June 2 2014
Patrice J. Lee
Our tax dollars go to pay for wacky, ridiculous, and frivolous things – just see Senator Tom Coburn’s annual Wastebook for examples. And there then are the expenditures that Americans not only disagree with but downright abhor.
The latest head-scratching use of taxpayer dollars is on gender reassignment surgeries.
Last week, President Obama lifted the ban on Medicare coverage of such procedures. Transgender advocates are cheering, but is this the right use of our public taxpayer dollars and what does it mean for the private insurance market?
Since 1981 the federal government has banned payment for transgender surgeries, which are meant to help people uncomfortable with their gender. Once considered experimental, such procedures are now commonplace but far from uncontroversial. After reviewing three decades of research, Health and Human Services decided last week that it’s time to add such surgeries to the list of services on the taxpayer dime.
The Washington Post reports:
Although Medicare coverage is only for people 65 and older, and the transgender population makes up only about 0.3 percent of the U.S. adult population, private insurance plans often take their cues from Medicare on what should be considered a medically necessary covered treatment. As a result, the ruling is likely to open up more options for transgender individuals.
But in some ways, the ruling was more important from a symbolic standpoint than a practical one. Medical professionals say very few people opt for surgical interventions. And the cost to insurers that offer coverage — which can be anywhere from $10,000 to $50,000 per surgery — is often negligible in relation to their entire patient pools, according to several studies.
The federal decision comes at a time of radical change in attitudes in transgender care across the country.
California, Colorado, Connecticut, Oregon and Vermont have affirmed the idea that transition care for transgender individuals should be considered an essential part of medical coverage. In February, D.C. Mayor Vincent C. Gray (D) said the city would recognize gender dysphoria as a medical condition — effectively forcing insurers to cover gender-reassignment surgery.
According to this report, this is not an open door for all Medicare recipients who want the surgery to get it. Apparently, they must justify need for the surgery as with any other medical treatment. It also doesn’t apply to Medicaid for low-income individuals and families, but we shouldn’t be surprised if a ruling isn’t far behind as well.
Gender reassignment is a controversial topic as are the treatments surrounding them. While liberal groups are cheering this ruling, some conservative groups oppose for varying reasons such as on moral grounds that it teaches children not to respect who they are or how they were born.
Gender reassignment is a deeply personal issue and we’re not going to take on. It also has implications affecting communities. We join those however, who are asking the larger question of whether the government –and by extension taxpayers – should be paying for such surgeries.
It’s one thing for Medicare to help an elderly person replace a broken hip, it’s another for us to pay for someone to change someone’s entire lifestyle. We have a right to ask why we should pay for something that could be considered elective surgery.
There are elective procedures that help people feel better in their skin, but they are not essential. If someone on Medicare wants plastic surgery to tighten her face that’s absolutely her business, but it should be paid for entirely by her.
Beyond the government, this ruling adds pressure to private insurers to also cover the surgery as medically necessary rather than elective. Sounds like another expensive surgery to drive up healthcare costs.