Define “gender-affirming”
Washington state now appears to allow minors to undergo life-changing gender reassignment surgery without parental consent.
Under a new law, health insurers must cover “gender-affirming” care, including surgical treatments that were previously denied coverage. Democrats rejected a proposal to apply the new law to patients over 18 years old.
So young Billy age 13 can get his penis lopped off and present his parents with a fait accompli? Seems a bit rash.
Up until this law, gender reassignment surgery and other procedures like facial reconstruction or laser hair removal were considered cosmetic by health insurance companies. Due to its classification as cosmetic, health insurers did not usually cover the procedures, even when doctors medically recommended them.
If only it were just “cosmetic.”
The source self-identifies as “conservative talk radio” but…sometimes the other team has its head up its ass.
This feels a little misplaced.
The law does not appear to have anything to do with what care doctors can or can’t provide, or when doctors must obtain parental consent. It’s just a question of what insurers must cover.
Whatever you think about whether and under what circumstances minors should get medical or surgical interventions for transgenderism, I think it’s really hard to make the case that insurers should be making the call. Insurers don’t have ethical duties, and they don’t give a damn about their insureds, they’re concerned with minimizing their expenses.
This would seem to make it easier for a minor to have radical surgery than an adult. Have I read this portion correctly?
Screechy, one portion I find absolutely alarming is the fact that this can be done without the insurer informing the parent, even though the child is on the parent’s insurance plan. Surely the policy holder has a role in decision making for members of their insurance plan?
Holms,
Why should the policy holder have any say? It’s not their money (ok, unless we’re talking about a deductible or co-pay).
Do you feel the same way if it’s a teenage girl getting birth control or an abortion?
And does the same principal extend to the provider of the insurance, i.e. the employer? Hobby Lobby and other employers have some very strong feelings about what kind of health care women employees should be able to get.
Screechy, birth control and abortion do not make a permanent change to the body. Cutting parts off the body is a much more lasting surgery than having an abortion.
Do I think the insurer should get a say? It has been standard for an insurer to have a say, but the only thing they have a say about is whether they will pay for it, not whether we can have it. I have some problems with that, because I don’t think my insurer should be able to elect to pay for one asthma medicine, but not another, when a patient has an allergy…as a for instance from my personal life. I do think medical care should be between the patient and the doctor, but parents are usually consulted with minor children.
I was not allowed to have my wisdom teeth out at the age of 17 years 11 months; I had to have my mother’s permission. That again is something much less serious than removing healthy breast tissue or penis tissue. When I had a major accident when I was 18 years, 1 month, I was not allowed to sign to have the surgery done. My parents had to come back from a function in another town to sign, even though my brother in law, who was over 21, was able to sign. If I didn’t have the surgery, I wouldn’t have walked again. This is, again, something much more medically necessary, yet I was not able to sign to have it done.
When my doctor planned my hysterectomy, he had to fill the forms out three times before he could get them to accept the surgery. Is that right? Not really, but there is a history of doctors overdoing hysterectomis, so I was actually somewhat glad for the extra level of caution.
No, I don’t think abortion or birth control can in any way compare with “gender affirming” surgery, because there is no permanent change that could render you a patient for the rest of your life. Especially since doctors are quite careful, in my experience, to discuss the risks and possible dangers of those treatments/surgeries, while hiding much of what we know about gender surgery. The child is not informed, and is signing away their future without knowing what it is they are giving away, and if they might want it back someday.
Washington state has a history of rash actions in this regard. For example, the opening of women’s toilets, changing rooms, etc. to men* was made legal by an unelected government committee (the Washington Human Rights Commission), not by a vote of the legislature or any kind of popular vote. They made “gender identity” a protected status, and although they claim that “men who abuse this rule to gain access to female spaces” are not protected by the rule, all that is required is that the men “identify” as female, so of course that proviso is meaningless. They claim that a period of public review was allowed, but I’m VERY interested in these things and I never heard a thing about it. It was kept quite hush-hush.
*To quote: “the rules apply to all employers who employ eight or more
employees. In a public accommodation situation, the rules apply to all places of public
accommodation, including (but not limited to) schools, gyms, public facilities, stores,
restaurants, and swimming pools, and the gender segregated facilities within those places of
public accommodation.”
