Totally Other People's Problem

[Trigger warning for transphobia]

Cara's got an excellent post up about a proposal to provide employees of Berkeley, California, insurance coverage for "sex reassignment surgery", and the subsequent backlash. She hits it out of the park (I recommend you read the whole thing), but here are a few highlights:
"I’m so sick of debating whether all people deserve access to health care, or just the ones who meet some arbitrary standard of social approval. Until we view health care as a fundamental human right, there’s always going to be someone who is undeserving of it — whether it be because they’re poor, or sex workers, or disabled, or trans, or in need of care related to their reproductive organ that offends somebody’s sensibilities. Until health care is a fundamental human right, there will always be someone whose life is not worth as much as 'our' tax dollars.

At the same time, it’s important to remember that even framing health care as a fundamental human right still wouldn’t fully solve the problem. 'Human rights' rarely end up applying to those who society still sees as less than human, and even 'universal health care' rarely works out well for trans people. So health care as right or not, until trans folks are properly understood to be just as human and deserving as cis folks, the equation of 'our' (super special cis-only) tax dollars being worth more than trans lives is unlikely to change."

I think I can offer some additional perspective here.

By an amazing coincidence, I happened to make my annual trip to the endocrinologist this morning. We spent time chatting about how things were going with transition. I brought up "surgery", and quickly dismissed it out of hand (money, etc.,). I didn't even need to bring the subject up, because she knew. That's how it is for pretty much all trans folk.

Here's the fun part: I have insurance that ostensibly covers "the surgery."*

I'm not clear on whether Berkeley is setting up a vaginafund** or whether it's planning to purchase better insurance, but here's the thing about insurance:

Even with good insurance, gender transition is incredibly expensive. If you're a trans woman, it's pretty likely that you'll be paying for electrolysis and facial hair removal-- typically anywhere from US $3k to US $10K. I'm not aware of any insurance that covers cost, including the health care systems in godless socialist countries.

Many insurance companies don't cover psychotherapy, which is a huge gate-keeping hurdle and is also many times useful because OMFG transphobia. This lack of coverage isn't always necessary exclusive because of transphobia, but also because psychotherapy is generally not covered, as society tends to code mental health needs as feminine.

There are surgeries that aren't "the surgery."* Trans men often need mastectomies. Trans women often need facial reconstruction and breast augmentation surgeries. And no, we're not going to debate this. Because society views non-genital surgery as cosmetic, health insurers often don't cover these surgeries either-- and this isn't just a problem in the US.

Then there's reproductive health care. If you're a trans woman, anti-androgens should (hopefully) make you sterile. Given that adoption while trans is, um, difficult, this tends to leave artificial insemination of a cissexual loved one or surrogate the only option. Even if you're fortunate to have insurance coverage for fertility services, you're likely on your own for collection and storage of, uh, "specimens", presumably you can find a clinic you can work with.

And then there's "the surgery."* I theoretically have insurance coverage for "the surgery."* I've verified that Blue Cross will pick up my hospital bills. An unnamed provider may well reimburse me for a portion of the surgeon's fees, but I need to pay surgeon fees (maybe around $10k) upfront. It gets complicated. For the record, I'm actually with the surgeons' on this one. To hell with my unnamed insurance provider.

Oh, and since I don't live in a town where they do "the surgery"*, I'm responsible for travel, and lodging for loved ones.

In other words, even with insurance, gender transition is extraordinarily expense. More to the point, even with insurance, most trans people can't get the health care they need. I have no reason to believe the situation in Berkeley would be any different were this proposal be passed. It's a good start, but as Cara says, we need to do far more. The idea that Berkeley will be paying for "sex changes" is a canard. Berkeley is thinking about giving modest assistance to help their trans employees with their massive health care bills. Good on them.

I'd be remiss if I didn't address Businessweek's OMFGAwexome!!!11! analysis of the situation:
"Berkeley, California, facing $252.8 million in deficits for pensions, disability and worker’s compensation, may set aside $20,000 a year to reimburse municipal employees for sex-reassignment surgery."


Facing a $252.80 million dollar deficit, Berkeley is thinking about setting aside $0.02 million dollars to somewhat offset the medical needs of trans employees. Alternatively: $252,800,000 deficit, Berkeley is thinking about setting aside $20,000 dollars to somewhat offset the medical needs of trans employees. Incidentally, this would increase Berkeley's deficit to $252,820,000, which rounds to $252.8 million. Assholes.

As a public employee and trans person, this is business as usual (times two!). We'll give you kibble, but only a bit, and only when things are going really well for us. When the economy is going to hell and/or we don't feel like collecting taxes, you're on you own.

Has anyone insinuated that employers' insurance should hold off on paying for boner pills due to the economy? I thought not.

* So, I like to refer to all surgeries as "the surgery," although in this case I am specifically referring to genital surgery. This is one of my reclamation projects, though.
** Yeah, you probably shouldn't repeat this. I just get the giggles when saying vaginafund, even though trans health doesn't necessarily involve vaginas. Lots of things don't involve vaginas.

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