While there are many who feel that morality must be built into law, I believe that the elimination of transsexualism is not best achieved by legislation prohibiting transsexual treatment and surgery but rather by legislation that limits it and by other legislation that lessens the support given to sex-role stereotyping, which generated the problem to begin with. Any legislation should be aimed at the social conditions that initiate and promote the surgery as well as the growth of the medical-institutional complex that translates these stereotypes into flesh and blood. More generally, the education of children is one case in point here. Images of sex roles continue to be reinforced, at public expense, in school textbooks. Children learn to role play at an early age.
- Raymond (1980), Paper Prepared for the National Center for Health Care Technology on the Social and Ethical Aspects of Transsexual Surgery
The TERF movement played a significant role in the revocation of trans healthcare access. In fact, TERF activist, Janice Raymond, helped engineer what became the government’s anti-trans position.
The National Center for Healthcare Technology was a government funded body that reviewed metadata so that Health & Human Services (HHS) would be able to make evidence-based judgements about the efficacy of medical technologies. In short, they informed the US government on what was and what was not medically efficacious. The NCHCT had Janice Raymond, author of The Transsexual Empire: The Making of the She-Male issue their position on the efficacy of trans medical care in a paper titled, “Technology on the Social and Ethical Aspects of Transsexual Surgery.” This position paper makes practically all the same assertions about trans people commonly found in far right-wing anti-trans propaganda; however, unlike other extremist group propaganda, this misleading report informed HHS’ position on trans medical care. The report was available through the Office of the Associate Director for Medical and Scientific Evaluation, Public Health Service.
Raymond asserted that trans medical care was a new phenomena, unethical, asserted that legislation should block trans medical care and that it would be best to institute a national program of reparative therapy.
Until Raymond’s HHS paper, the US government supported trans care as medically necessary. I want you to reread that previous sentence. This meant that poor trans people could freely access psychological and medical care and it meant that public and private insurers had no basis upon which to reject coverage of trans care.
It was only after the NCHCT pushed Raymond’s bigotry in 1980 that the US government reversed course in 1981 and took up Raymond’s views and rhetoric. Raymond’s hate became the government’s stance. Raymond – a seminary-trained ethicist, not a clinician – was the architect of the anti-trans stance the US government adopted in the 1980s. This official anti-trans stance soon spread to private insurers and the American trans population soon found itself without access to medically necessary health care.
There’s a reason many trans people lay the death and suffering of untold numbers of trans people at the feet of Janice Raymond, PhD.
In a time when employment discrimination against trans people became legal, Raymond helped dismantle the trans community’s ability to access trans health care through public and private insurance. Raymond heralded in the era in which trans people (many to most of whom were unemployed, depending upon the study) had to pay out of pocket or go without. In essence, Raymond helped ensure the future of a medical system that was unresponsive to the needs of the trans community at every level.
How many trans people have taken their lives because they were not able to access the medically necessary psychological and medical they needed? How many trans people died as a result of their encounter with an unresponsive and transphobic medical system?
One of the most severe results of denying coverage of treatments to transgender insureds that are available to non-transgender insureds is suicidal ideation and attempts.
A meta-analysis published in 2010 by Murad, et al., of patients who received currently excluded treatments demonstrated that there was a significant decrease in suicidality post-treatment. The average reduction was from 30 percent pretreatment to 8 percent post treatment.
De Cuypere, et al., reported that the rate of suicide attempts dropped dramatically from 29.3 percent to 5.1 percent after receiving medical and surgical treatment among Dutch patients treated from 1986-2001.
According to Dr. Ryan Gorton, “In a cross-sectional study of 141 transgender patients, Kuiper and Cohen-Kittenis found that after medical intervention and treatments, suicide fell from 19 percent to zero percent in transgender men and from 24 percent to 6 percent in transgender women.)”
Clements-Nolle, et al., studied the predictors of suicide among over 500 transgender men and women in a sample from San Francisco and found a prevalence of suicide attempts of 32 percent. In this study, the strongest predictor associated with the risk of suicide was gender based discrimination which included “problems getting health or medical services due to their gender identity or presentation.”According to Gorton, “Notably, this gender-based discrimination was a more reliable predictor of suicide than depression, history of alcohol/drug abuse treatment, physical victimization, or sexual assault.”
A recent systematic review of largely American samples gives a suicide attempt rate of approximately one in every three individuals with higher rates found among adolescents and young adults. According to Dr. R. Nicholas Gorton, MD, who treats transgender people at a San Francisco Health Clinic, “The same review also noted that while mental health problems predispose to suicidality, a significant proportion of the drivers of suicide in the LGBT population as a whole is minority stress.” He continues to conclude that, “[f]or transgender people such stress is tremendous especially if they are unable to ‘pass’ in society. Surgical and hormonal treatments — that are [also] covered for non-transgender insureds — are specifically aimed at correcting the body so that it more closely resembles that of the target gender, so providing care significantly improves patients’ ability to pass and thus lessens minority stress.”
