Sex-change surgery appropriate use of Medicare and Medicaid funds?
 

What do you think, after reading this article and then the article linked on always-looming cuts to Medicare providers?

WASHINGTON -- The Centers for Medicare and Medicaid Services (CMS) said it would reconsider covering gender change surgery under Medicare for patients with gender identity disorder.

Formerly called transsexual surgery, the procedure is not currently reimbursed by Medicare, under a policy dating back to 1981. At that time, the agency determined that gender change surgery was "experimental" and therefore not eligible for coverage.

The new review was prompted by two individuals who wrote to CMS, arguing that gender identity disorder and surgical gender change treatment were now accepted in medical practice. One of the petitioners cited a 2008 American Medical Association resolution backing "public and private health insurance coverage" for treatment of gender identity disorder.

CMS's decision to reconsider coverage of surgical treatment triggers an initial 30-day public comment period, which will end April 27. In announcing the review, the agency said it was "particular interested in clinical studies and other scientific information relevant to the topic under review."

In general, CMS requires evidence that a treatment is both effective and medically necessary before it will approve Medicare coverage.

Although allowance of Medicare coverage would probably benefit few transgender individuals directly, such determinations often affect coverage policies for Medicaid and private health plans.

CMS to Review Gender Change Surgery

Medicare doctors face 29% pay cut in New Year

CNN (12/31/12)

....On Jan. 1, physicians face a 26.5% cut in reimbursement rates....

....Fed up with the uncertainty, Hoven said doctors are evaluating their practices to determine whether they can afford to stay in business, since private insurers also base their reimbursement rates on Medicare rates....

Medicare doctors face 29% pay cut in New Year - Dec. 31, 2012

No under any circumstances. If somebody wants that sort of surgery, let them reach into their own pocket and pay for it. Not Medicare's money, not private insurance money, not medicaid money. NO! If they want it..they can spend their money.

My ex-spouse practices male to female reassignment surgery....gratis! No anesthesia...no instruments...just sharp teeth and an attitude. You just need to ignore the growling and massive bleeding.

The word is that the CIA is sending her on a secret mission to North Korea....that poor little dictator.

If it is cosmetic, it should be disapproved. However, if the doctors declare it a mental disorder than cannot be corrected by medication, perhaps the surgery would be appropriate. I mean, don't we wish for everyone to enjoy a full and rich life?

After seeing this section of Centers for Medicare & Medicaid Services, indicating that Public Comments are welcome and must be submitted using their "section 508 compliant" submission window and "orange Submit button" on their site, I've now searched the site for over 30 minutes looking for a Public Comments section on this particular topic, and still haven't found one. (Maybe the timeframe for commenting has ended?)

Public Comments
Section 1862(l)(3) of the Social Security Act establishes an opportunity for the public to submit comments on proposed national coverage determinations. CMS encourages public comments and the submission of additional medical, technical, and scientific evidence, and must respond to these comments in our final determination as required by law. Public participation increases the quality of agency decision making.....

..NOTE: In accordance with HHS guidelines, CMS will only post materials that are 508 compliant. Comments submitted electronically through this website (using the orange comment button) are automatically entered into 508 compliant format. We are requesting that submitters that send comments outside of that electronic process ensure that the comments are 508 compliant...."

Public Comments - Centers for Medicare & Medicaid Services

I think contacting our congressional representatives is in order.

I read that as of 2003 the Centers for Medicare/Medicaid Services determined this, quoted below. It is definitely not cosmetic, when you see the complexity and the dangers involved in the numerous anatomical and organ system restructurings done. I'd question whether the whole of surgical techniques, medical followup and outcomes have advanced all that much in ten years:

Transsexual surgery, also known as sex reassignment surgery or intersex surgery, is the culmination of a series of procedures designed to change the anatomy of transsexuals to conform to their gender identity. Transsexuals are persons with an overwhelming desire to change anatomic sex because of their fixed conviction that they are members of the opposite sex.

For the male-to-female, transsexual surgery entails castration, penectomy and vulva-vaginal construction. Surgery for the female-to-male transsexual consists of bilateral mammectomy, hysterectomy and salpingo-oophorectomy which may be followed by phalloplasty and the insertion of testicular prostheses. Transsexual surgery for sex reassignment of transsexuals is controversial.

