Patterico's Pontifications


Now In The Public Square

Filed under: General — Dana @ 6:35 am

[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.


60 Responses to “Now In The Public Square”

  1. The much prettier Dana wrote:

    Clearly, this is a victory for transgender rights.

    And what about taxpayer rights? This is clearly elective surgery.

    The Dana trying to get in the first comment (3e4784)

  2. There are political battles worth fighting. This is not one of them. Every day we taxpayers subsidize things we’d prefer not to–some of them really big expensive things. The affected with this Medicare change are, and will always be tiny tiny subset of the population. In the immortal words of Paul McCartney, sometimes it just works best to “let it be”.

    elissa (8fc081)

  3. Mr Williamson wrote:

    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.

    People are more than just their genitals, and are very much defined by their experiences growing up. Someone like Bradley Manning, regardless of how much he believes he should be female, is biologically male, physically male, and has grown up with the experiences of being treated as a male for his entire miserable lifetime. Some butcher can castrate him, and stick fake tits under his skin, but he still won’t be a woman; he’ll be a castrated male.

    And please note my use of language: he will always be a male, but he was never a man.

    The Dana trying to get in the second comment as well (3e4784)

  4. It was Bradley Manning, by the way, who provided the information the New York Times used to tell us who the 5 released Taliban were. (otherwise it might not be known because it is classified))

    Manning’s leak of a 2008 U.s. government assessment may not be the only source of information – it was not cited by other newspapers.

    Sammy Finkelman (c3c6b4)

  5. It is worth considering what biological differences mean as medicine gets better at these kinds of surgeries. If functional transformations become routine, why would this be of interest to those not involved?

    Kevin M (b357ee)

  6. It’s not a win for transgender rights. It’s a win for mentally ill individuals to get elective cosmetic surgery at taxpayer expense.

    egd (2130a5)

  7. Will Dr. Frankenstein be the new Surgeon General?

    askeptic (8ecc78)

  8. @Kevin M

    Biological reality indicates that we are male or female, down to our DNA. However good medical science gets, that fundamental reality will not change. There are a large number of physical changes that occur very early in development as a result of biological sex. Those changes cannot be erased.

    Our minds are powerful instruments, and they allow us to react to and to some extent shape reality, but they do not alter reality. Some things can be changed by us, but our own sex is not one of them. It’s ironic the way people, in the same breath, claim that there is or should be no difference between men and women and then insist on having serious surgery and an accompanying host of hormone treatments in order to cross a line they claim is nonexistent or unimportant. They also tend to adopt the stereotypical traits and behaviors of the other sex (in this case having long hair and wearing dresses), while claiming there is or should be no different in traits or behaviors.

    This is a line that should not be crossed, because this way madness lies. There is no real difference between the idea that I am what sex I say I am, regardless of biological reality, and the idea that I am what species I say I am, or that I am what height I say I am, or what blood type.

    I feel sympathy for people with this disorder. A truly compassionate society would teach people to accept reality and help them cope with whatever mental problem causes them to feel a disconnect between their inner world and the real world. Some people want to amputate healthy limbs because of their mental problems; we should no more indulge that impulse than this one.

    Rob (aefa16)

  9. Speaking as a gay man, I’d like to see some studies on the mental health of transgenders after the surgery.

    As in, does it help. More than a placebo.

    I know plenty of TGs, and there but for the grace of God go I; and man, do they run up the therapy bills.

    luagha (5cbe06)

  10. a senior legislative assistant with the Family Research Council,

    That’s where I tuned out.

    carlitos (e7c734)

  11. “That’s where I tuned out.”

    carlitos – Always makes sense to shoot the messenger and not pay attention to the message. Bravo!

