If other surgeries like breast enlargements / nose jobs / tummy tucks decreased suicide rates, should they be under mandatory coverage too?

Sending someone on a weeklong holiday at the Ritz in Hawaii each November might also decrease suicide rates, but is a poor argument for what is ultimately public funding of it. (The cost is far less than surgery.)

So how many cleft palets or other physical problems would be solved with the same funds? You cannot fault people for being hesitant to fund something that will end up costing other people money or cut short funding for things that affect them. Why is one persons gender reassignment more worthy than anothers needs?

As long as trans lives are seen as worthless no one will want to pay to save them.

Well said Danielle. I think there is a significant lack of understanding about this issue and about the experience of transgender people. Thanks to the Gender Justice League for the work they are doing to change this understanding. These interventions are far less expensive than a lifetime of mental health services related to a persistent depressive disorder, and they improve overall well being for those who need them. This doesn't even address the lost potential when one commits suicide. As far as "cleft pallets and other physical problems" go, these ARE covered by insurance, and I cannot imagine an instance where they would not be covered as a result of covering what has been determined by the American Medical Association to be medically necessary treatment for transgender people.

Has anyone checked the cost of an inpatient psychiatric stay after a suicide attempt? According to Michael Stensland, Ph.D.; Peter R. Watson, M.B.A., M.P.H.; Kyle L. Grazier, Dr. P.H., in their study: An Examination of Costs, Charges, and Payments for Inpatient Psychiatric Treatment in Community Hospitals (Psychiatric Services 2012; doi: 10.1176/appi.ps.201100402) the cost is as follows: "depression treatment, $6,990 for 8.4 days and $3,616 for 4.4 days; drug use disorder treatment, $4,591 for 5.2 days and $3,422 for 3.7 days; and alcohol use disorder treatment, $5,908 for 6.2 days and $4,147 for 3.8 days."

Take a look at the suicide rate in the transgender community here: http://williamsinstitute.law.ucla.edu/wp….

It doesn't take a rocket scientist to do the math and figure out that this money would be well spent on surgery and related transition treatment. Parity in healthcare for ALL!!

@2,

Some insurance plans in the U.S. and government health care plans outside of the U.S. already cover cosmetic procedures for transpeople who feel their appearance doesn't conform well enough to their identified gender. In other words, transwomen who feel they look too masculine can get facial feminization procedures paid for by insurance or taxpayers.

Presumably, masculine-looking ciswomen don't get that kind of consideration even if their "ugliness" causes them suicidal ideation.

The arguments about "this money should go elsewhere" and "what about people who just don't like how they look" show the deep ignorance the general public still had about both how insurance works and the realities of Gender dysphoria.

@2 sure, but my argument is "if the primary thing we're worried about here is suicide rates, and see averted suicides as free money for funding elective interventions, then there's a long line of people with a wide range of conditions to look at"

@7 not worrying about cost shows a profound lack of respect for the taxpayer

@3 Reconstructive surgery for children born with cleft palates in the U.S. Is covered under Medicaid and other insurance plans. That's why you don't see (U.S.-born) adults walking around with cleft palates. As for cleft-palate-having children in foreign countries, I'd like all of them to get reconstructive surgery too. But, whether my Washington-approved health insurance plan covers gender confirmation surgery or does not will have no effect on those children.

I have to admit I've been on the dense about tax funding for this. To be honest, the groups who are against it are the biggest reason I'm OK with it. And this article has made me even more OK with it.
But to be honest, as someone who has never dealt with this issue, and doesn't feel close enough to the TG people in my life (professional relations, and im bery happy to work with them) to ask them to help me understand it better, it sometimes comes off as frivolous, especially in light of the other healthcare issues that aren't being addressed.
Personal doubts about tax funding for gender reassignment surgery is truly the worst I have to say about TG's. Whatever drives someone to change their gender is something I've never experienced, I've never known someone who felt this way before they made the change, and at the end of the day, it is nothing that will sway my regard for a person for better or worse.

So what if a transgender person changes his/her mind after having the surgery and want to reverse it ? Do tax payers have to foot the bill again ?

@11, one thing I have yet to hear about is someone who goes through with this changing their mind. Have you met someone who regretted their sex change? Have you read about someone who changed their mind?
Closest I can think of is a friends teenage sister in law who briefly contemplated becoming a man. She sorted it out and realized she liked being female.

Just a strange concept to me. I'm all for whatever floats yr boat, but there's male and female. That's it. Do you think that if you're born as a dude and have gender reassignment surgery you no longer need worry about prostate cancer?

@13, No. Trans people don't think that because trans people aren't idiots.

@13 There is no thing as purely male and female that most like you think of. Here are just some examples. 1) Females and males have both testosterone and estrogen. Some folks don't have the same ratios as typical males or females. 2) Some with XY genes have http://en.wikipedia.org/wiki/Partial_and…. Those totally insensitive to androgen grow up looking and sounding female. 3) XY folks rarely have given birth (http://www.ncbi.nlm.nih.gov/pmc/articles…). 4) What do you call those with http://en.wikipedia.org/wiki/Sex_chromos… The modern term is intersex. 5) http://en.wikipedia.org/wiki/Mosaic_(gen… where different cells in the same body have different genotypes again refutes the notion of just male or female. 6) Besides the genetic mutations, there are many things that happen in fetal development (e.g. natural variation, drugs and hormones pregnant women get, environmental chemicals) that cause the brain to develop one way and the body the other. There are studies that show that transsexual brains are closer to their preferred gender identity than their sex assigned at birth.

