eric76 wrote:
I fail to understand why if we must have socialized medicine, it should cover anything that has nothing to do with returning oneself to health when sick or injured.
To more directly answer your question, not all countries with universal health care cover SRS, such as Japan--though there has recently been a petition for it. Some cover it a little, but not nearly enough to pay for all of it, like Australia. New Zealand pays for a really old, suboptimal procedure with a years-long waiting list--and I believe the doctor that performed it has since retired, leaving no one to receive it.
Nevertheless, it does appear that in many countries with universal health care it is covered. I think it's because they know that for certain appropriately selected patients with gender dysphoria they can ultimately save more money by not having to pay for the debilitating depression, the suicidality, and other problems that result from not treating. The health care system is on the hook regardless of the patient's condition.
It was different in the U.S., because we had a fragmented system. For private plans, the insurers could reject those with pre-existing conditions (so those who had already started transition by, say, taking hormones could simply be rejected). The insurer didn't need to take on the cost. For those for whom gender dysphoria started after getting on the plan, it was still worth more to deny coverage because once the patient started getting more expensive, like say if they started to develop debilitating depression or suicidality, then the insurance plan could simply drop them, leaving them to wallow in agony without access to effective treatment of any sort. Private insurers have now largely lost the ability to do that, so we'll see how much of an expansion of coverage we can get on private plans; coverage has expanded in certain states, but that has been largely due to being required by the government. Nevertheless, in California the government required coverage of mastectomy and hormone therapy, but not bottom surgery, but Kaiser Permanente, a California insurer, went ahead and started covering bottom surgery on its plans on the exchange, anyway, so they might now be understanding the balance of the costs.
Another reason it has not been covered can be found in this link, the 2014 Medicare ruling removing the ban on covering sex reassignment surgery, that looked back at a 1981 Medicare decision on the matter as it looked at 9 follow-up studies that stretched from 3 months all the way up to 13 years (p. 18) (replaced brackets with parentheses) (emphases added):
Quote:
The 1981 report (on transsexual surgery) summarized the findings of nine studies on ?[t]he result or outcome of? transsexual surgery. NCD record at 15-18. With respect to those studies, the report stated that ?surgical complications are frequent, and a very small number of post-surgical suicides and psychotic breakdowns are reported.? Id. at 17-18. However, the report also acknowledged that eight of those nine studies ?report that most transsexuals show improved adjustment on a variety of criteria after sex reassignment surgery, and that ?(i)n all of these studies the large majority of those who received surgery report that they are personally satisfied with the change(.)? NCD Record at 17. Notwithstanding its discussion of these studies, the 1981 report (and the NCD) cited an alleged ?lack of well controlled, long term studies of the safety and effectiveness of the surgical procedures and attendant therapies for transsexualism? as a ground for finding the procedures ?experimental.? Id. at 19. The 1981 report did not define ?long term? for the purpose of assigning weight to study results and the NCD record provided no clarification of that phrase. The 1981 report noted ?post-operative followup? and ?followup? times for eight of the nine studies on the outcomes of surgery, with ?average,? ?mean? or ?median? periods ranging from 25 months to over eight years, and individual periods from three months to 13 years. NCD Record at 15-17. If these studies do not qualify as acceptable long-term studies, the basis for such a conclusion is not adequately explained in the NCD record.
http://www.hhs.gov/dab/decisions/dabdec ... ab2576.pdf
Medicare tends to set the example for coverage, so this decision encouraged many private and public insurers to cease covering it, but as you can see from the Departmental Appeals Board's determination as quoted above, the original analysis that led to this chain of decisions that deprived American gender dysphoric people of access to medically necessary care was
flawed, because they clearly cherrypicked what studies they considered
acceptable, ignoring the studies that disagreed with their predetermined conclusion--they gave no reason why they left certain studies out. In the trans community, we suspect that an unholy alliance between the radical feminists, represented particularly by a paper written by Janice Raymond that said, "I contend that the problem with transsexualism would best be served by morally mandating it out of existence," and the Reaganites created the political pressure that led to this flawed decision in 1981, a blade aimed straight at the heart of the trans community from which we are just now finally beginning to recover. Prior to that decision, gender reassignment was generally covered by both private and public insurers in the United States.
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"You have a responsibility to consider all sides of a problem and a responsibility to make a judgment and a responsibility to care for all involved." --Ian Danskin
21 Sep 2014, 9:58 am
