Insurance Exclusions for the Treatment of those Diagnosed with GID Should be Illegal in the US

My opponent, The Contender ("Contender") relies upon a single article from the NYTs "Health Guide." In fact, Contender relies on a single paragraph in this article: "Treatment: Individual and family therapy is recommended for children to create a supportive environment at home and in school. Individual and, if appropriate, couples therapy is recommended for adults. Sex reassignment through surgery and hormonal therapy is an option, but identity problems may continue after this treatment." Conceded are the following points: 1.Gender Identity Disorder, as it was called in the DSM-IV, is real. 2.People with GID are very often denied treatment. 3.This transgender population suffers from a variety of very real difficulties related to their condition. 4.Banning such exclusions would not significantly increase premiums for cis-gender premium payers. (Trans " to move across; cis " on the same side; cis-gender people do not have a disconnect between their gender identity and biological selves.) 5.In fact, I argued without reply that banning such exclusions would cause the trans population (between .3-1% of the US population), to be more likely to get insurance and be less likely to forgo insurance thereby burdening the medical system with more uninsured patients. Therefore, the ban can be justified on practical grounds without going any further in this debate. Contender argues it would be "unfair" to provide coverage for GID treatment because (i) it"s optional in the same sense as cosmetic surgery and (ii) a cure is not guaranteed. Of course, in one sense most surgery is "optional" and very rarely is a cure "guaranteed." Contender ignores the paragraph immediately following the portion of the Health Guide Contender cites. This section says, "Diagnosing and treating this disorder early can reduce the chances of depression, emotional distress, and suicide." http://www.nytimes.com... The vital nature of the problem is clear: "Transgender people, people who feel that their biological sex does not reflect their true gender, have astonishingly high rates of mental health problems: A 2010 survey found that 41 percent of transgender people in the U.S. have attempted suicide." "Researchers attributed those rates to discrimination and stigma, as well as a lack of laws protecting transgender people from employment discrimination. Poor insurance coverage of hormones and other treatments to help a transgender person transition to their desired gender also account for the rates, the researchers found." http://www.livescience.com... Conversely, Contender provides no authority that treatment is not "vital" in some cases. The WPATH Standards of Care recognize that treatment is not appropriate in every case. Therefore, the following criteria exists for hormone therapy: http://www.wpath.org... "1. Persistent, well-documented gender dysphoria; 2. Capacity to make a fully informed decision and to consent for treatment; 3. Age of majority in a given country (if younger, follow the SOC outlined in section VI); 4. If significant medical or mental health concerns are present, they must be reasonably well-controlled." Id. p. 34. "The criterion for gender confirmation surgery are equally specific: 1. Persistent, well-documented gender dysphoria; 2. Capacity to make a fully informed decision and to consent for treatment; 3. Age of majority in a given country; 4. If significant medical or mental health concerns are present, they must be well controlled; 5. 12 continuous months of hormone therapy as appropriate to the patient"s gender goals (unless hormones are not clinically indicated for the individual). 6. 12 continuous months of living in a gender role that is congruent with their gender identity. " "Although not an explicit criterion, it is recommended that these patients also have regular visits with a mental health or other medical professional." (This dovetails with the NYT Health Guide " counseling is a good idea.)" "Two referrals"from qualified mental health professionals who have independently assessed the patient"are needed for genital surgery. " These are cases where carefully crafted guidelines have been applied by medical professionals and a conclusion has been reached that a need does exist and that a specific patient's life would likely benefit. The NYT Health Guide does not call this surgery cosmetic. Contender"s source collapses an entire body of medical research to make the unremarkable statement that counseling is appropriate. WPATH standards of care agree. A variety of treatment options exist but detailed criteria exist to guide the application of those treatment options. This is nothing unusual. I learned I had a heart defect when I was 38 which had caused a stroke. I was given the "option" of letting the defect remain as it was without surgery living with the risk of having a second stroke or having the defect corrected with open heart surgery. I researched source materials and found that either approach was appropriate and it came down to my doctor"s opinion with my concurrence. I was balancing the risk immediately of a very invasive surgery against a lifetime of risk. Patients with GID who meet surgical criteria face a similar "option." They can have the surgery with quite a bit of pain, loss of income due to recovery time of 4 weeks or so, and risk of death from general anesthesia or they can continue to suffer a condition which causes considerable lifelong pain. In no way is inverting a penis and rearranging a scrotum "cosmetic." It is "optional" in the sense that a patient can decline surgery just as any indicated surgery will not be performed without informed consent. In terms of the efficacy of the treatment, keep in mind that anyone getting surgery has had over a year of counseling, a year of hormones, a year living as the correct gender, and two evaluative medical professionals (one of which is a medical doctor) agree with the criteria are meet . The American Psychiatric Association disagrees with Contender: "[T]ransgender and other gender variant people benefit from treatment with therapists with specialized knowledge of their issues (Lurie, 2005; Rachlin, 2002), and that the Ethical Principles of Psychologists and Code of Conduct state that when scientific or professional knowledge ...is essential for the effective implementation of their services or research, psychologists have or obtain the training....necessary to ensure the competence of their services..." (APA 2002, 2.01b);" Citations Omitted due to space limitation. http://www.apa.org... Contender"s "Health Guide" merely said that identity issues "may" continue. Likewise, my health issues upon having a stroke could have been worsened by open heart surgery. On balance, however, the medical and psychiatric community has taken great care to allow for treatment when very logical criteria are met and the patient would benfit even if, as always, life gives no guarantees. The comparison of this issue to having a tummy tuck or other cosmetic surgery is inapt.