These studies provide overwhelming evidence that removing discriminatory barriers to treatment results in significantly lower suicide rates.
The ghost Janice Raymond’s hard work is still alive today. TERFs continue to advocate against any movement away from the medical landscape Raymond wrought. Even in 2013, 33 years after Raymond’s successful effort to dismantle trans healthcare, trans people continue to suffer each and every day.
Even though the American Medical Association, American Psychological Association, American Academy of Family Physicians, National Association of Social Workers, World Professional Association for Transgender Health, National Commission on Correctional Health Care, American Public Health Association, American College of Obstetricians and Gynecologists all agree that trans care is medically necessary, trans people still endure under the TERF movement’s yoke.
After decades of trans people living a dying behind this policy horror born of TERF hate, today – 5/30/2014 – HHS announced the beginning of the end of the scourge of TERF ideology governing the heath of all American trans citizens. Here’s the announcement from the ACLU:
WASHINGTON – The U.S. Department of Health and Human Services (HHS) Departmental Appeals Board ruled today that that Medicare’s policy of categorically excluding coverage of sex-reassignment surgery, regardless of a person’s individual medical conditions and needs, is unreasonable and contrary to contemporary science and medical standards of care.
The ACLU, Gay & Lesbian Advocates & Defenders (GLAD), and the National Center for Lesbian Rights (NCLR) have issued the following statement about the Board’s decision:
This decision removes a threshold barrier to coverage for medical care for transgender people under Medicare. It is consistent with the consensus of the medical and scientific community that access to gender transition-related care is medically necessary for many people with gender dysphoria. The removal of the exclusion of coverage for surgical care for Medicare recipients means that individuals will not automatically have claims of coverage for gender transition-related surgeries denied. They should either get coverage or, at a minimum, receive an individualized review of the medical need for the specific procedure they seek, just like anyone seeking coverage for any other medical treatment.
The HHS Departmental Appeals Board is an independent board within HHS staffed by career civil servants. The Board’s decisions constitute the final decision of HHS and are not subject to further review by political appointees.
The ACLU, GLAD, NCLR, and civil rights attorney Mary Lou Boelcke filed an administrative challenge last year on behalf of Denee Mallon, a transgender woman whose doctors have recommended surgery to alleviate her severe gender dysphoria.
Mallon joined the U.S. Army when she was 17-years-old and worked as a forensics investigator for a city police department after she was honorably discharged from the Army. She was later diagnosed with gender identity disorder (now known as gender dysphoria), a serious medical condition that is characterized by intense and persistent discomfort with one’s birth sex.
Here’s more coverage:
WASHINGTON — In a relatively quiet announcement Friday, the Obama administration struck a major blow for transgender rights by ending a decades-long blanket ban that prevented Medicare from covering sex reassignment surgery.
The Department of Health and Human Services’ Departmental Appeals Board, an internal review structure within the byzantine federal agency, issued a ruling that ended a ban on Medicare even considering covering sex reassignment surgery and related care because a fear of “serious complications” resulting from the “experimental” surgery. That language was issued in 1981, and most medical professional organizations now consider sex reassignment surgery a safe and accepted procedure. The DAB ruling noted the change in how sex reassignment surgery is understood 33 years after the Medicare ban was issued.
“Even assuming the [National Coverage Determination]’s exclusion of coverage at the time the NCO was adopted was reasonable, that coverage exclusion is no longer reasonable,” reads the ruling. “This record includes expert medical testimony and studies published in the years after publication of the NCO.”
“Denying Medicare coverage of all transsexual surgery as a treatment for transsexualism is not valid under the “reasonableness standard” the Board applies,” the HHS board ruling continues.
Jennifer Levi, a lawyer who directs the Transgender Rights Project of Gay & Lesbian Advocates and Defenders in Boston, said the ruling does not mean Medicare recipients are necessarily entitled to have sex reassignment surgery paid for by the government.
Instead, the lifting of the coverage ban means they now will be able to seek authorization by submitting documentation from a doctor and mental health professionals stating that surgery is medically indicated in their individual case, Levi said.
“They should either get coverage or, at a minimum, receive an individualized review of the medical need for the specific procedure they seek, just like anyone seeking coverage for any other medical treatment,” Levi’s organization said in a statement after the ruling was issued.
Transgender health advocates said that because private insurance companies and state-run Medicaid programs that provide health insurance for low-income individuals often take their cue from the federal government on which treatments to approve or exclude, the decision could eventually pave the way for sex-reassignment surgeries to be a routinely covered benefit.
No statistics exist on how many people might be affected by the decision. Gary Gates, a demographer with The Williams Institute, a think tank on LGBT issues based at the University of California, Los Angeles, has estimated that people who self-identify as transgender make up 0.3 percent of the U.S. adult population. Over 49 million Americans are enrolled in Medicare.