozens of procedures that fit into the transition surgery category) as elective cosmetic procedures. Cosmetic enhancement procedures that are conducted ELECTIVELY for the sole purpose of emotional and psychological satisfaction, as opposed to disease, injury, or malfunction of the body organ or part.

I don’t see any of these procedures as “medically necessary”, because the parts in question function just fine, and are disease and damage –free, at the time of decision for the surgery. That is what puts these procedures, IMO, into the “cosmetic elective” category. Psycho/ emotional "distress" (or desire) just isn't enough, IMO, to deem any elective cosmetic procedure as "medically necessary."

These procedures should be IMO, "cash on the barrelhead"-- fee for service, procedures. Just like all manner of elective cosmetic enhancements (face lifts, breast enlargement, etc.)

 

[K_Z]

And why are people so preoccupied with what others may get on welfare?

IMO, when someone is on the public dole, with their hand out for all sorts of social and financial help from tax payers, then YES, I do believe WE as a society DO have both the RIGHT and the RESPONSIBILITY to limit and control what those individuals receive—particularly individuals who are capable of providing for themselves, and lack the desire or motivation to do so. I think a whole host of restrictions and compliance parameters should be placed and monitored on those who take social welfare. I believe that putting limits and compliance parameters on those individuals is a societal moral and ethical responsibility, to be a good steward of scarce public resources. We should respect the tax dollars and the efforts of those who WORK and contribute to the upkeep of those who receive benefits. IMO.

Those on social welfare always have the option NOT to take benefits (benefits, not “rights&#8221.

There are MANY cosmetic AND elective procedures that enhance health, enhance emotional and psychological well-being. A hip replacement, for example, is done electively on a deteriorated (or diseased or damaged) joint for the purpose of improving chronic pain, and preserving mobility. A breast removed for cancer can be reconstructed, as well as someone with naturally small breasts who can be augmented to the cup size and shape of their choice. The issue is where do we, the tax payers, draw the line for what is described as “necessary”, versus what is "beneficial", versus something that is just a “want”.

If you read the 26 page complaint, Evan Thomas describes the inconvenience of breast binding activities that he chooses to perform, and an occasional bothersome yeasty rash under the breasts from doing so. (ET is also significantly overweight, from pictures, which definitely contributes to his issue with breast rashes and discomfort with binding.) For that minor level of “dysfunction”, in addition to his emotional and psychological response to his breasts, he wants a $6000- $10,000 “free” elective cosmetic procedure to remove his breasts. (And IMO, he will very likely next want “bottom” surgery, too.) So, let’s think about the entire population of obese women with large breasts on Medicaid, who get sweaty rashes under their breasts. Should we pay for breast reduction surgery for all of them that might want it? Why should ET or any transgendered person receive MORE elective cosmetic services than the general population of Medicaid recipients?

He can have his surgery. He just needs, IMO, to pursue other options besides Medicaid to fund the surgery he wants.

 

[LaborDayRN]

The high suicide rate -- is that linked solely to body image, or is it more likely to be linked to transphobic behavior and attitudes from society at large?

I have really mixed feelings about this. I have a disfiguring, debillitating disease that has no cure and precious few treatments. One of the most successful treatments is a special type of surgery, which is offered in Germany (and a few other European countries) for women who have the earliest stages of this disease, which means that they will likely NEVER progress to the later disabling stages. Meanwhile, in the United States, insurance sees the surgery as cosmetic-only, and they flatly refuse to cover it in most cases. Needless to say, many women with this condition struggle with deep depression and anxiety.

Basically, I feel a little sour-grapes-y at the idea that someone can have a so-called elective surgery on the taxpayers' dime while I can't get the surgery I need to live an active, healthy life using my paid insurance. But at the same time, I feel like none of us should have to fight so hard to get treatments that are needed. It all comes down to defining need, though, and clearly, the insurance companies don't think I "need" my surgery. And that's not fair. Nor is it fair for insurance companies (or the government) to define need for transgendered people. These things really should be between a doctor and patient. The biggest problem with that is weeding out the unethical doctors.

If you read the study I posted, it breaks it down into many sub groups statistically. But, the high suicide rates are not only related to surgery, it's just one of the issues covered.

I'm sorry to hear you are unable to get the surgery you need.