Argh this site truncates and doesn't make my links active! Just Google and learn about the tremendous natural variation in species, not just humans. We are not digital; we are analog and exist on a spectrum. It soon becomes apparent to any with an open mind that there are not just your stereotypical males and females. We all start off as female, and all babies with develop as female unless the fetus gets a signal to develop as male.

@9 so if a proper reassignment costs x dollars and we start covering it but those same surgeries could help 10 children but those funds are no loner there, how is that just?if Everyone gets medical coverage but only 70% of us are paying for it we are simply not going to be able to afford every elective procedure that improves someone's self image, my sympathies go out to the individual s affected by gender dysphoria but simply being affected by it is not a good enough reason to simply give it away at the cost of others receiving less so one individual can receive more is not fair, how about we do something crazy like let people put money into a account for said surgery before being taxed or remove the taxes associated with the surgery? That never gets brought up, just more talk of why its just to make the general public pay for one single persons transition.

I just want to put out there for everyone who seems to think that it is a 'piece of the pie problem' -- that no in fact, you obviously do not understand the very basics of how insurance works. People gaining access to hormones, doctors visits, blood work, mental health care and for an extremely small number some surgeries (many of which are inexpensive) -- DOES NOT TAKE AWAY FROM OTHER PEOPLE'S HEALTH CARE. They literally are 100% NOT RELATED. Transgender people, our families, co-workers, friends, neighbors, and community all pay insurance premiums - ones we would gladly see go to alleviate the very real and serious suffering, bigotry, and hatred that Transgender people face when they cannot appear in the gender they know themselves to be. When transgender people have access to medical care, they become far more stable, are more likely to be employed, less likely to harm themselves (and thus cost insurance companies and tax payers a LOT more in the long run). Denying this care is penny wise, pound foolish. Great - you refuse to pay for someone's hormones, so instead they get black market hormones which then cause them to have liver cancer in 5-7 years which costs a hell of a lot more than the $8.00 for a month of estrogen or whatever. All of these examples likes -- people are getting frivolous access to surgery at the expense of someone else is absolute hogwash. In reality - non-transgender people are stealing Transgender people's premiums to pay for their healthcare, while applying discriminatory double standards (I a non-transgender person get hormones by just requesting it, my transgender friend does not. I can get a preventative mastectomy covered because I have the BCRA-2 Gene and am more likely to get breast cancer, my transgender male friend has to walk around as a dude with DD's). The reality is that - discrimination and bias are the primary motivator for people's objections no matter how you look at it. Every major medical body who has taken the time to review the peer-reviewed, extensive medical literature on Gender Dysphoria has agreed - this care is just as medically necessary as anything else. Surgeries are NOT elective when they result in alleviating suicide attempts, depression, impaired daily functioning that is not touched by anti-depressants or therapy. No amount of anti-depressants or therapy makes Transgender people happy. Access to hormones, mental health care, and for those who desperately need it surgery does. What America lacks at it's core and what is deeply shameful is any ounce of compassion. I don't get to dictate what medical conditions are covered with my insurance premiums (there are literally thousands of things covered that are far more frivolous, less proven to improve people's lives). People get penis pumps paid for by Medicaid and Medicare. Viagra is covered on many plans. Billions of dollars are wasted on unnecessary defensive medicine, excess testing, waste, over prescribing, etc... If you want to be healthcare penny pinchers - bitch about that stuff. Focusing on a very small number of people's very real and intense suffering. Get educated google: The National Transgender Discrimination Study. Read: California Department of Insurance Transgender Healthcare Cost assessment (basically .008 cents per person per year for this coverage).

@18 You are arguing that as the pie slice is quite thin that you are not growing the pie. The California study shows that claims are way fewer than anticipated. The pie still grew.

@ 18 we do bitch about that stuff to, again I see zero justification for forcing others to pay for someone to get an elective surgery, suicide only occurs by one own hand and shouldn't be used to make others feel guilty or responsible for another's care, ever notice how the American cancer society or the juvenile diabetes research foundation have collected private funds to help out with select individuals that cannot fund their own treatment, until I see something like that taking place within the trans community I can't help but think those that want to use public funds, rather than earn it, are not worthy of money from the public dole based on the promise of improved quality of living for someone else who is unhappy with a situation the rest of us had nothing to do with. I feel safe saying that this article has done zero to end any debate regarding the subject, show me some solid data that all of society will benefit and I'll hop on board but until then I say no.