Screechy, I am sure we would all prefer the system of American health care be radically different, where a person can get care without it involving private insurance at all. Until the necessary overhaul happens, American families are stuck with private insurance provided by the parents. In this environment, yes, I think it horrific that an insurance plan could possibly provide e.g. surgery to a child without notifying the parents.
You raise birth control and abortion by way of comparison, but I think those are only weakly analogous. One difference is that they do not involve making irrevocable changes to the child, making the ethical case of hiding from parents much less dire; another difference is that the expense of sex reassignment is orders of magnitude higher, which would make an impact on the parents’ insurance costs and so presents a practical difficulty in hiding the procedure from the parents.
I assume. I have no experience with the American system, so I am having to guess at some of the details… but surely a procedure costing tens of thousands of dollars would increase premiums or require out of pocket spending. Correct me if I am wrong there.
You also raise employer-provided health insurance. This is also alien to me, but I think it uncontroversial to say that the relationship of employer-employee is different to that of parent-child, and so different information protections apply. Parents have a greater right to know about the child than the employer does for the employee.
iknklast,
My point is not that “gender affirming care” is the equivalent of abortion or birth control.
I’m just saying that I think using insurance companies to be gatekeepers is a bad idea, and it doesn’t become a good idea just because you want to throw up a roadblock for a particular type of treatment for what you think (perhaps correctly) are excellent reasons. That is a weapon that will easily be used against treatments you do approve of, because insurers are not motivated by the same things you are.
But insurers are not responsible for getting informed consent, doctors are. Whether an insurer can inform the policy holder of the treatment is irrelevant to whether a physician can provide treatment without parental consent.
This highlights how language is such a big part of the problem. We call it “gender affirming care” as a euphemism for what should be more accurately (and soberingly) called something like “cosmetic cross-sex-imitating genital and chest modification surgery” (and accompanying lifelong pharmaceutical therapy). This “gender affirming” euphemism locks in the conflation between people’s biological sex and their sense of their “gendered” personality, almost invisibly, without people even noticing that’s what they’re doing.
(I do think there’s some use for the word “gender” in that I think masculine and feminine aren’t entirely useless terms to describe people’s personalities — there’s an observable difference between, say, a young man who gravitates towards taking a job selling cosmetics at Sephora and a young man who enlists in the Marines, and we could use a word for that, and the word “gender” seems about right to me I suppose. Or, maybe it did seem like the right word at one time, before its meaning got all blurred up with the transgender movement…)
When we present something so drastic as pediatric body-modification surgery as simply a natural and necessary “affirmation” of one’s “gendered” personality, people just nod along without noticing the horrific conceptual switcheroo that’s taking place: subtly, everyone’s been told that of course boys with “feminine gender expressions” need to have their penises surgically fashioned into superficially vagina-resembling orifices, and of course girls need to have their healthy developing breasts amputated. This is affirmation, and who but a religious conservative bigot wouldn’t want to affirm kids’ gender-diverse personalities?
And when we try to challenge supporters of this horror by pointing out the grotesqueness of it (and I have tried, so very many times), they shift the focus: they tell us there’s more to it than just declaring “feminine” boys to be girls and declaring “masculine” girls to be boys; they tell us we’re missing the secret ingredient: that it’s boys who are feminine and who ALSO feel deep down inside like they’re girls who they’re doing this to (and girls-to-boys vice-versa). But of course that’s a circular argument, because these are the same people teaching kids in the first place from a very young age that to feel in any way disinclined to embrace feminine stereotypes as a girl or masculine stereotypes as a boy is equal to feeling like the opposite sex, and therefore literally being the opposite sex and in dire need of urgent medical attention to fix the “problem”.
I’m in despair every day over what’s being done to these healthy normal kids. What a world we’re living in.
I think Screechy is saying basically like, “you” were mad about the PATRIOT Act but now want to use it on the Capitol rioters… Now you’re wanting to use the Hobby Lobby decision vs this shit… Kind of dangerous tools to be using.
Or am I missing something?