 

[LaborDayRN]

BBM for focus.



http://thinkprogress.org/lgbt/2014/01/28/3214581/transgender-suicide-attempts/

To be fair, I want to re-iterate that I do not oppose surgery for transgendered individuals. My issue is that I strongly believe it should not be paid for by Medicaid. This isn’t a debate on whether or not the surgeries transgendered people want “are” or “could be” beneficial. Sure they “can be” beneficial. The bigger issue is that transgendered people have a uniquely complex constellation of issues, of which things like cosmetic breast removal are only one small piece. It’s not like if you do a surgery, like breast removal, their multifaceted situation is “fixed”.

I understood from your previous posts that you don't think Medicaid should cover surgery for transgender people. I also realize it isn't a debate as to whether surgery is beneficial to transgender people. (Actually, I was hoping for a discussion rather than a debate I hope I didn't come off that way) I certainly never thought, nor implied that surgery is a "fix" to "their multifaceted situation". I was only sharing my opinion on the importance of considering surgery as part of treatment for people in need. My opinion is that the issue of surgery is far more than a cosmetic one.

In this kind of case, the surgeons creed “to cut is to cure” is not relevant. Surgery doesn’t “fix” the emotional, social, and psychological problems they face, nor does it remove the social stigma. It “may” make them more emotionally and psychologically content, but not always.

The reasons that the suicide rate is so high among transgendered people are multifaceted—it’s not just because they have, or don’t have, the surgeries to change their outside appearance. Transgender people have a huge raft of difficulties under the best of circumstances. And in some cases, the surgeries may add to that raft of difficulties.

I agree that transgendered people face a many challenges. The information I posted was broken down into suicide rates based on MANY factors, not just surgery.

Here's a 2011 study done in Sweden. It's a good study, but has one glaring hole-- the population of surgical transgendered patients were compared to the general normal population in Sweden-- not compared to the non-surgical transgender population. Hopefully someone else will do that kind of study.

Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden



http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0016885

Thank you for posting this study. I always enjoy sharing ideas with others.

 

[Margo/Mom]

Yep. The harder and longer you work, the more benefits you should get, not the other way around.

Ummmm, why?

The reason it makes sense to provide various benefits to some is because we recognize that some folks--for various needs they are unable to fulfill through the fruits of their own labors.

 

[Margo/Mom]

IMO, when someone is on the public dole, with their hand out for all sorts of social and financial help from tax payers, then YES, I do believe WE as a society DO have both the RIGHT and the RESPONSIBILITY to limit and control what those individuals receive—particularly individuals who are capable of providing for themselves, and lack the desire or motivation to do so. I think a whole host of restrictions and compliance parameters should be placed and monitored on those who take social welfare. I believe that putting limits and compliance parameters on those individuals is a societal moral and ethical responsibility, to be a good steward of scarce public resources. We should respect the tax dollars and the efforts of those who WORK and contribute to the upkeep of those who receive benefits. IMO.

Those on social welfare always have the option NOT to take benefits (benefits, not “rights&#8221.

There are MANY cosmetic AND elective procedures that enhance health, enhance emotional and psychological well-being. A hip replacement, for example, is done electively on a deteriorated (or diseased or damaged) joint for the purpose of improving chronic pain, and preserving mobility. A breast removed for cancer can be reconstructed, as well as someone with naturally small breasts who can be augmented to the cup size and shape of their choice. The issue is where do we, the tax payers, draw the line for what is described as “necessary”, versus what is "beneficial", versus something that is just a “want”.

If you read the 26 page complaint, Evan Thomas describes the inconvenience of breast binding activities that he chooses to perform, and an occasional bothersome yeasty rash under the breasts from doing so. (ET is also significantly overweight, from pictures, which definitely contributes to his issue with breast rashes and discomfort with binding.) For that minor level of “dysfunction”, in addition to his emotional and psychological response to his breasts, he wants a $6000- $10,000 “free” elective cosmetic procedure to remove his breasts. (And IMO, he will very likely next want “bottom” surgery, too.) So, let’s think about the entire population of obese women with large breasts on Medicaid, who get sweaty rashes under their breasts. Should we pay for breast reduction surgery for all of them that might want it? Why should ET or any transgendered person receive MORE elective cosmetic services than the general population of Medicaid recipients?

