[guest post by Dana]
This past week saw the Obama administration end a 33-year ban on Medicare coverage for gender reassignment surgery. Clearly, this is a victory for transgender rights.
The ban had been put in place when gender reassignment surgery was considered risky and experimental. Medical professionals now consider it a relatively safe option for those suffering from gender dysphoria.
As private insurance companies tend to follow Medicare’s lead, there is a likelihood we will begin to see a shift in coverage.
Although Medicare coverage is only for people 65 and older, and the transgender population makes up only about 0.3 percent of the U.S. adult population, private insurance plans often take their cues from Medicare on what should be considered a medically necessary covered treatment. As a result, the ruling is likely to open up more options for transgender individuals although very few people opt for the complicated surgery.
What caused delays in lifting the ban were the challenges made by conservatives and religious groups. Certainly, lifting the ban will ignite further debate: What defines a “man” and a “woman”? Is it malleable? Is the taxpayer obligated to subsidize deemed “medically necessary surgeries” such as this?
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.
One of the attorneys who worked on the case — which was filed by the American Civil Liberties Union, Gay & Lesbian Advocates & Defenders and the National Center for Lesbian Rights — said that decades of bias and prejudices have resulted in a crisis in health care for some transgender people.
“For someone who cannot get treatment, the impact can be devastating,” Jennifer Levi said. They can be depressed, have serious problems with self-esteem, and have difficulty working and forming social relationships, she added.
So, like it or not, the debate about transgenders is here to stay. With that, this past week the discussion ratcheted up a few notches with two notably different views being aired.
Time debuted its first transgender cover with Laverne Cox, an actor starring on the Netflix drama Orange Is the New Black. Cox has become the public face and spokesperson for the transgender community. Laverne Cox’s personal story is a sad one that includes being raised by a single mother, being bullied and beaten up in school, an attempted suicide in later years, and a pivotal moment in third grade when the teacher called Laverne’s mom, telling her,
‘Your son is going to end up in New Orleans wearing a dress.’
Cox summed up the moment,
Up until that point I just thought that I was a girl and that there was no difference between girls and boys. I think in my imagination I thought that I would hit puberty and I would start turning into a girl.
Cox shares her outlook on societal views and perceptions of the transgendered and needed changes in said perceptions,
Folks want to believe that genitals and biology are like destiny! All these designations are based on a penis, however many inches that is, and then a vagina. And that’s supposed to say all these different things about who people are. When you think about it, it’s kind of ridiculous. People need to be willing to let go of what they think they know about what it means to be a man and what it means to be a woman. Because that doesn’t necessarily mean anything inherently. Folks are just really uncomfortable with that sense of uncertainty, or that shift.
In response to the Laverne Cox story, NRO’s Kevin D. Williamson rolled out his thesis, boldly titled Laverne Cox Is Not A Woman and as a result, has received some vicious tweets. His premise is as follows:
The obsession with policing language on the theory that language mystically shapes reality is itself ancient — see the Old Testament — and sympathetic magic proceeds along similar lines, using imitation and related techniques as a means of controlling reality. The most famous example of this is the voodoo doll. If an effigy can be made sufficiently like the reality it is intended to represent, then it becomes, for the mystical purposes at hand, a reality in its own right. The infinite malleability of the postmodern idea of “gender,” as opposed to the stubborn concreteness of sex, is precisely the reason the concept was invented. For all of the high-academic theory attached to the question, it is simply a mystical exercise in rearranging words to rearrange reality.
Thus concluding that Cox is not a woman, but rather an effigy of a woman.
Sex is a biological reality, and it is not subordinate to subjective impressions, no matter how intense those impressions are, how sincerely they are held, or how painful they make facing the biological facts of life.
The trans self-conception, if the autobiographical literature is any guide, is partly a feeling that one should be living one’s life as a member of the opposite sex and partly a delusion that one is in fact a member of the opposite sex at some level of reality that transcends the biological facts in question. There are many possible therapeutic responses to that condition, but the offer to amputate healthy organs in the service of a delusional tendency is the moral equivalent of meeting a man who believes he is Jesus and inquiring as to whether his insurance plan covers crucifixion.
Labeling it a delusional tendency certainly isn’t winning him any fans, but Williamson sticks to his guns. His concern is the impact and weight on society.
The mass delusion that we are inculcating on the question of transgendered people is a different sort of matter [than homosexuality], to the extent that it would impose on society at large an obligation — possibly a legal obligation under civil-rights law, one that already is emerging — to treat delusion as fact, or at the very least to agree to make subjective impressions superordinate to biological fact in matters both public and private.
As a matter of government, I have little or no desire to police how Cox or any other man or woman conducts his or her personal life. But having a culture organized around the elevation of unreality over reality in the service of Eros, who is a sometimes savage god, is not only irrational but antirational. Cox’s situation gave him an intensely unhappy childhood and led to an eventual suicide attempt, and his story demands our sympathy; times being what they are, we might even offer our indulgence. But neither of those should be allowed to overwhelm the facts, which are not subject to our feelings, however sincere or well intended.