From AngryBrownButch:
An important victory was recently won in the struggle for trans rights, specifically around health care. Judge Sheldon Rand of the Manhattan Family Court found, for the second time, that the City of New York is obligated to pay for the sexual reassignment surgery of Mariah Lopez, a young trans woman of color who was denied this important and necessary medical care while in the care of the NYC foster system. The City is constitutionally required to provide adequate medical coverage for all children in its care, and SRS is a medically approved procedure, one that is often necessary for trans people. In the decision, Judge Rand wrote: “Mariah L. should be treated in order that she may go on with her life and be in a body which blends with the gender with which she identifies.”
Fortunately, Judge Rand was far more understanding and respectful than most of the media coverage, which has ranged from iffy to downright disgusting…
Please click through to read the ugly details, including a cut-and-paste email that you can send to the Post. And make sure to read the first post in the comments, as well.
Thanks for posting this, Amp. I hope that many of my fellow “Alas” readers send their own email to the Post, to demonstrate support for Mariah and to let the Post know that this kind of ignorant, disrespectful “journalism” is unacceptable.
I think the way the post portrayed the situation was crude and offensive. I agree with the poster on that. On a slightly related note I’m not sure I think the state should be paying for medical procedures that aren’t medically necessary.
I have no objection to the surgery in question. But since resources are limited shouldn’t state medical dollars be spent on non-elective surgery?
If you disagree can you explain why this surgery is medically necessary?
Joe,
If you want more information on how the judge arrived at his decision you can read the text of his decision as well as this amicus curiae brief that was prepared by two dozen different doctors, specialists, professional organizations, community organizations, etc. detailing why the health care procedures that this case concerns are deemed medically necessary for this patient, have a proven track record and a long history of research and practice behind them, etc.
On top of that, it should be up to doctors to define what is “medically necessary,” and an individual patient’s doctor at that, since individual health needs vary widely. State agencies, administrative bureaucrats, and politicians don’t have the expertise needed to decide whether something is medically necessary or not — would you want them overruling your doctor’s opinions about YOUR health?
Almost all doctors who work in the area of transgender care agree that these procedures are medically necessary for many trans people; the dissenters are a few extreme conservatives in the “we can cure people of being gay and trans” camp that’s mostly discredited, except in fundamentalist press releases.
Holly, Thanks for the pointers. I gave the amicus a quick read. The clinically significant distress was the medical ‘need’ i was looking for . I’ll admit that I’m not well informed on trans medical issues. I didn’t know if the operation was more like joint replacement or more like tattoo removal.
I’m going to pass on discussing the medical decisions issue since I think that would lead to a serious thread drift.
I have a BIG problem with the taxpayers having to pay for this procedure, just as I would have for taxpayer financed plastic surgery, or viagra, etc. When there are limited funds for health care, it is irresponsible to fund something as nonessential for life and health as this. Let the kid grow up, get a job, and pay for it him/herself.
NovatheCat,
I don’t consider it nonessential for life and health. Why do you?
Also, I imagine she’ll pay taxes, her money goes into it as well, as does mine when someone sees fit to hire me. Quality of life is as important as the physical aspects, she’ll most likely be a much more productive member of society this way. As for considering plastic surgery nonessential for life and health, there’s a broad range of what can be done, I’d imagine canceling all of it for insurance purposes would cause more physical health problems. Plastic surgery isn’t all about looks.
A gender/body discrepancy can make it very, very difficult to get a job at all, much less a well-paying one.
Aww, hell — just read the statements.
NovatheCat – as I wrote in my post, Mariah Lopez was in the NYC foster system when she was denied access to trans health care, including SRS. The foster system is required by law to provide adequate medical care to all children under its care. SRS is widely acknowledged and approved by the medical community as an appropriate and, yes, sometimes necessary treatment when someone is diagnosed with gender identity disorder. Therefore, she should never have been denied that surgery, plain and simple. This isn’t about changing any rules or making new allowances; it’s about forcing the City to adhere to the dictates of law universally and evenly, instead of picking and choosing who is worthy of care and who is not.
There is no reason why SRS should be separated out from other medically approved and necessary treatments, except that people deem it less necessary because they don’t take trans people’s health and well being seriously. Also, see what Holly wrote above.
Well, is it even ethical to perform such a drastic irreversible procedure on a minor? I’m surprised that any surgeon agreed to do it. With adults they usually require the patient to live as the other gender for years before going under the knife. And regardless whether or not NYC foster care is is required to pay for it, on principle I do not want my tax dollars going to these treatments. I don’t think trans people’s health and well being are less important than others, I question the ethics and allocation of scarce resources to something that is not life or death or physical health. Do we next finance a flat-chested teenager’s breast implants? In my area a kid died from an infection from a tooth abscess because Medicare does not adequately pay for dentists. Should funds be taken from dental health and given to sex change? Unfortunately, with govt funds it is a zero-sum game. Spend $100,000 for SRS then that money is not there for someone with a life threatening physical problem. SRS is optional elective surgery. No one will die without it, and we all have to learn that we cannot have everything we want when we want it, and NOT on the taxpayers’ dime.