He can have his surgery. He just needs, IMO, to pursue other options besides Medicaid to fund the surgery he wants.

As someone who actually knows a number of people on the middle part of the gender spectrum I take issue with your determination that reassignment is merely a cosmetic and therefore purely elective procedure. For one thing, it is among the recommended treatments, as I understand it, contained within the DSM. What may be elective is the specific means appropriate to each person in carrying out re-assignment. Some may elect to alter only their mode of dress, others utilize hormones and still others choose from a menu of available surgeries.

But, there are a plethora of issues that tend to drive the individual decision-making. Many trans persons find themselves to be unemployable, or only marginally employable in their identified gender without physical alteration. Very few workplaces are willing to take on someone that they perceive to be "a man in a dress." Going to the bathroom anywhere but home may be dangerous for such people (regardless which on they choose). Simply walking down the street may be dangerous--as some neanderthals seem to think this very act is an invitation to a brawl. As a result, some may feel that they must suppress their gender identity and live a dual lifestyle just to go to school or have a job. I know someone in a very lowly retail position who faces daily taunts from the uneducated public who are uncomfortable with gender ambiguity.

As an analogy, some plastic surgery, such as breast reduction, repair of facial anomalies, even extensive dental work are sometimes a necessary pre-requisite for employment. A hip replacement may well make the difference between qualifying for disability (also a public benefit) and being employable.

 

[Tawny]

I'm ok with my tax dollars going toward gender reassignment surgery. People seem to believe that trans* individuals just wake up one day and decide it's super trendy to just switch genders and there's no thought to it. These same people seem to deny the very real issue of violence toward trans* individuals.

If it keeps another person alive and feeling secure in themselves, I'm ok with my tax dollars going there.

Comparing it to cosmetic elective surgery is willfully obtuse. moo

 

[human]

I live in a foreign country with "gasp" universal health care!

People do not have to worry about losing everything they own if they become ill. What a weird concept ,huh!

They do have transgender surgery here.

Someday I hope at this time of the year we will learn to be more kind to others who have less or other issues. There but by the Grace of God go I.

We are lucky. Anything can befall anyone at anytime.

 

[SophieRose]

http://www.nytimes.com/2015/10/22/u...eassignment-surgery-policy-for-prisoners.html

California has become the first state with a policy of providing sex reassignment surgery for some prison inmates, adopting a set of specific guidelines on what services it will provide to transgender prisoners, state officials and advocates for transgender people said.

 

[bluesneakers]

http://www.nytimes.com/2015/10/22/u...eassignment-surgery-policy-for-prisoners.html

California has become the first state with a policy of providing sex reassignment surgery for some prison inmates, adopting a set of specific guidelines on what services it will provide to transgender prisoners, state officials and advocates for transgender people said.

Wow.

“This is care that, for too long, people have been denied simply because of who they are. It’s especially important because transgender people are incarcerated at six times the rate of the general population.”

Good for California.

 

[1&2&3]

I am totally against Medicare/Medicaid paying for transgender reassignment surgeries! This is not a one time surgery, but consists of various operations in redesigning the body to one's desire. There is also all the mental health appointments needed with therapists throughout and after the procedure, not to mention the various drugs a person must take in preparing and maintaining this new "designer body".

The government programs will need to do much changing to allow the seniors and disabled on their programs to have dental service, at least trying to save the teeth in their mouth, glasses, hearing aids, and monthly medicine as prescribed by their doctors, surgeries that are needed but the patient doesn't have money for co-pay or help at home for after surgery. This list is endless as to what our people suffer from.

I do have a difficult time including the unemployed who use this method of living as a free pass! The unemployed who are jobless because of no fault of their own are another story. The illegals burn me up! The girls who have baby after baby to get more money...enough said!

People using Medicare/Medicaid have to have approval for any surgery. It makes total sense that this elective expensive surgery is not included.

 

[K_Z]

http://www.nytimes.com/2015/10/22/u...eassignment-surgery-policy-for-prisoners.html

California has become the first state with a policy of providing sex reassignment surgery for some prison inmates, adopting a set of specific guidelines on what services it will provide to transgender prisoners, state officials and advocates for transgender people said.

