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  •  Sigh. Devil's Advocate (0+ / 0-)

    This is going to sound cruel and heartless and Republican, but here's another take, given the limitations of 'x amount of available medical care' and 'y amount of people with problems'.

    Am I a fan of insurance companies?  Hell no, I was in hospital myself for a few days this year, and initially the policy that supposedly had a 1k deductible then paid 80% of medical expenses didn't plan to pay a dime.  Eventually I got them to cough up 1k... 20% of expenses after deductible.

    BUT...I was there through the emergency room, because of a life-threatening emergency, as in, I could easily have died within another 24 hrs if I didn't receive medical attention right then.

    The person who DECIDES they need gender reassignment surgery has done just that, decided they have to get it.  They may have a fixed view of themselves as the other gender, they may even have the genetic makeup of the opposite gender.  Their life may be a psychological hell because of constant obsession with being the 'wrong' gender.

    But does that really differentiate them in nature from the person who has a fixation on being so slender they have ribs removed, so busty they have breast implants, so psychologically insecure they have a nose job, or heck, have non-malignant skin warts removed?

    They aren't going to die from being the wrong gender unless they decide to kill themselves, or do something like hang around yokel redneck bars in feather boas lisping at ex-cons.

    You decided you were the wrong gender, believed it firmly, and acted to correct what you perceived as wrong, and corrected it.  I applaud you for that.

    But as little as I like medical insurance companies, I can see why they don't want to pay for things that aren't medically statistically necessary...  Even ignoring the fact that they're not here to help people other than their shareholders, they do serve some slight purpose when they pay for cardiac surgeries, organ transplants, disease-related hospital visits and the like.  Public health is always going to be a loss leader to some extent, just like fire crews, rescue helicopters and so on.

    Force them to start paying for elective (ie decided upon by the individual) treatments such as pec implants, bust implants, or penis implants drives the costs up for all, ties up already strained hospital staff.

    So is it the greatest good for the greatest number, or the greatest good for the few who desperately believe they need to be different than they are?

    I'm not trying to fan any flames here, just saying why I have to agree with several other commenters - TS's will likely always be low priority for insurance types.

    Got a problem with my posts? Email me, and let's resolve it.

    by drbloodaxe on Fri Jul 13, 2007 at 11:00:24 AM PDT

    •  poopdoodle (4+ / 0-)

      If you're going to apply that standard, you have to apply it universally; that is, only conditions which are life threatening are covered.

      Not broken legs. Who 'decided' the leg was broken?

      Certainly no birth defects, because what's a bigger 'defect' (note the quotes, please) than being born in a body that is the wrong sex?

      That standard comes down to, pretty much "almost no treatment for anyone".  

      Now up: What are you reading? Coming: What is it like to be LD? and WHYGTL?

      by plf515 on Fri Jul 13, 2007 at 11:05:08 AM PDT

      [ Parent ]

      •  The doctor (0+ / 0-)

        who read the x-ray decided it was broken.  If you go to the hospital and they tell you your leg isn't broken even though you swore it hurt so much it had to be, do you go home and tell people 'my leg is broken, but they won't believe me'?

        And, quite frankly, given the extraordinary measures frequently used, I feel scarce resources are being misused in a number of birth situations.  The state that spends a year's extraordinary medical fund to keep alive a baby on life support for 4 months knowing full well it's ancephalic, as an hypothetical example.  To the individual it's a tragedy, and life altering.  But is society served best by keeping that child alive when there's no hope for it?  Or using that room and those staff to keep a dozen other people alive with lesser problems?

        That 'standard' as you call it, is what happens in most places.  It's called 'triage' - someone, somewhere is given the power to decide who to use resources on.  It's why some people sit in hospital waiting rooms for hours while others are whisked right in.

        Got a problem with my posts? Email me, and let's resolve it.

        by drbloodaxe on Fri Jul 13, 2007 at 11:14:12 AM PDT

        [ Parent ]

        •  And Robyn did not just sort of (3+ / 0-)
          Recommended by:
          Moody Loner, melvin, jessical

          decide one day
          "Oh golly gee..... I think I'm really female!"

          I do indeed know about triage.  I have been in emergency rooms, sometimes whisked in (e.g. when I was choking; or when I was sure my son had swallowed poison) and other times not (e.g. when I broke a toe).

