Open Doors, by @ReginaHolliday
Short answer: because I and my fellow physicians went into medicine to support the ability of every human being to achieve their life goals.*
*see my note at the bottom of this post about the physician role
Capital Transpride is May 18, 2013, in Washington, DC.
Kaiser Permanente is a Gold Sponsor for the first time, this year. As of 2013, Kaiser Permanente covers and provides medically necessary care for its employees who are trans, earning it a 100% rating on the Human Rights Campaign Corporate Equality Index. Every member is covered for hormone treatment and behavioral health services. Not every member is covered yet for surgery, however, because not every employer purchases a supplemental insurance rider for this coverage.
There are also clinical facts about this care, and an increasing trend of coverage across the United States, which I have written about in several posts on this blog, since November, 2012.
Since then, I have been having dialogues with others in this area, some friendly, some extremely hostile.
I’ll answer some of the questions I have actually been asked, here. I have reworded a few and not answered a few because they were asked too insensitively to post in their original format – it’s okay, we’re on a learning journey :).
Q: This is a small population of people, why should they be advocated for?
That’s what people asked in 1993 about persons with HIV/AIDS.
Today, we look back in horror at the way the medical profession carried itself during that era.
I’m relatively certain the medical profession will be horrified by its treatment of trans people when it looks back as well. I’m going to TransPride to help shorten and end the horror.
Q: Isn’t this care way too expensive? Why should I have to pay for it?
That’s what people asked in 1993 about persons with HIV/AIDS.
A few additional points:
- Trans persons who are insured and have so-called “exclusion clauses” for their care are paying for everyone else’s care, including care that has been deemed unnecessary and wasteful. Hormones, sex affirmation surgery, and behavioral health, when medically supervised are necessary and effective. Treating this rare condition (the way I refer to it with medical colleagues, understanding that every person doesn’t see it as a “condition”, it is an identity) using established guidelines promotes other positive health outcomes, and supports the achievement of life goals, which is what the health care system is for.
- Most insurance plans that won’t cover surgery or hormones cover the complications of surgery or hormones. In other words, if a trans person obtains surgery and has an infection or other complications, or complications from non-prescribed hormones (heart attacks, clots, strokes) you will pay for their care. This doesn’t even touch on lost productivity, behavioral health issues, and suicide. Gender dysphoria is not a mental illness – much of the mental illness that is associated with gender dysphoria is caused by bias in society that the health care system promotes. Medically supervised care is likely to be less costly in the long run.
Q: Isn’t sex affirmation surgery cosmetic?
No, it is not. I’ll state it again for the search engines out there: Sex affirmation surgery is not cosmetic.
The below is from American Medical Association Resolution 122 (A-08), 2008
Whereas, Health experts in GID, including WPATH, have rejected the myth that such treatments are “cosmetic” or “experimental” and have recognized that these treatments can provide safe and effective treatment for a serious health condition; and
Whereas, The denial of these otherwise covered benefits for patients suffering from GID represents discrimination based solely on a patient’s gender identity; and
Whereas, Delaying treatment for GID can cause and/or aggravate additional serious and expensive health problems, such as stress-related physical illnesses, depression, and substance abuse problems, which further endanger patients’ health and strain the health care system; therefore be it
RESOLVED, That the AMA support public and private health insurance coverage for treatment of gender identity disorder (Directive to Take Action); and be it further
RESOLVED, That the AMA oppose categorical exclusions of coverage for treatment of gender identity disorder when prescribed by a physician (Directive to Take Action). Fiscal Note: No significant fiscal impact.
If hormones and behavioral health are covered and performed, but not surgery, is this discrimination?
Yes. Medically necessary care includes all three components, appropriately prescribed in consultation between a patient and physician. Not every patient needs all three components. Disallowing any of the components represents discrimination based on a person’s gender identity.
Weren’t you attacked recently on the Yale Daily News website when you commented about their decision to cover sex affirmation surgery?
I was. By 3 or 4 people.
By the way, Yale University is in the group of 37 universities who now cover this care for their students.
Once the attacks became ad hominem in nature, I went away. I just checked back in, an lo and behold, and comments like this popped up:
I admire Dr. Eytan’s remarkable patience and forbearance in responding to the comments on this thread. Even when respondents have turned to devaluation and ad hominem attacks, he has maintained a respectful stance toward all.
And then an email like this arrived in my box, from 15-year Yale Alumnus, Rachel See, JD:
Just wanted to drop you a note to thank you for your accurate and even-handed comments to the Yale Daily News story on Yale’s extension of health benefits (including surgery) to transgender students. This trans Yale alumna who graduated some 15+ years ago from Yale College was deeply gratified to see an accurate, and compassionate voice of reason in the comments.
In many trans*-related discussions in the popular media, I often see a tagline of, “…and as always, don’t read the comments.” I routinely ignore that advice, but its presence reflects an unwelcome reality that there can be a lot of rancor (and plain old fashioned ugliness) in online comments.
In a totally different context (blogging about ichthyosis), my wife and I have asserted that a calm, rational and respectful voice can act as a humanizing buffer against the propagation of some of the uglier trolls. But we’ve also noticed that those (lone) voices often go unrecognized.
So — thanks. 🙂
These messages cancel out 10,000 attempts at devaluing other human beings, because they show that the world is learning to love better.
If more attacks come in any venue I’ll just get one or two more of these messages that will cancel out 10,000 more.
The lesson is the same here – un-love can’t win – so great to see that affirmed, again.
Ted, are you transgender?
Feel free to select the answer that will allow you to have the greatest empathy.
The truth is:
- I am not transgender
I am also not
- a person who fears for my safety every time I use a public bathroom
- a patient who has been humiliated, harassed, or physically abused in a clinical setting because of my gender identity
- a person who was forced to spend my own money on a medically necessary procedure, present to an emergency room after an infection complication and then asked, “are you a man, woman or what.”
- a person who was denied emergency care after a car accident and left to die in an emergency room because of my gender status
- a person who was left to die in a university hospital ward in 1993 because of my sexual orientation
But I have met or seen the stories of people who are/were.
We didn’t go into medicine to un-care for people, and in 2013, we don’t have to. More and more clinicians are practicing the medicine of inclusion every day, and we’re going to change everything.
If I missed any questions above, feel free to ask more in the comments.
See you there. Oh yes, and love always wins :).
*A note about the physician role. There are a lot more people than physicians working in this area, and they have been doing it for a very long time. Our role is to bring the patient story into every conversation, and help the people and communities we serve take control of their destiny. With that in mind, I acknowledge many dedicated people and organizations, including Casa Ruby , @casarubyDC , the DC Center @TheDCCenter and those who I have not met or worked with, yet. See you tomorrow as well.