Fiscally shocking, IMO-- financially very irresponsible, given the state of California's finances. But then, it's California.

Strangely hypocritical that the state of California Bureau of Prisons will pay to REMOVE unwanted breasts for FTMs, but will not augment or enlarge, according to the article. Because they have determined that the latter is purely cosmetic. I guess small breasted inmates, or MTF transgender inmates, will have to augment with TP or something.

I wonder if all large breasted female inmates who have 2 years left on their sentences can request breast reduction? Or only FTM transgender inmates?

Under the new policy, the state will cover mastectomies as well as operations to remove and reconstruct reproductive organs. But it will not cover services the state considers cosmetic, including breast implants or procedures or drugs for hair removal or hair growth.

Out of 125,000 inmates in the California system, 400 are being treated for gender dysphoria, the condition of not identifying as the sex indicated by bodily organs, Ms. Hayhoe said. She said that gender reassignment operations and related care for one inmate could cost $50,000 to $100,000, compared with $500 to $3,000 a year for hormone therapy alone.

http://www.nytimes.com/2015/10/22/u...gnment-surgery-policy-for-prisoners.html?_r=0

Seems to me all Evan Thomas needs to do is move to a state, like California, that covers this surgery under medicaid-- establish residency, sign up for all the welfare services, and get it done. Would be a lot faster and "easier" than parading this lawsuit thru the system. But then, I think that's the whole point-- with OutFront and ACLU footing the bills. He could even move back to MN after he qualified for welfare and medicaid, and had California pay for the surgery.

Or, he could take his PhD and get a job and pay for the surgery himself.

Or, he could WAIT about 24 months, and petition medicare to pay for it. He's 63, and at 65 will be on medicare. Medicare is not prohibited from paying for it, as of May 2014.

https://www.washingtonpost.com/nati...bcd122-e818-11e3-a86b-362fd5443d19_story.html

http://www.hhs.gov/dab/decisions/dabdecisions/dab2576.pdf

I will never be able or willing to see sex reassignment surgeries as any kind of "need". They are firmly in the "want", purely elective category for me. Fine if you can pay for them, otherwise, should not be covered by taxpayers.

And for whomever asked, yes, I do know transgendered individuals-- several of them, fairly well. One had tremendous and life threatening complications from sex reassignment surgery, and still has problems many years later. Another helped us for a short time with childcare for one of our kids. We've rented one of our properties to a transgender person for many years. I've also cared for several with post-surgical complications, who needed additional surgeries to fix various problems. One patient I think I took to the OR about 6 different times over a couple of years. I'm not heartless, or ignorant about the transgender condition or the process of transitioning-- I just think the surgeries are not medically necessary, and often lead to lots of other (expensive) problems. I don't think a psychological/ emotional condition (the depression, not the transgender identity) is enough justification to re-label unnecessary surgery as "necessary". The treatment for depression and anxiety is mental health treatment and pharmacology, not surgery. Cosmetic surgery is expensive, and a luxury-- not a necessity.

 

[al66pine]

In reading about proposed/new policies/legislation, I often think about possible implications down the line or further away on the horizon, others who may/will be affected, etc. Sometimes the law of unintended consequences follows.

Will some CA inmates requesting these surgical procedures be paroled earlier than they otherwise would, so St. DoC is not obligated to pay for these surgeries???
Per guidelines* summarized below, seeeeeeeems like that should not happen. But wording is "two years left to serve before parole is expected." Hmmm. "Expected" IDK.


______________________________________________________
"The policy, which took effect this week, grew out of a pair of successful lawsuits filed by inmates. In one, a federal court in April ordered the state to provide surgery to a prisoner, which transgender advocates hailed as a landmark victory, but the inmate was paroled while that ruling was on appeal, making the point moot."

* "A review committee of doctors and psychologists will decide whether to allow surgery, based on a prisoner’s physical and mental condition. And a request will be granted only if an inmate has more than two years left to serve before parole is expected; “has continuously manifested a desire to live and be accepted” with a particular sexual identity, including a desire for surgery, for two years; and has lived as a member of that sex, with hormone therapy, for a year."

From K_Z link^, October article: http://www.nytimes.com/2015/10/22/u...gnment-surgery-policy-for-prisoners.html?_r=0

 

[K_Z]

Yes, al66pine-- I think that stepping up the parole is definitely a possibility.