          Now, as to babies.... well, yes, somewhere the line will have to be drawn.  And doctors should be the ones doing the deciding.  Who decided Robyn should be Robyn?  Well, Robyn, but then she got doctors to agree to that.  

          Where do we spend the resources? Well, that's going to be a hard choice.  Is the life of a 'normal' person worth more than the life of a baby who will be profoundly retarded?  hmmmm... if it is, then is the life of  a genius worth more than mine?

          Now up: What are you reading? Coming: What is it like to be LD? and WHYGTL?

          by plf515 on Fri Jul 13, 2007 at 11:29:19 AM PDT

          [ Parent ]

          •  Yup (2+ / 0-)
            Recommended by:
            plf515, jessical

            Extremely tricky business all around, and definitely  something that should be debated in terms of the public good, rather than the bean counters, which swings back around to universal health care.

            Got a problem with my posts? Email me, and let's resolve it.

            by drbloodaxe on Fri Jul 13, 2007 at 11:35:12 AM PDT

            [ Parent ]

            •  I am no expert on insurance (5+ / 0-)

              at all.  I've stayed out of those diaries because, well, frankly, I spend all my free time here as it is, and don't want a whole other series of diaries to further obsess about.

              I leave such matters to experts like nyceve and drsteveb, who have been studying it a long while.

              I would rather concentrate on the ethics and morality of the situation.

              A society that condemns a person to live in the wrong body because that person cannot afford to switch to the right one is a society that I do not care for.  I cannot imagine what it would be like to be the wrong sex.  I've tried.  But I can't.  It's gotta suck. And I don't want to live in a place that lets people live that way.

              Just like, as a learning disabled person, I don't want to live in a society that lets LD people go through life without help.

              And, as a person with a pretty high income, I am perfectly willing to pay taxes so that others, less fortunate than I, can be so served.

              To me, that is the essence of being a progressive, and close to the essence of being a decent person:

              If I am not for myself, who is for me?
              If I am for myself alone, what am I?
              If not now, when?

              I am for myself.  And I am for Robyn. NOW.

              The rest is detail.

              Now up: What are you reading? Coming: What is it like to be LD? and WHYGTL?

              by plf515 on Fri Jul 13, 2007 at 11:41:07 AM PDT

              [ Parent ]

    •  Low priority? Maybe. (2+ / 0-)
      Recommended by:
      rserven, drbloodaxe

      But I'd think higher priority than Viagra.

      •  Agreed (1+ / 0-)
        Recommended by:
        Moody Loner

        Viagra should never (hah, absolute, somebody will come up with an extreme case to prove me wrong) be funded out of public pockets.

        Got a problem with my posts? Email me, and let's resolve it.

        by drbloodaxe on Fri Jul 13, 2007 at 11:15:13 AM PDT

        [ Parent ]

        •  Extreme? (1+ / 0-)
          Recommended by:
          rserven

          My employment-based health care covers Viagra as standard and gender reassignment as optional.

          I don't know what keeping my pecker up, if you'll pardon the crudity, has to do with my workplace performance - but were I transgendered, getting that resolved quickly and easily would certainly improve it.

          Nevertheless... and yes, I'm well aware you said public money.

          Once single-payer goes through, do you want to bet me on whether or not Viagra will be covered before SRS? 'Cause I have money here says it will.

    •  Oh, and regarding: (3+ / 0-)
      Recommended by:
      TiaRachel, cfk, rserven

      They aren't going to die from being the wrong gender unless they decide to kill themselves

      From what I understand, the suicide rate among transgendered is fifty percent.

      Sounds to me like a life-threatening condition. Maybe we should cover it.

    •  ick... (5+ / 0-)

      Just a sec...gotta take off that feather boa...'scuse me a minute there Jimmy (oh! nice tattoo! Oh my!)...

