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Inflationary Insurance
HHS Requires Coverage for Sex Changes

On Friday, the HHS appeals board decided that Medicare must cover sex-reassignment surgery, reversing its long-standing policy of excluding the procedure. The reactions to this expansion are already taking a cultural turn, as the WaPo’s report on blowback against the decision shows:

Leanna Baumer, a senior legislative assistant with the Family Research Council, said that the ruling “ignores the complexity of issues” surrounding gender identity issues.

“Real compassion for those struggling with a gender identity disorder is to offer mental health treatments that help men and women become comfortable with their actual biological sex—not to advocate for costly and controversial surgeries subsidized by taxpayers,” she said.

Frank Schubert, national political director for the National Organization for Marriage, said he also objects to the decision for moral reasons and that it does not encourage children “to respect who they are, how they were born.”

But the cultural politics of this are largely unimportant and irrelevant. Both sides are using this issue as a dog-whistle to their teams, an occasion to rally the troops. Those who think sex-change surgeries are a sign of cultural degradation will duke it out with those who see supporting these surgeries as a necessary validation of transgender people. Each side will fill its war chest from that battle, but none of us will come out any wiser.

Culture aside, there’s a more serious point to be made about the increasingly comprehensive insurance federal legislation guarantees, whether through ACA mandates or Medicare benefits. Our patched together national insurance system, viewed as a whole, simply will not be sustainable if we insist that insurers cover even elective surgeries. The distorting effects of burdening a third-party payer mechanism like insurance with elective procedures are well known: the more generous your insurance is, the greater your incentive to let others foot the bill for unnecessary medical procedures. Many on the right are suggesting we replace Obamacare and its non-essential “essential benefits” with universal catastrophic insurance. Whether this is the right move or not, it’s closer to the answer than an ever-expanding benefits list.

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  • Boritz

    Is it possible to categorize the types of elective surgeries that are preferred by liberals vs. conservatives? If some surgeries are chosen much more often by one political camp or the other then the law could be written to reward supporters and punish enemies. It’s always beneficial to break the bank as long as it isn’t done in a politically neutral way.

  • Andrew Allison

    Not only do we not have a national insurance system (coverage for all), but the hodgepodge that we currently have is manifestly not sustainable even without coverage of elective surgeries.

  • gabrielsyme

    Is there actually persuasive evidence to indicate that gender-reassignment surgery has better outcomes than psychotherapy? Gender Identity Disorder is the only mental illness which is normally “treated” by major, irreversible surgery. The appalling rates of post-operative suicide suggest that even if an improvement over non-treatment, gender reassignment may well simply be making the underlying mental problems deniable. At any rate, those who struggle with gender identity deserve better than the ideological consensus that drives them to a surgical “treatment” which many find was not the answer to their unhappiness.

  • lhfry

    Excellent article by the Johns Hopkins psychiatrist who set up at JH the original “sexual reassignment” surgery program and then terminated it.
    This surgery is cosmetic – you cannot change your chromosomes. So expanding coverage by Medicare (don’t focus on the elderly here, not too many of us are going to be seeking this surgery, the instant case aside. Focus on those on disability and covered by Medicare) is going to create huge problems. Lots of people want cosmetic surgery for lots of reasons and I’m sure a psychological case can be made for any of them.

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