As Irma brings up in her first post, “according to the Transgender Law Center, many transgendered individuals are denied health insurance altogether solely because they are transgender” (TLC, 1). Both Irma and Leigh Ann mention the broken arm/leg incident in which transgendered individuals have been denied coverage for a non-transgender related issue. This is clearly an example of stark discrimination; however it is not what this debate is centered on.
Before I continue, I would like to remind everyone that the question presented by this debate is not asking whether or not whether insurance companies should cover transgender and transsexual people overall, it’s asking whether or not insurance providers should be required to cover medical procedures related to being a transgender or transsexual (refer to my previous blog post’s definitions segment to see which procedures these are). There’s a difference between an insurance company being required to cover a certain procedure, versus an insurance provider deciding to cover transgender people. As stated in my previous post, by requiring insurance coverage for transsexual and transgender services, we are required to consider them as victims of a mental illness.
Irma mentions the Harry Benjamin Standards of Care which, “strictly outline the diagnosis and procedure that must be followed for a true, medically necessary transition” (TAW, 2). What Irma doesn’t acknowledge however, is that these standards, which Transgender at Work highlights as “the appropriate standard[s] of diagnosis and treatment,” reinforce a dichotomous and inflexible definition of gender. The Harry Benjamin Standards of Care state that “Two Primary Populations with GID Exist–Biological Males and Biological Females” (Harry Benjamin International Gender Dysphoria Association). If all insurance companies were instructed to meet the Harry Benjamin Standards of Care, not only would this reiterate the need for a diagnosis for an identity presumably wrong, but also reinforces the confusion of sex with gender, and the incidence of black-and-white, harsh, and narrow definitions of gender.
In her first debate, Irma referred to a segment of the Transgender Health Benefits article produced by Transgender at Work that also struck me as quite interesting. The article states that the best way to see if health benefits are discriminatory is to “see if the same procedures would be covered for non-transsexuals by the same plan” (TAW, 1). This would seem to be a reasonable strategy, however it only further stresses how being transgendered or transsexual is equivalent to having a disease. By calling for the comparison of mastectomies or hysterectomies being covered in the case of cancer to being transsexual, there is clearly a preexisting assumption that those who are transgendered or transsexual are tormented by an illness. I would argue that this assumption isn’t safe to make because not all of those who identify as transgender express a need for surgeries, or as Susan Stryker highlights “some transgender people question why gender change needs to be medicalized in the first place” (Stryker, 14).
Irma calls for my attention to the National Coalition Article for LGBT Health in her second debate. She mentions “suicidal ideation rates as high as 64% and suicide attempt rates ranging from 16% to 37% with most attributing their ideation or attempts to their gender identity issues” (NCLGBTH, 2). These percentages are definitely concerning, and are not to be taken lightly. However in my opinion, the suicide rates mentioned do not solely reflect the fact that insurance doesn’t guarantee them surgeries and hormone treatments, but rather the stigmas they face, personal concerns, and society’s refusal to accept transgendered individuals as people as a whole. This refusal to accept transgender and transsexuals by society is echoed by another troubling statistic: “on average, one transperson [dies] from hate crimes every month” (Stryker, 148). And while I still feel troubled denying someone the right to have a surgical procedure they feel is necessary to align themselves with their understanding of gender, I have even more trouble with legitimizing the stigma that labels them as mentally disabled.
Many commenters raised questions of what forms of action I would recommend along with my argument. Meghan specifically asks “how, then can coverage for transgender procedures happen? Is it through the health care system but with different definitions? Or is there a separate entity that should be made to provide funds to cover these procedures?” First, I would encourage all of you to think about what you would recommend, too (I do not have all the answers). However, I will set forth a few propositions (bear in mind that I am no expert):
>> Change the DSM’s definition of Gender Identity Disorder. An organization called GID Reform Advocates calls for the DSM to include “diagnostic criteria that serve a clear therapeutic purpose, are appropriately inclusive, and define disorder on the basis of distress or impairment and not upon social nonconformity” (Winters, 2). Health Insurance and health care providers utilize the Diagnostic and Statistical Manual of Mental Disorders (DSM) to direct their work, therefore changing its criteria would potentially lessen the discriminatory nature of GID. However, I would still be cautious with this action, because as Ashley points out in her comment, “the word “disease” is powerful. It is by definition harmful and abnormal.” Identifying transgendered and transsexual individuals as afflicted with disease has strong and negative connotations within society.