      1. Are you addressing quality of life, or life or death?  Any NHS scheme is going to address both of these things, to some degree.  Holding up "absolute" and "relative" medical issues the way you do -- and going for that particular frame with such ferocity -- says a lot about your position.  Some stuff will be covered, some won't, and trans care may be in the "won't" column at first.  But that it should be entirely off the table?  That's your opinion of transsexuality.  From here, it's a rather ugly one.
      1. Trans care ultimately is a transsexual person walking into an emergency room, bleeding from a car accident.  What kind of care are they going to get?  If my vagina is a pointless cosmetic mutilation or absurdity as a result of self diagnosis, if there's some godawful tear, you're going to have no problem sewing it up for the greater good?  This reductio ad absurdium arguement, alas, applies far less absurdly to a range of trans medical care, normal, day to day medical care.  You have these people with partially constructed bodies.  Are you going to treat those  bodies like other people's bodies, or are you going to treat those bodies as vanity showcases, not particularly worth extra effort?  I'm guessing I know the answer.
      •  You misinterpret me (0+ / 0-)

        And I hope not intentionally.

        I was implying that that was a viewpoint that was probably fairly common, hence the words 'devil's advocate'.  We live in a monetary based rather than humanitarian society, so in the end a lot of issues will come down to money.

        I am all for quality of life issues, and glad you reminded me of the frame words.  But I am thinking that quality of life is a separate issue from medical necessity to a large degree.

        Do I want rserven to be mentally happy and healthy as whatever gender (I lost track of which direction things went)?  Certainly.  I'd rather everyone was happy and healthy and living out whatever desires they had for their own lives.

        But I also believe that I am destined to be 100 lbs lighter, and spend enormous amounts of time obsessing over it.  I'm not looking for somebody else to pay for me to lose that 100 lbs, though.  My lifespan is shortened by maybe even decades by my obesity, my quality of life is far less than it could be.  But it's my own responsibility to fix it, not my insurance company's.  In fact, my weight routinely rules me out of less expensive policies, because it's such a liability to the company.

        I used to DATE a person who was planning to become a transsexual.  She was lovely as a female, and I wish her well as a male, although she moved, and I lost touch as I do with pretty much all of my friends who move.  I have no bigotry against transsexuals as you seem to imply.

        I respect rserven, I applaud rserven, but I can understand why other folks don't want to pay for the surgery, is what I said.

        Got a problem with my posts? Email me, and let's resolve it.

        by drbloodaxe on Fri Jul 13, 2007 at 11:28:39 AM PDT

        [ Parent ]

        •  I guess my bleeding heart is bigger... (4+ / 0-)
          Recommended by:
          Moody Loner, TiaRachel, rserven, Chacounne

          ...or something, 'cause I'd include your weight as an issue that medical care should address, and argue that by helping you address it proactively now for a few thousand dollars, the state or company saves many more dollars later.  Granted, you could die cheaply of a massive heart attack, but a certain percentage of heavy folks are going to tie up big bucks.  

          The lisping at ex-cons and the way you referenced suicide were, in fact, really offensive, albeit unsurprising.  I'm sure that colored my words.

          My own arguement is that you don't leave people out of the system, cold, for simple reasons of social cohesion and fairness.  There are going to be transsexuals, whether they get surgery in Phuket, Montreal, Brussels or Portland...and they are going to be part of the medical system.  If their primary care and surgery comes from outside the system...the system is unlikely to be a safe or effective place to get continuing care of the most basic kind.  

          •  Acknowledging we exist would be a good thing. (3+ / 0-)
            Recommended by:
            Moody Loner, jessical, Chacounne

            I've had to personally train 5 doctors how to treat me.  As a result, my health has gone to hell.  I've nearly lost my vision, have had my thyroid irradiated, have a hiatal hernia and arthritis (okay, those last two are because I am old :-) ), have high blood pressure, and allergies I never had before.

            I made a video with a doctor at the University of Arkansas Medical School, for use in teaching their future doctors that we should be treated like human beings.

            And last year, an endocrinologist here in Jersey refused to treat me, postoperative by a dozen years, because she "doesn't treat men".

            I thought she was going to break her neck falling out of the window trying to escape from my presence.

            Insurance? For whom? is open
            Teacher's Lounge Saturday, noon EDT

            by rserven on Fri Jul 13, 2007 at 11:54:59 AM PDT

            [ Parent ]

            •  Well (2+ / 0-)
              Recommended by:
              rserven, jessical

              I certainly hope it is in your medical record and maybe on one of those little medical bracelets.  I've seen dismal attempts at verifying past medical history in the hospitals I did rotations in.  Knowing that somebody is transsexual makes treatment a lot trickier, I imagine, but it's a hell of a lot better than not knowing.