Screechy,
This isn’t about the vagaries of American health insurance companies’ corporate policies dictating policy, that’s backwards. This isn’t an arbitrary “making the call” (your words) by private Insurance companies. It’s a government-imposed legal decision regarding medical care for children. Medical care happens to operate through private insurance companies in America, so they play a central role, but that’s just a matter of the practical application of the law. Ultimately it’s government regulations that determine what is covered and what isn’t, and this is pretty much the same no matter what kind of health care system your government happens to have.
In the real world, when the government instructs whichever body pays for medical care to remove all barriers for a child to opt for and be covered for a medical procedure without parental consent, that’s the same as greenlighting children to opt for and be covered for that medical procedure without parental consent. In Canada, that happens to be provincial Health Ministries that run our government-subsidized health insurance plans; in the UK that’s the federal NHS that runs the whole medical sector from top to bottom; in the US it’s a mishmash of weird private corporations. But the effect is the same: if the government instructs the administrators to remove barriers for children to lop off their genitals without telling mum and dad, that’s exactly what you’ll get.
As for your comparison with abortion and birth control, I guess you’re confusing medical providers choosing to refuse to provide (or pay for, which is the same thing at the end of the day) services like abortion or birth control with medical providers legally having the choice to refuse such services taken away from them.
We’re not enabling parents or health insurers to make decisions about what children can and can’t do, we’re taking those decisions away from parents and health insurers. Quite a significant distinction there. Because the argument for ensuring underage girls can unilaterally opt for abortions and birth control is an established and solid one, and the argument for allowing underage girls and boys to unilaterally opt to carve up their bodies because of “gender” anxiety is nowhere near the same level of ethical consensus.
To support Arty’s argument, Screechy, the insurance companies are already making the call, about this and a million other medical questions. Questioning whether they should make calls would be a different debate. What’s up for debate now is which call the government will require insurance companies to make when a child wants surgery on his body because he thinks he’s trans.
In this case, the Washington state law appears to order insurance companies not to communicate directly with parents (policy holders) about sensitive health care matters (such as their kids wanting their penises cut off), if their kids request such confidentiality.
Here is SB 5889:
https://lawfilesext.leg.wa.gov/biennium/2019-20/Pdf/Bills/Senate%20Passed%20Legislature/5889-S.PL.pdf?q=20201113082521
I find one of the key paragraphs to be this one:
It does not answer the question of whether a child has the right to consent to what is euphemistically called “gender-affirming care,” i.e. having his penis cut off because he thinks he’s trans.
Minors in Washington state may consent to some medical treatments, but may not consent to others. Some are determined by age. For example, minors over 14 may get STD tests and treatments per their own consent.
https://depts.washington.edu/uwhatc/PDF/guidelines/Minors%20Health%20Care%20Rights%20Washington%20State.pdf
Under 14, and they would require their parents’ consent.
Minors can get, or refuse, birth control services at any age without their parents’ consent.
The bill does not answer the question of what is the age at which a person may give consent for transgender surgery. I’d be interested to see someone substantiate the idea that that age is younger than the age at which they could, say, be tested for STDs. I expect it will end up being decided in court.
Per this bill, the insurance companies aren’t supposed to tell kids’ parents if they get “sensitive health care.” How this is supposed to work is perplexing. The parents will still have to pay the bill. If there’s a charge on it that they don’t recognize, they may well dispute it. I don’t see “You have to pay it, but you can’t know what it is” as standing up in court forever.
In other WA state bills, the government has ruled that insurance companies are prohibited from refusing to cover transgender surgery as long as any doctor says it’s “medically necessary.”
https://lawfilesext.leg.wa.gov/biennium/2021-22/Pdf/Bills/Senate%20Passed%20Legislature/5313-S2.PL.pdf?q=20220112023046
We know how craven TRA doctors are; you can always find one who will say chopping a child to bits is medically necessary. But the piece I’m still missing here is the age at which a child may consent to these procedures. This bill only says that if a child can consent to these procedures, he can tell you not to tell mum and dad about it.
Screechy, we crossposted and so you may have missed my reply to you at #6. Do you think this adequately answers your questions?
If there’s any way this new law makes sense, it’s for minors to get surgery, then their parents find out, then it’s too late to stop the surgery.
Holms,
I understand (and understood all along) the argument you and others are making. I just disagree with it. I think you’re all letting your feelings on trans issues override broader principles. But I’ve made that point and am content to leave it there.