    You show consistency in avoiding messages of those denying anthropogenic climate change. The ostrich strategy can eliminate cognitive dissonance. It’s one of Sammy’s favorites.

    daleyrocks (bf33e9)

  12. What the hell does climate change have to do with the FRC? Is this one of those “look, a squirrel” thingies? The FRC are execrable. They want to take human rights back 2000 years. Screw those assholes.

    carlitos (e7c734)

  13. Since it is becoming mandatory for Americans to support, subsidize and cheerlead for transexuals, I have to wonder what we will do when people begin declaring that they are of a different race. If I can unilaterally declare myself a woman (as appears to be the case in California schools), why cannot I declare myself to be black? Or Mexican? Why can’t I take advantage of affirmitive action set-asides for minorities, even though I am whiter than a mayonnaise milkshake? If we can ignore–or actively deny–chromosomes, why not melanin?

    I am sure that liberals will have some clever rejoinder as to why this is not the same (such as “Shut UP!”.) Ah well, give it a few years and we’ll see.

    The Other Andrew B (5f9e7b)

  14. We are all ‘White Hispanics’ now.

    askeptic (8ecc78)

  15. Everyday I need to bang my fricken skull on the table.

    mg (31009b)

  16. Rob (aefa16) — 6/2/2014 @ 9:52 am

    Some people want to amputate healthy limbs because of their mental problems; we should no more indulge that impulse than this one

    And surgeons will do it. Maybe tehy “understand” too much. Even if there is areal problem.

    Sammy Finkelman (d22d64)

  17. very few people opt for the complicated surgery

    Hmmm… are they going to try and market this surgery more better?

    That would be interesting – like how they did with food stamps, and I bet it’s exactly what they do. National Soros Radio loves this approach when it comes to the expansion of fascist social programs – for example…

    Still, Rosenbaum says only 79 percent of those eligible for food stamps receive them.

    So expect to see some fresh-faced piece of ivy league trash given the portfolio of “outreach” to make sure everyone who is in need is connected with the Chineser-funded operations and hormones et cetera.

    Or maybe the failmerican leviathan simply has bigger fishy fishy fish to fry. We’ll see.

    But what we know for certain is that ultimately failmerica will become a country where the State has the wherewithal to chop off your junk and give you boobies.

    And after what happened at the IRS, this is a little worrisome.

    happyfeet (8ce051)

  18. This seems like a great idea for use of taxpayer $$$$$$$$

    JD (065ca0)

  19. “What the hell does climate change have to do with the FRC?”

    carlitos – Derp. It’s about not reading sources which contradict your point of view. You don’t like what the FRC says and neither do I on everything, but that does not mean I automatically will not read what they say. The SPLC publishes pretty much pure lies, but I will still read the lies before having to shower to see what lies they are peddling because a lot of brain dead people apparently believe the lies. You take a different approach.

    daleyrocks (bf33e9)

  20. carlitos – Can you say “epistemic closure?”

    Sure you can.

    daleyrocks (bf33e9)

  21. the Family Research Council helps make it to where normal people hate the Republican party

    in this sense for sure yes they are a hate group

    happyfeet (8ce051)

  22. “I’d like to see some studies on the mental health of transgenders after the surgery.”

    I read an article a while ago about Johns Hopkins not doing sex changes anymore because they don’t really help — a nontrivial percentage end up wanting to go back, and suicide risk is pretty much the same after as before. What was interesting was the way they approached the question in a rational way, i.e. does this help in practice, rather than focusing on how people feel.

    Can’t find the article within a couple of minutes though. Saw it linked on Richochet a year or so ago, it was written I believe by the person who was in charge of making the decision about discontinuing the surgery.

    Rob (1858aa)

  23. I might consider “sex change” to be an accurate statement when they can put a vagina and ovaries in the proper place in someone with an X chromosome and a Y chromosome, and the body accepts it.
    Until then, calling such a person “female” is no more accurate than referring to a barrow that stands for a boar as a sow or gilt.
    “Male” and “female” refer to biological function, not what clothes someone wears or if some inert material got stuck in their body.