              And it would be good to see doctors start treating all patients like human beings.  Too often the condition is the patient, not the patient is the patient.

              Got a problem with my posts? Email me, and let's resolve it.

              by drbloodaxe on Fri Jul 13, 2007 at 12:05:40 PM PDT

              [ Parent ]

            •  bingo... (1+ / 0-)
              Recommended by:
              rserven

              ...in the absence of a legal and medical framework, care is a roller coaster.  There are great systems and horrible ones, and very little consistency.  

              But..."acknowledging we exist would be a good thing" sums it up perfectly.

              •  blathering... (1+ / 0-)
                Recommended by:
                rserven

                (down here in a subthread where I suspect only you'll see it Robyn) I'd suggest that this whole issue changes dramatically when framed in terms of inadequate access to care for a class of people.  Surgery is a pretty small cost when put in that frame; indeed, in the terms of arguement, it changes presumption.  When it is in terms of "SRS" people focus on genitalia, choice, squick -- at worst -- and noble tale of obstacles and overcome -- at best.  And the issue can be seen as neither of those things, but rather one specific treatment in a group of people who have a HIV rate which rivals or surpasses Africa's.  People can still contest the cost of this or that because they're squicked -- but if the discussion starts from that, presumption lies with relatively complete treatment.

                •  Well... (1+ / 0-)
                  Recommended by:
                  jessical

                  ...I had hoped we'd talk about more than just surgery.  I didn't flesh that out as well in the diary, but it was getting too long as it is.

                  And the truth is, I * won * that part of the battle.  Many people don't.  On the one hand, I wanted to talk about treatment in general, but on the other hand, * squick * draws a crowd...know what I'm saying?

                  And it is a bigger issue.  It's an issue for all people with non-popular diseases.  Democracy is not a good doctor.

                  Maybe some people with similar issues can find common cause with us.  That would be nice.

                  Insurance? For whom? is open
                  Teacher's Lounge Saturday, noon EDT

                  by rserven on Fri Jul 13, 2007 at 01:34:28 PM PDT

                  [ Parent ]

                  •  eh... (1+ / 0-)
                    Recommended by:
                    rserven

                    ...no criticism of the diary.  I was thinking about the comments, and my own reaction -- specifically how people talked about SRS right off the bat.  Not the immediately offensive stuff but the comparisons to -- let's see -- gastric bypass, erectile dyfunction, obesity, burns (my little contribution), nose jobs.  The lifeboat measuring was predictable.  What the discussion felt like, for me, was initially pretty uncomfortable.   I don't like simplified contexts, even if they work :}  I kept thinking of my NL experience.  They have this really hard headed, cost-benefit system, but they cover everything -- electrolysis or laser even, to a point.  But it's in a larger social context.  You don't leave a class of people on the street, because it's socially and ultimately monetarily expensive.  And that is an arguement I think finds common cause of it's own :}

                    Anyway, back to work...

          •  Ouch (3+ / 0-)
            Recommended by:
            rserven, plf515, jessical

            Yeah, you're right. That was offensive, I just reread it. I'm going to head out after this post, otherwise I'll spend all my time apologizing to everyone again and again at the rate I'm going.

            What I was trying to say, without spending several paragraphs at it, was that I can't think of anything INHERENTLY life threatening about being the wrong gender, other than (and I'm not saying these are small issues) one's own psychology and possible behaviour.  

            And I'm not trying to get in a bleeding heart contest either.  The world is so hosed up, there are too many issues to bleed for for all of us.  Getting emotionally tied in every one of them is a sure way to wind up catatonic.

            While it's a wonderful principal to say you don't leave anyone in the cold for reasons of fairness, the reality is that health care access isn't unlimited, and people will always be finding places to draw lines to try and get 'the most good' for 'the most people' out of it.

            Where that breaks down, is of course at the individual level.  If more people need help than can get it, somebody is going to get left out.  The real challenge lies in figuring out how to best draw that line.  

            And I don't have the answers.  I don't know whose approach is best.  Whether you backburner people with really rare problems, people with problems that take a lot of effort to fix, people whose problem - in the eyes of the person deciding - aren't important immediately.

            Hell, maybe we should switch to a big lottery system - anybody with a problem draws a number, and you get seen if your number is in range.  That way at least you wouldn't have human beings deciding whose problem needs treating and whose doesn't.

