Since Tommy Douglas fought valiantly for the right of universal health care, Canadians have been blessed to know that in times of illness our medical needs would be covered by the state. Universal health care has become one of our most cherished social benefits. Though the tax burden is high and there are faults within the system regarding wait times for procedures, no Canadian is turned away from a doctor or a hospital in a time of need – unless, of course, they happen to be transgender.
After repeated slash-and-burn budgets by former premier Ralph Klein, in which he attacked the poor under the guise of balancing the budget and the decline of the oil sands revenue, the province of Alberta is once again in a position where it must run a deficit budget. Alberta is Canada’s most conservative province and so it comes as no surprise that the government has decided that the delisting of sex reassignment surgery is a justifiable sacrifice in an effort to save seven hundred thousand in a twelve point nine billion dollar healthcare budget. With a total deficit of four point seven billion what does cutting seven hundred thousand really accomplish?
When the province of Ontario delisted sex reassignment surgeries it was a ten-year battle to get them re-approved. Only when Ontario lost a human rights case was it forced to once again cover the surgeries.
Biatric surgery was also delisted at the time and fat activists argued that their surgeries were necessary because they were life and death whereas; sex reassignment surgery was presented as merely cosmetic. Despite the fact that the trans community as well as medical professionals have repeatedly stated that sex reassignment surgery is a necessary procedure for those diagnosed with transexualism according to DSM guidelines, there is a public failure to acknowledge its importance in an effort to maintain cisgender privilege.
By framing sex reassignment as cosmetic, those that are opposed to recognizing its importance are able to argue that tax dollars are only meant to cover necessary procedures. There is, however, a large difference between a face-lift and sex reassignment surgery.
“Dr. Lorne Warneke, the only psychiatrist in Alberta who specializes in transgender issues, says it’s a common misconception that gender reassignment is elective surgery and therefore shouldn’t be funded by taxpayers.
“It’s not. It’s a well-known condition that people are born with,” he says, adding that if left untreated, it “can cause tremendous psychological anguish and distress.”
Warneke, who runs the transgender clinic at Grey Nuns Hospital, was not consulted or even notified that the funding would be cut”. [source:Edmonton Times]
The tax argument is specious as well, because in order for this position to be valid it would mean ignoring the fact that the trans community works and pay taxes that support our medical system. The government of Alberta is well aware that when this policy gets challenged they will lose, because precedent has already been set in Ontario.
By enacting this policy even temporarily, the government is oppressing bodies that it deems less than, because it has the ability to do so and not because it will result in any significant budget cuts. Finding seven hundred thousand in a budget this large could easily be done by examining some of the bureaucracy involved. Yet Alberta has a long history of attacking the GLBT community and this policy is just one in long line of affirming cisgender, heterosexual privilege.
The government has agreed to pay for those already on the waiting list, but those who have yet to qualify will be expected to pay a fee between eighteen and twenty thousand out of pocket. This comes as a great hardship to many members of the trans community who are either unemployed or seriously underemployed – due to discrimination. Even at the previous rate of sixteen approved surgeries per year, many trans people faced long wait times to have a procedure that is medically necessary.
The delisting of sex reassignment surgery tells us that we can never become complacent because we have been granted a right by the law. It further highlights the fact that there is a great misunderstanding of the issues that the transgender community faces, despite clear medical documentation.
Though we claim to have a commitment to equality, the ease at which we can dismiss the needs of a minority section of our population reifies our belief in the tyranny of the majority. Liberty must continually be reaffirmed as those that seek to assert their undeserved privilege will not be content until all marginalized bodies are suitably repressed.
Not that it should make a difference when people’s lives are at stake, but the costs of ongoing psychiatric treatment, social assistance, etc. for people unable to get surgery often end up being much more than the cost of surgery itself. Denying treatment for a treatable disorder and forcing people to live in a limbo where they can’t function as productive members of society has it’s own very real costs to the government.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association (APA) is the “standard classification of mental disorders used by mental health professionals”. It’s widely used by mental health professionals worldwide, including clinicians and researchers as well as insurance companies, pharmaceutical companies and policy makers. In this context it’s a hugely influential document which includes five different diagnoses for ‘Gender Identity Disorder’ (GID), or gender dysphoria – the medical condition which, in its long-term, extreme manifestation is known as transsexuality.
And although it’s far from perfect, it does at least formalise access to medical services, including GPs, therapists, medication (eg HRT) and surgery. Most of the comparatively few rights and protections that exist for trans people are there mainly because they are in the DSM.
At the moment, the DSM is under review pending the publication of DSM-V (scheduled for 2012), and one option being considered by the APA’s Sexual & Gender Identity Disorders Work Group is to declassify GID entirely; in other words, it would no longer fall under the category of a medical condition and would therefore no longer be deemed a suitable subject for funded surgery and other appropriate treatment.