    Ibidem (3ede5e)

  24. Mr. Feet – Those words “normal people” don’t mean to most people what I think you mean.

    daleyrocks (bf33e9)

  25. do too

    happyfeet (8ce051)

  26. Andrew B@13:
    If you read the papers that ask for racial information closely, a good number of them ask what race or races you identify with (or “primarily identify with”).

    I’m glad they started acknowledging that people can be of more than one race; I wish the government could just stop asking…
    Anyhow, I’m about 1/16 Native American (various Algonquin tribes), but a whole lot more than 1/16 proud of it. 😉

    Ibidem (3ede5e)

  27. Now they/we will also have to cover the reversal of gender reassignment surgery. Right?

    Amphipolis (d3e04f)

  28. 27. Of course. Anything the doctor ordered.

    Sammy Finkelman (d22d64)

  29. Johns Hjopkins stopped doinmg this sometimes before 2004.

    It quotes something written by a Dr. Paul McHugh, psychiatrist-in-chief at the Johns Hopkins Hospital from 1975 to 2001.

    Sammy Finkelman (d22d64)

  30. Article in “First Things” 2004:

    This information and the improved understanding of what we had been doing led us to stop prescribing sex-change operations for adults at Hopkins”much, I’m glad to say, to the relief of several of our plastic surgeons who had previously been commandeered to carry out the procedures

    Sammy Finkelman (d22d64)

  31. calling a dog a cat doesn’t make it a cat … Cox is a male not a female … no matter how many surgeries he has …

    JeffC (8ad636)

  32. i’m perfectly happy calling Laverne a she.

    She doesn’t need to have any surgery at all.

    I question two things.

    Why the whole T thing gets tacked on to L, G and B.

    Why the borkedick fascist government of America needs to get involved here.

    I also wonder why I never heard of “Canadian Style Sour Cream” til yesterday.

    God bless America that’s the stuff.

    happyfeet (8ce051)

  33. carlitos – Derp.

    It’s not worth my time to post link after link after link that the FRC are assholes. Feel free to read their nonsense, but don’t call me closed-minded for avoiding their shit. I hope that Gary Bauer dies in a car accident.

    The SPLC publishes pretty much pure lies


    carlitos (e7c734)

  34. “do too”

    Mr. Feets – Ima need some Venn Diagrams.

    daleyrocks (bf33e9)

  35. expletives edited for moderation:

    carlitos – Derp.

    It’s not worth my time to post link after link after link that the FRC are a$sholes. Feel free to read their nonsense, but don’t call me closed-minded for avoiding their $hit. I hope that Gary Bauer dies in a car accident.

    The SPLC publishes pretty much pure lies


    carlitos (e7c734)

  36. made myself a strawberry-soda water with my soda-stream, carlitos. Quenched my thirst, thank you very much.

    mg (31009b)

  37. you really just need the one of these things is not like the other song Mr. daley

    happyfeet (8ce051)

  38. Gary Bauer is not a nice man

    happyfeet (8ce051)

  39. Stranger. Danger.

    happyfeet (8ce051)

  40. Good point about race. I am sure the amount of DNA involved in determining the amount of melanin in skin is far less than a whole chromosome.

    carlitos, how tolerant of you.

    It is not primarily a political question, but I bet many more people are sympathetic with males sharing a locker room with only biological males and females sharing locker rooms with only biological females, than saying the way to accommodate the needs of one child is to make an entire school act as it everything is normal, when its not.

    MD in Philly (f9371b)

  41. :roll:

    nk (dbc370)

  42. carlitos – You misspelled epistemic closure.

    daleyrocks (bf33e9)

  43. i misspelled *brokedick* above up there

    happyfeet (8ce051)

  44. Mr. Feets – I misspelled “Is that the bigoty, hatey, shutuppery hill you want to die on?”

    daleyrocks (bf33e9)

  45. practice practice practice

    happyfeet (8ce051)

  46. this article the hotairs found today talks about what a hateful horrible person Gary Bauer is

    it is very interesting to read

    happyfeet (8ce051)

  47. Speaking as a gay man, I’d like to see some studies on the mental health of transgenders after the surgery.

    As in, does it help. More than a placebo.