            Got a problem with my posts? Email me, and let's resolve it.

            by drbloodaxe on Fri Jul 13, 2007 at 12:15:53 PM PDT

            [ Parent ]

            •  eh... (2+ / 0-)
              Recommended by:
              Moody Loner, rserven

              As a trans chica, I had mixed reactions to your posts.  There was something that felt like a strain of transphobia, but there are real issues here (though we disagree about what they are), and an advocat diaboli serves a purpose.  Your statements helped me clarify my position a bit.  

              I found myself remembering all the docs I've dealt with, in various countries and at various points in transition and passability.  Maybe we'll get a single payer system here and have a chance to argue this out before a national or state board, which would be great.  But in the meantime...since you're treatin' folks...any and all medical professionals paying attention to how attitude and perception -- their own but other's too -- affect the care of transsexual people is a good thing.  A huge thing.

        •  It is my understanding that (2+ / 0-)
          Recommended by:
          rserven, jessical

          insurance companies do pay for gastric bypass - in cases where the appropriate doctors have signed off on it.

            Just my two sad cents,
                Heather

    •  So much for the modicum of respect. (5+ / 0-)

      I didn't expect it would last.

      Insurance? For whom? is open
      Teacher's Lounge Saturday, noon EDT

      by rserven on Fri Jul 13, 2007 at 11:22:00 AM PDT

      [ Parent ]

      •  well... (3+ / 0-)
        Recommended by:
        TiaRachel, rserven, Chacounne

        mine just went way up, for what it's worth(not that it was low or anything!!!)  This  brings it home to the issues people are talking about.  

      •  My apologies (1+ / 0-)
        Recommended by:
        rserven

        If you found my choice of words disrespectful.

        They were not so intended, nor written for any such purpose.
        As I've stated in replies to others, I wish you only the best happiness with whatever decisions you made, and hope that your choices have or will work out for you in the long run.

        Got a problem with my posts? Email me, and let's resolve it.

        by drbloodaxe on Fri Jul 13, 2007 at 11:30:24 AM PDT

        [ Parent ]

        •  I've changed my nind from the first impression... (3+ / 0-)
          Recommended by:
          TiaRachel, jessical, Chacounne

          ...I got from the parent to this thread.  The feather boas, etc, didn't catch me on my good side.  The most common occupations among transpeople who can remain employed, and hence are likely to be here reading this right now, are in education and computer services.  So those of us you are presently interacting with are not the feather boa type.  

          Insurance? For whom? is open
          Teacher's Lounge Saturday, noon EDT

          by rserven on Fri Jul 13, 2007 at 12:07:52 PM PDT

          [ Parent ]

      •  ummmm (0+ / 0-)

        I disagree with drbloodaxe, but he/she did (to my eyes) seem to be respectful.  Wrong, yes.  But not obnoxious.

        Of course, you may be offended by something I am not seeing.  If so, enlighten me.  

        Now up: What are you reading? Coming: What is it like to be LD? and WHYGTL?

        by plf515 on Fri Jul 13, 2007 at 11:33:06 AM PDT

        [ Parent ]

        •  Curse it all (2+ / 0-)
          Recommended by:
          rserven, jessical

          Why is everyone intent on saying that I'm the one waving a pitchfork and saying 'no gender reassignment'!

          I tried to make clear that this is an argument I feel is out there, not one I personally subscribe to :P

          I made a 'know your enemies' argument.  If you don't know what or why people think, you can't come up with logical reasons to refute them.  If you don't explore the talking points, you aren't prepared to combat them.

          If I know some miserable person who can't afford gender reassignment, but really feels they need it, I'll chip in.

          I already help a single mom on welfare because welfare doesn't pay enough, and share my living space with another person without charging rent because they make far less despite working as hard.  Quit trying to say I don't want to pay for folks to have what they deem necessary. :P

          I simply said that was one line of arguments, sheesh.

          Got a problem with my posts? Email me, and let's resolve it.

          by drbloodaxe on Fri Jul 13, 2007 at 11:40:30 AM PDT

          [ Parent ]

    •  I'm just going to say (2+ / 0-)
      Recommended by:
      rserven, jessical

      you really don't get it.

        My two sad cents,
          Heather

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