However, many, if not most, of the parolees will shift right onto some other publicly funded healthcare, so early parole would just be cost-shifting to a different pot of public money. (Assuming the parolee continues to seek surgery.)

 

[al66pine]

Yes, al66pine-- I think that stepping up the parole is definitely a possibility.
However, many, if not most, of the parolees will shift right onto some other publicly funded healthcare, so early parole would just be cost-shifting to a different pot of public money. (Assuming the parolee continues to seek surgery.)

Yes, ^ agreeing - shifting of med exp from CA DoC to another st. agency.

The diff being - some violent (& non-violent) offenders wd/be out on street earlier w new CA rules. Maybe/likely/probably/most? IDK.

 

[PeregrineFaulkner]

Yep, just quit work. Or divorce my husband. These rules really make you want to work and achieve something in life, don't they?

Yes, it does. Because I see how hard people struggle daily when living in poverty. It's hard, very hard. Being envious of those who are barely able to get by because they get a tiny amount of help is extremely bizarre in my opinion.

 

[PeregrineFaulkner]

Fiscally shocking, IMO-- financially very irresponsible, given the state of California's finances. But then, it's California.

Strangely hypocritical that the state of California Bureau of Prisons will pay to REMOVE unwanted breasts for FTMs, but will not augment or enlarge, according to the article. Because they have determined that the latter is purely cosmetic. I guess small breasted inmates, or MTF transgender inmates, will have to augment with TP or something.

I wonder if all large breasted female inmates who have 2 years left on their sentences can request breast reduction? Or only FTM transgender inmates?





http://www.nytimes.com/2015/10/22/u...gnment-surgery-policy-for-prisoners.html?_r=0

Seems to me all Evan Thomas needs to do is move to a state, like California, that covers this surgery under medicaid-- establish residency, sign up for all the welfare services, and get it done. Would be a lot faster and "easier" than parading this lawsuit thru the system. But then, I think that's the whole point-- with OutFront and ACLU footing the bills. He could even move back to MN after he qualified for welfare and medicaid, and had California pay for the surgery.

Or, he could take his PhD and get a job and pay for the surgery himself.

Or, he could WAIT about 24 months, and petition medicare to pay for it. He's 63, and at 65 will be on medicare. Medicare is not prohibited from paying for it, as of May 2014.

https://www.washingtonpost.com/nati...bcd122-e818-11e3-a86b-362fd5443d19_story.html

http://www.hhs.gov/dab/decisions/dabdecisions/dab2576.pdf

I will never be able or willing to see sex reassignment surgeries as any kind of "need". They are firmly in the "want", purely elective category for me. Fine if you can pay for them, otherwise, should not be covered by taxpayers.

And for whomever asked, yes, I do know transgendered individuals-- several of them, fairly well. One had tremendous and life threatening complications from sex reassignment surgery, and still has problems many years later. Another helped us for a short time with childcare for one of our kids. We've rented one of our properties to a transgender person for many years. I've also cared for several with post-surgical complications, who needed additional surgeries to fix various problems. One patient I think I took to the OR about 6 different times over a couple of years. I'm not heartless, or ignorant about the transgender condition or the process of transitioning-- I just think the surgeries are not medically necessary, and often lead to lots of other (expensive) problems. I don't think a psychological/ emotional condition (the depression, not the transgender identity) is enough justification to re-label unnecessary surgery as "necessary". The treatment for depression and anxiety is mental health treatment and pharmacology, not surgery. Cosmetic surgery is expensive, and a luxury-- not a necessity.

I'm sorry, but your info on California's finances may be out of date or something? We have had a budget surplus for a while now.

And what exactly are your medical qualifications for determining want versus need for gender dysphoria surgery? Are you a psychiatrist or expert in the field? Or is this just a lay opinion based on your feelings towards the medical condition, that full treatment is never necessary? What has lead you to differ from the experts in this field?

 

[human]

I would rather have my insurance payments go to pay the millions of dollars a year in CEo salaries or the beautiful buildings or the golf memberships and the other perks that the insurance industry personnel get. Who cares about providing for prople? Not me. I only care about me, me and more me.