@ 18 I think it is you that has the lack of understanding of how health insurance works, traditionally insurance was used to cover catastrophic things like appendectomys and car wrecks that you wouldn't have the cash laying around to cover, now it has been expanded to cover life sustaining meds and programs that are offered for minimal costs to improve overall health, now the way that money is spent is decided by a plan administrator who must ensure that everyone that is paying into the plan is covered, now I did some research and feel comfortable saying the average cost of transition is between 90k-120k with ongoing costs such as therapy and hormone treatment rising along with everything else, now if that person is making a minimal contribution for basic coverage then thats all they are entitled to. If you look at things like Susan G. Komen or the lymphoma society they are groups of people affected by the same things that come together to work on a common problem to acquire funds to fix them, they also have lots of doctors and researchers and financial advisors that volunteer their services and do a good job of fundraising. I haven't been able to find a single example of a nation wide trans advocacy group that works collectively like that, just examples of trans groups asking for money for what is an elective surgery that does little to benefit anyone outside of the surgeon or patient.

The author did not provide citations for her references. Can anyone help in this regard?

@18 you state that the costs to cover trans related health care in California is around .008 cents per person, now if the current population is around 37,700,000 that works out to only $301,600 dollars, and thats if everyone is paying, now since California has around 9% unemployment and you figure in children, the elderly and disabled not working I can't figure how you think that number is realistic or accurate, sounds more like a number you just want to be real, now the current population of Washington state is around 6,897,000 with a higher percentage of trans identifying individuals than California, so to say that the costs are less thsn pennies per person is either wishful thinking or flat out lying. Also since you think that allowing a natural born woman access to meds to ensure her endocrine system is working properly is descrimitory I have to say you don't actually understand theddebate, is giving a diabetic insulin also descrimitory? Thats a hormone that everyone dies without, much like a natural born woman could be on deaths door quickly if her system is not taken care of, your trans pal just has to deal with their own issues with body image.

We all pay taxes for things we personally do use. I do not have children yet my taxes pay for schools. How about pregnancy costs? Vaccines? Broken arms? Sometimes the parents are unemployed and costs are 100% covered by taxes. Cleft palet, isn't that a cosmetic surgery? Wouldn't someone still be alive without it? What about a child with cancer? That's expensive. ADD medication? Depression medication? I gladly pay for all of this. Everyone has a right to be treated for medical issues. Adults that have a treatable medical condition should be given it. That's without emotion. No one receives these reassignment surgeries without extensive proof that it is medically nessessary. Artful you are probably homophobic so this debate brings a special hate out. Try to use your talented mind for good.

Actually I'm not homophobic at all, I just fail to see why everyone should pay for one person's elective surgery,(being homophobic has nothing to do with trans issues fyi, they might benefit from separation actually as one is viewed as a psychological issue and another being a physical issue), and the ongoing costs associated with it, a cleft palette is a one time surgery without the ongoing costs of hormone treatment and such, also since most of the trans individuals I have encountered have unfortunately. been in triage due to domestic violence and not. suicide attempt,it brings up another question, are we. going to be responsible for surgery for trans individuals who get beat up and need surgery to maintain a positive self image as well? I have yet to see any indication that there is a national or collective trans advocacy group looking to fund individuals so I will continue to hold on to my belief that a very minor group does not deserve such vast resources earned by so many, if the need justified the want it would be, so far I have seen zero to that effect. Hell I'd even be willing to help a local trans advocacy group establish a trust to provide services for individuals that demonstrate the need for such services but I have yet to see anything other than demands for others tax dollars that could be used to benefit society as a whole. Nice try trying to paint me as a homophobe though, how many AIDS patients do you think those same funds could help?

And just so you know ritalin is poison #25 so way to jump on board with paying for something because someone else says its good without truly understanding what's going on. All I want is someone to show me two things before I'll get on board, the first being a collective of people working to solve the lack of funding proactively through their actions and a true benefit to all of society. Lets be honest you're asking for charity for a select group.

If you pay taxes, you pay for Ritalin. You pay for many many things you do not use or think are appropriate. You act as though if we allow these surgeries to be covered by taxes that no one else will be treated for anything. You act as if these procedures were covered a thousand people would line up. All people fall into a select group. We help everyone. This is not a choice someone makes lightly nor is it an easy road. You are finding any angle to place doubt and malic against a group of people that are already vastly misunderstood. Advocacy groups that will raise money, you compare this to cancer fund raising? Your an idiot (still homophobic too). People are afraid. People like you help perpetuate that fear. Your awesome.

@2 why not have public funding for things that people don't need but will make them happy (for those who can't afford it)? That's how Europe is doing it, and frankly their current standard of living and future economic prospects are looking far rosier than ours. We waste extraordinary amounts of money on things that generally increase misery (prison, largest military in the world, etc) with no benefit to those outside of the related -industrial-complex. Why are we willing to pay enough welfare to keep people alive, but only just enough to keep suffering? How does that benefit you?

@28 and yet there's still nothing being posted other than you whining about others not wanting to fund elective surgery, You cannot even offer a answer to my question of rather or not there are trans groups offering help financially other than to call me a homophobe. Since you are such an advocate for trans rights what steps have you taken to ensure they are covered other than getting on your soapbox here and arguing with me? I'm willing to bet none.