Because of the lack of well controlled, long term studies of the safety and effectiveness of the surgical procedures and attendant therapies for transsexualism, the treatment is considered experimental. Moreover, there is a high rate of serious complications for these surgical procedures. For these reasons, transsexual surgery is not covered.

http://www.cms.gov/Regulations-and-G...03c1_part2.pdf

True. This seems more complicated as you suggest than some make it out to be. I agree that purely cosmetic surgery should not be approved unless perhaps we are talking about someone who has been scarred by accident, violence or whatever. Are plastic surgeries covered??

OK...I sometimes assume that folks get my mocking...

Guess what kids...this is insignificant...we have real problems....banks too big to regulate...potential wars with North Korea and Iran....a huge division in public trust of their elected leaders...

Is sexual reassignment really an issue...we waste more money on weapons systems that even generals on government-funded golf courses mock.

Imperial Rome figured out that the key to power was "Lets you and him fight." Don't be played by sideshow acts...save your indignation for those who reach deep in your pockets...not the 17 folks who might get this surgery. Really, figure out the important sentence.

Good point. I did enjoy your humor. This probably affects more people than you would think. I drove through Trinidad CO in 1984 or so and it seemed that this small Colorado town had a thriving industry in sex change operations. I had wondered who was paying for these operations and how. I was just travelling along a more scenic route home to Reno, Nevada than the Interstates.

Granted there are more than 17 folks lined up to have their private parts reassigned...again, Voldemort (my ex-spouse) will do it for free...

Still, it's less than this..

F-22 Raptor Loses $79 Billion Advantage in Dogfights: Report - ABC News

Tax day is on the cusp!

You might find this of interest.

Marci Bowers - Wikipedia, the free encyclopedia

Do not remember her/him from the University of Minnesota where it looks like he/she was Student Body President of the U of MN. The U of Minnesota was extremely liberal in outlook so I am not surprised.

Beat this...

Divorce

Please address the topic and refrain from political and off topic comments.

Thanks.

BTW - speaking of U of M...

I had 2 major profs in graduate school....one was the historian for St. Augustine...but, the other went to U of M and his roommate was Bob (Dylan) Zimmerman....

He told me that Bob was a jerk but was always able to isolate the important sentence.

We can joke about silly stuff...but, "the importance sentence" is so named 'cause it is important.

And my dear mod...this addresses the ludicrous point of the topic without being overtly partisan.

All the people I know that had sex change operations did so at a much younger age, 30's or 40's, rather than wait until after age 65 to make this radical change. If the OP wants to make the change now, so be it. I hope he/she made their wishes known to his/her congressman.

Personally, I believe more medicare dollars should be invested in Alzheimer's and other dementia related illnesses than sex change operations.

I agree for the most part with what you say above and usually think about the same thing when politician start talking about cutting social security increases. We came up with hundreds of billions $$$ to bail out the banks but need to take food out of the mouths of people that worked hard their whole lives.

the answer is unequivically no....under any circumstances.

Slightly off topic but ditto for all the boner meds that ARE covered by medicare!!!.

btk

Apotemnophilia
 

There's a mental disorder called Apotemnophilia: People with this mental condition want to have perfectly good limbs amputated. Should medicare pay for this too? And how is this any different than a man wanting to have his ***** removed? Are they not both mental disorders?

Good point and I don't think it's off-topic. Those meds and many other hormonal ones would need to be covered by Medicare to alter the physiological functions involved.

I'm surprised no one above has commented on the aspect of spending on sex change surgery and after treatment while cutting other standard medical treatment reimbursements to the point of making primary care drs. unable to stay solvent in private practice.....a big topic here in TV since 85%+ of TVRH patients are Medicare and reimbursements are already extremely low.

If that doesn't bring home the point, I don't know what would!

My wife was a Neonatal RN and I recall her saying that sometimes the doctor had to make the sexual determination decision. Something called Ambiguous Genitalia and they decided the sex. Maybe they made mistakes.

I really wish people could be more open-minded in our divisive society.

:clap2:

Thank you, Hal. Not just a bit more open-minded but a heck a lot kinder!

A dear friend of mine had transgender surgery. It was not easy for her. As a matter of fact, it was extremely painful and required several surgeries. This is not something done lightly; not by the patient, not by the surgeon. Rather, the individual has to have extensive psychotherapy, must live in their "chosen" gender for one year before any surgery or hormonal therapy will be done. This is not someone asking for an amputation because of a mental illness. This is someone asking for a chance of happiness by having their body fit their mindset.

