Miranda Lee, a 40-year-old MTF Brit, is part-way through her government-paid transition. So far she’s had £60,000 worth of procedures to become a woman, but still needs £8,000 for a breast augmentation. And it’s that last line item the National Health Service is refusing her, saying they don’t have the funds for “cosmetic” procedures. So she’s suing — and, just like her gender reassignment, she’s using taxpayer dollars to do it, enlisting legal aid money to file charges. In reporting the story, The Sun is typically sensationalistic, but it comes down to this: If your nation’s health care system allows transgender citizens to use federal dollars for gender reassignment procedures, then there’s no going halfway. It’s all or nothing. Otherwise you end up with folks like Lee, in limbo between genders, and physically and mentally distraught.
Or as bio ethicist Jacob M. Appel argues: “One cannot assess the NHS policy toward transsexuals without comparing it to the treatment of breast cancer survivors. In Great Britain, women who have had therapeutic mastectomies have their reconstructive surgery paid for in full by the taxpayers. Although the United States does not have national health insurance, reconstructive breast surgery is guaranteed for virtually all holders of private insurance under the Women’s Health & Cancer Rights Act of 1998. Medicare also covers such reconstructive surgery, as do most (and possibly all) state Medicaid plans. The purpose of such funding, which seems both reasonable and compassionate, is that reconstructive surgery may be in the psychological best interests of certain patients. Needless to say, breast enhancement may also serve the psychological best interests of Gender Identity Disorder patients. But one should not lose sight of the fundamental fact that both “reconstructive” breast surgeries for cancer patients and “enhancement” surgeries for transsexuals are inherently cosmetic procedures. Nobody dies for a lack of breasts.”