Hm. Life/death or physical health. Would you believe me if I said that surgery can mean the difference in life/death and physical health? Certainly between life and death, there’s enough news coverage of that floating around the world wide web. But I think physical health might be harder to prove in some instances, and I’m unsure as to how to go about it. On the one hand, you can’t seperate physical and mental health, not completely. They affect each other and a problem with one invariably seeps to create a problem with the other.
I think that if only medical coverage for physical problems was accepted, there would probably be a significant rise for the population of the physical problems expressed. And I probably put that badly, but I’m not sure how to reword it. I did consider for awhile, that if I were in charge of the u.s.’s medical system, using the policies in the u.s., that only physical maladies were to be covered by insurance. But then I decided that was exceedingly cruel, because in regard to my own life, feeling down mentally is usually worse than when I’m down physically. And while that’s true for me up to date, I’ve no idea if it’s true for someone else.
Conditions such as schizophrenia, which I think is still classified as a mental condition, wouldn’t be treated if only physical maladies were accepted. And to pick and choose which ones are ‘alright’ and which are not, especially when a person can’t go through all of them in their life, well, there’s a word for it but it escapes me.
As for monetary concerns, I’m a realist. There isn’t enough people wanting to get srs when compared to the rest of the population that taking out an extra penny for every few dollars made by every person would break someone else. People lose that much change in their couch cushions or to the vacuum cleaner, to deny the same donation for a trans woman’s healthcare is beyond the pale.
A thing I’d forgotten to ask in my previous post.
NovatheCat,
Spend $100,000 for SRS then that money is not there for someone with a life threatening physical problem.
Where did you get that figure? A hundred thousand dollars for srs alone? The only remotely concievable way it would be that high is if it were for a particular ftm genital surgery, and the great majority don’t like the possible health complications associated with it so choose something else, if anything is chosen at all.
$100,000 is a figure I keep seeing bandied around and wondering who invented it. It’s a propaganda number that doesn’t actually seem to have anything to do with the usual surgeons and what they charge. I can see that, perhaps, if the gov’t or some insurance company was funding surgery for someone and required them to use a particular hospital not accustomed to the procedure, they may have made a mistake about what price to charge… ? That’s the only conceivable explanation I can think of, other than the confusion with the FTM surgery, which is much less reliable and more expensive.
It’s true that there are a lot more individual steps involved in going from male to female anatomy than vice versa. Therefore, while the cost of MTF genital surgery ranges from 7,000 to 24,000 according to answers.com (and I have heard individual reports from the low end of this price range) there are also other surgeries that may be necessary.
It’s also true that masculinization takes place over time, due to the effects of hormones, and some of these individual surgeries and procedures may not be necessary if the transgendered woman begins treatment early in life, and probably will if she waits. Therefore, the amount of money spent for this particular young woman’s surgery is in all likelihood MUCH lower than the cost of making her wait without proper care.
There isn’t enough people wanting to get srs when compared to the rest of the population that taking out an extra penny for every few dollars made by every person would break someone else.
This is true of practically everything that modest numbers of people want. Yet, the total sum of what just-a-few-folks-want is surely quite enormous. No one thing is going to break the bank; the summation of all the “just one things” will.
Robert: So, are rare diseases out?
If the experience of other wealthy nations is anything to judge by, it’s quite possible to have single-payer health care for all without breaking the bank.
Of course, you do need some means of rationing, if only so that we don’t end up financing surgical addicts for 50 needless surgeries. But it’s quite easy to imagine some means of rationing that would include S.R.S. in the “paid for” column.
But it’s quite easy to imagine some means of rationing that would include S.R.S. in the “paid for” column.
I’m going to finish this sentence: … Sucb as the advice of a board of doctors.
Can I just say that it’s hard to take arguments seriously when they’re so divorced from any kind of reality — as in, not bothering to do the research, read what doctors have to say on the subject, even check Wikipedia? The bogus “$100,000” figure and ideas like “adults have to spend years living as the other gender before surgery” (hasn’t been true since what… 1975?!?) are the kind of false data you see getting trotted out to try and argue against equal health care coverage for trans people. We ought to be resisting any kind of “zero sum equation” when it comes to people’s lives and well-being; it’s not acceptable to throw away any citizen’s health. The problem is, people simply don’t believe trans people or doctors specializing in trans health care when they say yes, this is a condition, yes, it can be life or death, no, it’s not just “mental illness” treatable through therapy, etc. And that disbelief is because of prejudice, no matter how you pretty it up and rationalize it.
Heck, cost/benefit analyses have been done that relate to the ongoing cost of having a trans patient who hasn’t received the proper care and keeps on having all sorts of other problems (depression, dysphoria, physical pain, inability to function, risk to life and limb due to prejudice) as a result, and it costs more to not treat trans people who need trans-specific medical care. Especially because we’re talking about a TENTH of the ridiculous figures mentioned above.
Amp said everything else.
Government funds are indeed a zero-sum game, but I’ve got some better ideas of where to start cutting than the couple of tens of thousands of dollars (at most) this surgery cost. I’m on the receiving end of Medicare sucking ass right now, so trust me, I feel for that kid with the dental infection. But Medicare isn’t underfunded and cutting programs because of SRS costs, it’s underfunded by someone having cut taxes during a time of monumentally stupid war.
DINGDINGDINGDING!!
We have a winner!