Should Your Taxes Pay for the Sex-Reassignment Surgery of Uninsured Trans People? REVISITED!

The health of trans people is still a thing we should all care about.

Nov 19, 2012 at 2:00pm | Leave a comment

The last time I was talking about public funding for sex-reassignment surgeries, the subject was Michelle Kosilek, the Massachusetts prisoner currently serving a life sentence. Kosilek had spent 10 years fighting for sex-reassignment surgery -- which, as a prisoner, would necessarily be paid for with taxpayer funds, as all prisoner health care is -- and a judge ruled in her favor back in September, although the state is currently appealing that decision.  

That topic sparked a heated discussion of how much comfort and well-being, exactly, a convicted murderer is entitled to -- a worthy question for sure, but one that ignores the fact that Kosilek’s fate is not hers alone, and that the decisions made in regards to her treatment will likely affect the treatment of all trans prisoners in the state, regardless of their crimes. The argument against providing the surgery (a stand recently taken by former congressperson Barney Frank, and earlier by former senator Scott Brown and incoming senator Elizabeth Warren) has been simply that it is not “a good use of taxpayer dollars.”

Which, hey, depending on your perspective, may be how you see it! But is it a better use of taxpayer dollars to spend ten years fighting the request? Because, as ThinkProgress has pointed out, the state has already spent twice as much as the surgery itself would have cost, a number that will only continue to increase as the appeals process continues at the usual snail-like pace.

My suspicions -- and call me crazy on this one -- are that the actual taxpayer dollars are not what have so many people in so many place3s up in arms about the Kosilek case; it is, rather, the idea that they might be contributing to a surgery they find offensive and abhorrent, as the ferocity of the anger about this procedure is a little different than if a prisoner simply had some form of cancer requiring expensive treatment. Which they would get, because prisoners get free, taxpayer-funded health care.

This disgusted resistance becomes clear in articles like this one from the Boston Herald, which pointedly uses male pronouns to refer to Kosilek, while an Associated Press article on the same subject IN THE SAME PAPER does not. Food for thought, that. Bias much?

The Kosilek question has been a difficult one primarily because of Kosilek’s crime -- the crime for which she was imprisoned. In 1990, as Robert, Kosilek killed her wife Cheryl by strangling her with wire and apparently very nearly severing her head completely in the process. Her crime is horrific, unthinkable, unforgiveable, and sadistic, and it being a domestic murder makes it all the more terrible. Kosilek is not a person you want to root for. However, she is still a person, and a person with doctors who have firmly recommended a particular surgery, which is why the court has ruled the way it did. 

But now we have a new example in the realm of public funding for these procedures, fortunately one that isn't about helping a single heinous murderer: San Francisco has recently voted to become to the first city in the US to include sex-reassignment surgeries among those covered under the city’s universal health care plan, which is, of course, tax-funded. Prior to this, the plan provided hormone therapy and other health services to trans residents without health insurance, but specifically excluded sex-reassignment surgery.

…[Public Health Director Barbara] Garcia described the move as "a symbolic process" for now because the city currently does not have the expertise, capacity or protocols in place to provide the surgeries through its clinics and public hospital. "The community felt the exclusion on Healthy San Francisco was discriminatory and we wanted to change that as the first step," she said.

If all goes as planned, the program should be up and running by late next year. Of course, there are many who are not so excited about the expanded offering, many who continue to argue that these surgeries are a waste of taxpayer dollars

{Thomas Moyer, conservative author and San Francisco resident] said people should pay for their own sex changes, and public money would be better spent elsewhere. This surgery is not an essential health function, especially when it would be taking money away from those suffering from chronic illnesses like cancer, Aids [sic], and heart disease,” Moyer said.

Part of the debate stems from the fact that San Francisco has been slashing expenses to lower a $7 billion budget, such that instituting a program to offer these services might not seem like a significant priority to many in the Bay Area right now. 

Also, there remains the issue of whether sex-reassignment surgery IS, in fact, an “essential health function” and not simply a cosmetic change -- many experts, as well as individual trans people, believe that it is as necessary to the health of some trans people as heart surgery would be to someone with a blocked artery. Trans individuals who require sex reassignment surgery usually suffer from severe depression; male-to-female people may attempt to self-castrate, and suicide attempts are common (Michelle Kosilek has attempted both of these events a total of three times). And while the surgery can be pricey, you know what also costs money? Treating a person who has attempted to remove her genitalia using ordinary objects found around the house (or prison). Also treating a person who has attempted to kill herself. Also: THERAPY.

As a cisgender woman myself, it is impossible for me to understand the body and gender dysphoria trans people feel, but I can trust trans people and their doctors with their own private health decisions, and I can just believe that they are together making the best choices for their health. They don't need to justify it to me, nor do they require my validation, any more than I would be entitled to give my opinion on a stranger's choice of cancer treatment, simply because some of my taxes may be going to help fund it.

Of course, I expect the real reason so many people are outraged by this possibility of their taxes going to help pay for these surgeries is rooted in a particular morality, one which finds trans people to be despicable. If we start funding this now, their logic goes, soon those icky trans people will be EVERYWHERE. It’s just enabling them! To be immoral! According to the scary predictions of one writer at the National Review:

Eventually with Obamacare, we will see the same thing happen on a national basis–a Free Sex Change Rule, if you will. Here’s why: Centralized health care is politicized health care. Thus, the Free Birth Control Rule was promulgated to reward an important Obama political constituency and help serve as a foundation for the planned reelection “War on Women” lie...
...California is a major artery of US politics, and California politics are controlled by San Francisco, even over areas such as LA with much higher populations. This isn’t by accident. I live in the Bay Area, and believe me, the people here are cultural hegemonists, profoundly intolerant of those who hew to more traditional values, and intent on fundamentally transforming the values of the entire country.
[...] In other words, “San Francisco values” often become “America’s values.” ...Unless Obamacare is fundamentally transformed and decentralized–still possible, I think–that will eventually include public funding of sex change surgeries.

FREE SEX CHANGES FOR EVERYBODY WITH NO RESTRICTIONS is the direction we’re heading! The whole suggestion is absurd, not least because there IS no “Free Birth Control Rule,” but also because sex-reassignment surgery is not the right choice for every trans person. Some trans people are their healthiest and most content without surgery; others require the surgery to thrive. Even if public funding for sex-reassignment surgery became a thing, it would hardly result in every trans person alive suddenly lining up to cash in.

More than that, though, the argument that this will open a political door to all kinds of healthcare anarchy, which is repeated among other conservative reactions, seems to imply that thanks to Obamacare, anybody will be able to get any procedure they want, anytime, no questions asked. for free. Like we could all walk into our nearest hospital to demand and receive some free chemotherapy, just for funsies. Even if we don’t actually have cancer. Or have a kidney removed. Just because we felt like it. All on the taxpayer dime.

WHY WOULD ANYBODY DO THAT? Surprise, surgery sucks. It is often an unpleasant (if not miserable) but worthwhile and necessary means to an end; however, it is not a shiny new toaster

Truth be told, I have no problem with the idea of tax-funded sex-reassignment surgeries for those who need them. Just like I have no problem with tax-funded contraception or tax-funded abortions or tax-funded healthcare even for people I don’t like very much, like that guy at the National Review. I am okay with my taxes hypothetically paying for his healthcare, even healthcare that keeps him alive, in spite of the fact that he offends me morally! Why? Because I’m a better person than he is. No. I don’t know why. I don’t know why we have developed this ideology that some people are more worthy of better and more thorough healthcare than others. Do you?