If you believe that prisoners should receive treatments deemed medically necessary by the American Medical Association, you should be fine with your tax dollars paying for Chelsea Manning’s sex reassignment surgery.
Just hours after BuzzFeed News reported that the transgender prisoner and former WikiLeaks source ended her hunger strike with assurances that the military would provide surgery, a predictable chorus emerged on the right. Their chief grievance: the allocation of tax dollars for a procedure that has long been recognized by major medical associations as a medical necessity for many transgender individuals.
Hot Air columnist Jazz Shaw bemoaned the “additional taxpayer funded medical expenses” that the surgery—which has not yet been officially confirmed by the military—would entail. Shaw went on to cite anti-LGBT physician Dr. Paul McHugh to claim that sex reassignment surgery is “dubious in its medical benefits at best.”
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Over on The Blaze, Jon Street was careful to refer to Manning's potentially forthcoming procedure as a "taxpayer-funded gender reassignment surgery."
Breitbart commenters have already worked themselves into a froth over the idea that the military would pay for Manning’s treatment, writing complaints like “I don’t want my tax dollars going to this!!!” and “Where is Congress. There is no way we the people should pay for this!”
On social media, too, the reaction was swift and kneejerk:
Of course, all of this is just an echo of what happened when Manning secured hormone therapy in February 2015. Breitbart announced, “Congratulations, Taxpayers, You Get To Pay For [Chelsea] Manning’s Hormone Therapy,” using her previous name instead of her chosen name in a flagrant violation of journalistic standards. And Russian news agency RT was sure to highlight in its headline that Manning’s hormone therapy would be “taxpayer-funded.”
According to the medical community, however, there is no question that both hormone therapy and sex reassignment surgery can be medically necessary for individuals suffering from gender dysphoria. In a statement to BuzzFeed News, Manning said her physician had recommended sex reassignment surgery in April 2016.
According to the American Medical Association, “An established body of medical research demonstrates the effectiveness and medical necessity of mental health care, hormone therapy, and sex reassignment surgery as forms of therapeutic treatment for many people diagnosed with GID [gender identity disorder].”
In a position statement, the American Psychiatric Association “[r]ecognizes that appropriately evaluated transgender and gender variant individuals can benefit greatly from medical and surgical gender transition treatments” and states its opposition to “exclusions of coverage for such medically necessary treatment when prescribed by a physician.”
As far back as 2007, the American Academy of Family Physicians argued that insurers should “provide coverage for comprehensive care” of transgender people including “mental health care, and, when medically necessary, gender reassignment surgery.”
And, according to the World Professional Association of Transgender Health, sex reassignment surgery “has proven to be beneficial and effective in the treatment of individuals with transsexualism, gender identity disorder, and/or gender dysphoria.” WPATH has repeatedly emphasized that this surgery can be “medically necessary.”
Even if you’re willing to dismiss the combined wisdom of the AMA, APA, AAFP, WPATH and other medical organizations as mere political bias, Manning’s surgery—if it takes place—is not likely to cost you very much money, as The Daily Beast has previously reported.
The municipalities and organizations that have disclosed the cost of providing transition-related health care have not seen much strain on their bottom line.
The city of San Francisco, for example, has been providing transition-related health care to government employees since 2001, initially estimating that there would be $1.75 million in claims annually. But a 2006 report found that there had been less than $77,000 in claims per year for the first five years. The cost per employee for adding this coverage was less than a dollar per year—so affordable that the insurer decided to “treat the benefit just as it does other medical procedures such as gallbladder removal or heart surgery,” according to then-mayor Gavin Newsom.
The surgery itself is not that expensive either. Some treatment centers provide sex reassignment surgery for transgender women for less than $20,000, including fees. The average cost of a knee replacement is over $10,000 more than that estimate.
So even though transgender rights are certainly controversial in the comments section, multiple major physicians’ associations agree that sex reassignment surgery is a well-established and often medically necessary form of treatment. And there’s no evidence that providing this treatment for all transgender prisoners—let alone a single one—would create a significant burden for the American taxpayer.
If you’re OK with Uncle Sam paying for prisoners to receive antidepressants or knee surgery or a CPAP machine, there’s no reason to get worked up over Chelsea Manning’s medical treatment.