    I know plenty of TGs, and there but for the grace of God go I; and man, do they run up the therapy bills.
    luagha (5cbe06) — 6/2/2014 @ 10:11 am

    I concur with this. By all accounts, transgenders have an extremely high suicide rate. Of course, most surveys are done for political purposes, but still, as laugha observes transgenders run up the therapy bills.

    The political surveys will assert that all transgender issues and stresses are caused by prejudice. But maybe gender dysphoria is actually a disorder, and like all mental disorders comes with a whole package of issues.

    Would surgery have helped this guy?

    …“I thought it was 1999 . . . and I was sure as hell that I was a man,” Ennis said in the e-mail titled “Not Reportable, Very Confirmed.”

    “Fortunately, my memories of the last 14 years have since returned. But what did not return was my identity as Dawn,” said Ennis, who had been wearing lipstick, skirts and heels.

    “I am writing to let you know I’m changing my name . . . to Don Ennis. That will be my name again, now and forever. And it appears I’m not transgender after all.

    “I have retained the much different mind-set I had in 1999: I am now totally, completely, unabashedly male in my mind, despite my physical attributes,” he said.

    “I’m asking all of you who accepted me as a transgender to now understand: I was misdiagnosed…

    Are we really helping people when we tell them they really are men trapped in women’s bodies, or women trapped in men’s bodies? And then carve them up accordingly?

    If I woke up tomorrow and decided I was Napoleon, would I have a taxpayer-funded right to my own country? Why is this the one disorder we pander to?

    Steve57 (61329d)

  48. No, Monsieur L’Emperor, you lost that war. C’est la vie, c’est la guerre. Vive La Republique!

    nk (dbc370)

  49. I misspelled “Empereur”.

    nk (dbc370)

  50. There is some SF that explores ubiquitous body-altering surgery. John Varley’s Nine Worlds series, for example. There is also LeGuin’s classic “The Left Hand of Darkness”, about aliens that naturally change sex during their lives.

    Right now, one REALLY has to have giant problems to even consider sex-change surgery (not to be confused with medically necessary sex-assignment surgery). But suppose the barrier was far lower, even trivial, and reversible. I don’t think I’d try it, but some might.

    Just sayin’

    Kevin M (b357ee)

  51. “Empereur”.

    I believe it’s “Chimperor.” :)

    carlitos (e7c734)

  52. Man, it was a little chilly last nite.
    Must be all that global warming.
    Or whatever.

    Damn SUVs !!!1!

    Elephant Stone (6a6f37)

  53. The MN GOP evidently has no interest in my vote. Shocked I am.

    Surrendering and suing for peace is so passive-aggressive. Let’s just have their babies.

    gary gulrud (46ca75)

  54. Gary Gulrud,

    C’mon, you don’t think that Al Franken is all that bad.

    Elephant Stone (6a6f37)

  55. 54. Like I said, ages ago, I don’t vote for the enemy. That he/she/undecided might be your friend is immaterial.

    gary gulrud (46ca75)

  56. Gary Gulrud,

    Your utopian aspirations remind me a lot of the paradise on earth which is the objective of…nevermind.

    Elephant Stone (6a6f37)

  57. 56. You’ve confused me with another.

    gary gulrud (46ca75)

  58. Gary,

    No, you’re definitely a utopian. You demand paradise in the voting booth.

    Elephant Stone (6a6f37)

  59. How long until someone is denied life-saving care so a lunatic can have their genitalia mangled?

    This is why the world seems so crazy — we indulge lunatics in their delusions.

    Rob Crawford (45d991)

  60. these procedures are too rare and infrequent as of today to appreciably tax the healthcare system Mr. C


    a good exercise for to understand how rarely this problem actually arises is to go door to door until you find a man who feels like a woman trapped in a man’s body

    pack a lunch

    happyfeet (8ce051)

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