In addition, declassification may pave the way for a concerted attack on trans people: our rights to correct our birth certificates, to marry in the correct gender, even to work near children, could be withdrawn because trans women will be nothing more than “self-mutilating male perverts or gays” (according to the APA), no matter what the practising and experienced gender specialists might say; and no matter that we are already anyway stigmatised by our condition being categorised as a mental disorder.
I can’t help but wonder if the decision by the government of Alberta is a preemptive move, made on the presumption that GID will be declassified in the DSM-V and that there will be no valid reason to object to the removal of its treatment from funding.
Alberta is not the only authority following this path: in the UK, the Oxfordshire Primary Care Trust (PCT) has been operating what amounts to a blanket funding ban on core surgical procedures for gender dysphoria treatment. Since December 2006, one patient has been granted GRS, but only after taking legal action. (Via). And in Michigan, the Blue Cross Blue Shield health insurance company has recently received permission from state regulators to change the insurance policies it offers, and the withdrawal of coverage for surgery for trans people was one of those approved changes. (Via).
A more cynical person than I might be forgiven for thinking that financial argument is a red herring, and that Alberta’s decision is part of a growing trend towards preemptively withdrawing access to procedures which have been proved beyond doubt to be hugely successful in alleviating the condition.
Although the commenter above makes a good point – that there may be a corresponding increase in the costs of ongoing medical treatment in other areas – my further concern is that the removal of surgical treatments by declassification may be accompanied by a skyrocketing of the numbers of suicides amongst trans people.
I have undergone the “sex change” surgery and it solved nothing, but did make me realize I needed psychotherapy, not removing body parts, they were correct to stop funding the surgery, it is not required as “treatment” at all.
Walt Heyer
I’m normally a very smiley person, but the classification of srs as a “cosmetic” surgery makes my face turn into a very ugly thing indeed. And this isn’t just in Canada either, America as well I believe, rest of the world? A nose job is cosmetic, a face lift; cosmetic, tightneing your face when you’re 70, that’s cosmetic. Putting SRS with these reinforces the idea that Transsexuals are just weak, undecided, possibly desiring to be sex object, or have a wierd fetish. It degrades the seriousness of an entire, albeit small group of people. I hope that very few people go out and say, I think I would be a better person if I went out and got a sex change. And not life or death, really? Do you know the suicide rate of teenage transsexuals? I think it’s something like 4 times more than the average, and somewhere around 60%-80% of transsexuals have attempted suicide by the time they turn 20. But hey, lets concider this cosmetic.
And Walt, no offence, but your opinion is not representitive of all, It is possible that you are not a transsexual, there is a portion of post-ops who regret the procedure, though it’s not actually as big as some would like people to believe. Also, surgury is not necessary for all. I don’t think any individual experience can say that SRS is not a necessary surgury for anyone but yourself.
I am 16 and pre-op, pre hormone, and… technically decloseted….well…. that didn’t go well… Before I started researching, and was really aware of a possibility of change (SRS etc)I was really, really depressed (borderline suicidal), for well over a year actually. Meaning very depressed for over a year, lesser depressions previous to that. Now that I have the possibility of leading a “correct” life, I am so much better, consistantly healthy. Unfortunalty, though it’s not all bad, I am going to have to work my ass off for a year between hs and college (10+ work days 6 days a week living in very minimalist conditions; actually a very valuable experience i think) in order to afford SRS etc, because SRS is like a face lift apparently, and the transphobic community doesn’t want to pay for our “cosmetic sugery” And i get not wanting to pay for other peoples things, but, if we’re going to pay for a decent healthcare system, why exclude a group of people?
Also on my list of horrible things; hormones are illegal for people under 18, that is, post puberty, 12-14 being the ideal age to start, but no….
Anyway, sorry for ranting a bit there, just, this is one more thing to add to the onslaught of slanders and igrnorant beliefs thrown by those uneducated our particular situation. Once upon a time, people thought that the “gay” virus was sweeping the nation, and the best inoculation was a good dosage of phyciatric care. Now, people who believe “gay” is a choice are looked down upon for their ignorance. Alas, we have no such condecending glaze to ice our cake of identity. (aaahahaha, you thought I’d slipped you a malapropism there!!! Nope, I actually meant glaze, not gaze =-)
Anyway, have a good night all, and a good morning too while we’re at it =-)
Oh, another happy stat for y’all; guess the demographic that suffers the most physical violance and murder? If you guessed the scary-ass clown form Kings, “It” you should be right, sadly, it’s……(went through a tunnel, but I’m sure you can guess.
There is again a radical group of trans activists that are [again] pushing for the removal of SRS from the DMV.Do these people, who also are against the delisting, not realize that if SRS is removed from the DSM, then there will be no justifiable reason for asking the Govt to relist surgeries.I realy feel for the poor people that are getting drawn inocentley into this.403-346-8858
Dana