So, my response is a resounding yes! I could never begrudge another human the right to have the life that was deemed right by not only themselves but also the specialists who would be performing these surgeries and working with these patients on a daily basis. Happiness is hard to find in this world. Some of us have been far luckier than others in this regard. Why should be begrudge someone the joy of being able to live in their own skin?

We probably would be more open minded if they would stay out of our pockets! Seniors are scrambling for chemotherapy treatments because of the sequestor - people should get sex change operations on our dime????
Doesn't make sense to me - especially if we are talking about medicare. You lived this long (65) the way you are, you can probably make it to the end of the road in the same body.:confused:

Agree...Agree..Agree...And let's add to this the jam that TVRH is in with fully 88% of it's entire revenue stream coming from Medicare. Those who are constantly finding fault with the hospital have to understand that the hosptial is being faced with handling more and more chronically ill people with ever-decreasing medicare reimbursements and no real alternative revenue streams to make up the difference.

The average hospital gets about 38% of it's revenue stream from medicare. TVRH has very little opportunity to benefit from private insurance or cash-paid elective surgeries. They are in a deep bind that's not of their own making and it's only going to get worse as time goes on.

I worked with "Michael" and he decided he wanted to be "Michelle". After becoming Michelle; Michelle became engaged to a man but then decided that she was lesbian and took a female lover. When that didn't work out Michele then had surgery to become Michael again. I promise that I am not making this up. The real tragedy in this is that Michael/Michelle had a 12 year old son. I think Michael/Michelle was never a happy person and left many unhappy people in his quest for identity.

Imagine waking one morning to find you had the wrong sex organs. Imagine the distress and even some revulsion, and the immense yearning to have the correct body parts back where they belong. And waking every day of your life with this wrongness, this distress, the self rejection and confusion. And imagine that it can be partially fixed which will involve incredible personal psychological stress and multiple surgeries and drugs. Imagine that your friends may turn against you, your employer fire you, your family reject you. But you have the wrong genitalia and want it made right. Compassion anyone? Taking time to understand the problem from a bit outside your own experience and preconceived notions, please?

Yes. Definitely, the gender-conflicted people need and deserve compassion.

And imagine wanting your sex organs amputated and internally disconnected and removed. Imagine wanting your ears or nose cut off or eyes taken out, and having your ear canals or nasal or eye openings surgically closed up. Should Medicare and Medicaid pay for that kind of self mutilation too?

Should Medicare and Medicaid provide and pay for a service dog and pay for an assisted living facility for the person who purposely had their eyes removed and is now blind?

Or should Medicaid and SSI pay tuition at a school for the deaf for a teenager "who woke up one morning to find he had the wrong ears" and had them and the canals removed and sewn shut?

Are there to be no boundaries to what individuals demand that taxpayers pay for, when it's the individual's choice to maim themselves as a way of making themselves happy?

Briefly going off topic ....
I do hope that Voldemorte can get things sorted out for us in North Korea.

If we taxpayers are to be footing the bills for some likely demented wack jobs seeking geriatric sex change operations, why not send them to Thailand and get the surgeries done cheaply?

This is why I love you.

Furthermore, don't go to TV hospital ER room for sex-change surgery. You might have a 24-hour wait.:girlneener:

I'm not sure about government funding of Gender Change surgery, when the medical system is already overloaded. But I agree we should have compassion for gender conflicted individuals. I don't see a benefit in thinking of them as Wack Jobs. How can we judge others if we haven't walked in their moccasins?

We are probably going to all catch that new mental disease-- KimJongunphobia. And have to resort to TOTVphilia for treatment.

There also seem to be some mental diseases that I cannot see how any physician who is adhering to the Hippocratic Oath would do any kind of surgery for that malady. Or, therapy (unless aversion) http://en.wikipedia.org/wiki/Apotemnophilia for that matter like with the desire to amputate limbs as some poster suggested. That seems like treating some sociopath by allowing him to kill dogs and cats in inhumane manners.

Do not really see an easy answer with the economy and medical care for ailments like this. Look at the career of Marci Bowers who got a MD and delivered a large number of babies before taking up the sex change business. Her life seems to have become so much better and beneficial to society after she had her sex change. http://www.denverpost.com/news/ci_16843484