>> Remove GID from the DSM altogether, just as homosexuality was removed in 1973.
>> Develop other organizations. As the National Coalition for LGBT Health reports, “ a few urban, community-based health care organizations have developed their own local Trans Health protocols that do not require a prior GID diagnosis” (NCLGBTH, 3).
>> Expand the overall definitions of depression-like illness to include transgendered or transsexual people who are feeling “unfit” in their own skin. Treat them accordingly as people, who happen to choose not to conform to a stereotypical gender identity.
Ashley asks a revealing question in her comment: “is it fair to make them wait if they could gain access to insurance coverage under the umbrella of ‘disease treatment?” The answer to this question is a catch-22. As Stryker writes, “some people resent having their sense of gender labeled as a sickness, while others take great comfort from believing they have a condition that can be cured with proper treatment” (Stryker, 13). No matter what position you take on this debate, not everyone is going to be happy. It touches on a theme we discuss in class: being willing to face the consequences of the decisions you make. As Jaime writes, “treating Gender Identity Disorder as a “condition” or “disease” [is inevitable] in order [for them to gain access to] needed medical care.” I argue that this is not going to solve the issue at large, and therefore should not be required of health insurance companies.
Jaime also brings up the incrementalist approach, stating that “the best way…is for change to take place incrementally; I am not necessarily saying that I think it is okay for us to continue to marginalize transgender individuals and deny them equal medical coverage, but I do think that the best approach to changing society’s view as a whole is by taking baby steps.” Considering the erosion metaphor brought up in class, the incrementalist approach is extremely time consuming. By supporting the incrementalist approach you are essentially patting the metaphorical rock on transgendered and transseuxals’ heads and saying “you can have the surgery, but you’re still diseased and mentally ill in our books.”
Meghan stated, “I do see some flaws in Rachel’s argument, though. I feel as if she did not tackle the question head on, rather she created a new argument in itself.” However, in my opinion, if a new argument can be made it’s not that the problem isn’t being tackled head on; it is showing that the original argument is missing something.
Just as the Transgender Law Center advocates, I am all for urging health insurance companies to stop discriminating against transgendered people or all people in general, but I am arguing they should not discriminate by mischaracterizing people as mentally disabled. Discrimination, as we have discussed in class, is being selective based off of irrelevant facts or characteristics. Being stigmatized as “diseased” in my opinion goes even farther than irrelevant categorization and is offensive at deeper, more fundamental levels. Perhaps a new definition of “effective treatment” of transgendered and transsexual people would be: not only medically necessary “sexual reassignment surgery, hormone therapy, and real-life experience” but socially necessary actions that aim to remove the stigmatization of those who are choosing to challenge societal accepted gender roles (TAW, 2). However in order to act accordingly, we must for the time being refrain from requiring insurance companies to broaden their discriminatory and “diseased” ways.
Harry Benjamin International Gender Dysphoria Association. The Standards of Care for Gender Identity Disorders (5th Version). http://www.tc.umn.edu/~colem001/hbigda/soc9.pdf
Stryker, Susan. “An Introduction to Transgender Terms and Concepts” and “The Current Wave”
TAW: Transgender At Work. “Transgender Health Benefits.”
TLC: Transgender Law Center. “Recommendations for Transgender Health Care”
NCLGBTH: National Coalition for LGBT Health. “An Overview of U.S. Trans Health Priorities.”
Winters, Kelley. “GID Reform Advocates.” http://gidreform.org/