If Your Health Care System Grants Taxpayer-Funded Gender Reassignments, You’ve Got To Finish the Job

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.”

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  • wmcarpenter

    What kind of breast-related surgery has Ms. Lee already had and of what nature is this particular breast augmentation? While I rarely trust the government to use judgment on calls like this, details are pretty important to the ethics of this particular case. With that said, I think all governments should subsidize their citizens gender-reassignment surgeries within reason.

  • Lance A. Worth

    The same old rag, “nobody dies for…”, is worn out and needs to be placed in the garbage where it belongs.

    What Appel is missing is not just the mental distress of having the wrong physical form, but the social risks transitioning folks live with daily–from job discrimination to assault and even murder. These risks increase when one’s transition process does not take them as far as they might like, leaving them in a sort of grey zone where they are either read as their birth sex (not their true gender) or not comprehended to be any clear gender.

    Do transfolks deserve to choose between illegal forms of employment and homelessness or starvation, because they’re trans? Do we deserve to face the risk of assault, rape, and murder for it, too?

    The breast enlargement surgery she asked for IS in many cases necessary–because breast size is a factor in gender perception and thus, in the case of a transwoman, literally could save her life or keep her out of the underground economy.

    Don’t we all deserve to live without fear?

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