Trans

VA Backtracks on Funding Transgender Surgeries, But Not Because of the Election

Somebody neglected to account for the expenses.

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plaque
Randy Pench/ZUMA Press/Newscom

It seems that when the Department of Veterans Affairs (VA) decided that it would change the rules and fund sex-change surgeries for transgender troops, it failed to account for something just a little bit important: paying for it.

So now, apparently the VA is having to backtrack on a proposed rule change. Over the past year, the military began instituting a plan to allow transgender troops to serve openly and to even transition while in service. For veterans, though, there is a blip in the system. While the VA covers different types of treatment that help transgender veterans, VA policy specifically excludes sex-change surgeries. This doesn't mean vets can't get sex-change or gender-reassignment surgeries. It means the government is not going to pay for it. It's treated as an elective surgery.

There's been a push to change this designation, and while some may find the idea controversial (and the idea of being transgender suspect), there is support among medical professionals that sex reassignment surgery is potentially an effective, valid form of treatment. But obviously not everybody agrees, and so funding for treatment for transgender concerns is politicized. I wrote more about the complex issues involved here (Summary: If we as Americans are going to fund medical treatment for veterans, it's hard to justify excluding this treatment just because people outside the medical profession don't think it's legitimate).

The VA announced this week that it's going to have to delay implementing a plan to cover these surgeries until "when appropriated funding is available." I had already seen a couple of "Oh, no, it's starting!" tweets from transgender folks thinking this was some sort of backtracking that's happening because of Donald Trump's election. That doesn't appear to be the case. The VA will still be covering all other forms of treatment related to transgender issues, but needs regulatory changes and appropriations to formally add surgery.

Now, of course, whether this will happen in a Trump administration is anybody's guess. The general thought is that Trump's conservative administration may end up being more hostile to these issues than Trump himself might be, given Mike Pence as vice president and whoever else from the Republican Party ends up in the administration.

I'm deliberately avoiding trying to speculate too much what might happen here because of the lack of clarity from Trump on LGBT issues. Trump is clearly not anti-gay and not anti-transgender, but his catering to populism makes it difficult to ascertain whose attitudes toward transgender accommodation are going to win out in his administration.

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  1. WHO… THE…. FUCK…. IS STUPID/DESPERATE ENOUGH TO ALLOW A VA BUTCHER TO OPERATE ON THEIR PRIVATES!!!!!!

    1. THEIR PRIVATES!!!!!!

      I see what you did there, soldier.

      1. “It means the government is not going to pay for it. It’s treated as an elective surgery.”

        So…my takeaway is that some people don’t think it should be elective to cut your dick off in the military.

        Seems like par for the course. Right up there with the government forgetting that it still needs to actually pay people for things.

    2. YOU’LL BE LEFT WITH A MAJOR PROBLEM!

      1. I hope they use general anesthesia for the procedure!

      2. I think they should tank the whole thing.

      3. Corporal punishment may be required.

    3. Maybe they aren’t trans and instead have a meat-vomit-for-junk fetish.

      1. So, Hillary voters?

        1. Hearing trapped Iraqis cook alive in a BMP can initiate some strange psychoses – until one remembers it was just Iraqis.

    4. They probably don’t even use general anesthesia.

      1. THAT GUY ALWAYS PUTS ME TO SLEEP!

      2. That sounds an awful lot like corporal punishment.

        1. So would making someone live in a latrine, as no one wants to be a loo tenant.

      3. There’s probably a colonel of truth to that.

        1. Could result in some divisions.

    5. Will VA pay for procedures outside their hospitals if they lack the expertise? Maybe they are hoping to get it done in private clinic and refunded before VA starts offering the procedure?

      1. That would be admiral-able of them.

        1. They’d be collecting the money well after the procedure, at some unknown date in the future; arrears admiral-able.

          1. You all have a major malfunction!

          2. Billing VA for doing ‘surgery’ on ZF 8-speeds…oh, wrong kind of trannies. My bad.

      2. That is what they are probably gunning for.

    6. As the old joke goes….why would a doctor join the Navy?

      So he can’t be sued for malpractice.

    7. Whoever it is better be some awesome kind of surgical specialist.

    8. Someday you’re all going to be sued for punitive damages

  2. “If we as Americans are going to fund medical treatment for veterans, it’s hard to justify excluding this treatment just because people outside the medical profession don’t think it’s legitimate”

    Why not just hand the government over to physicians?

    Of course, the voters had plenty of chances to do so this year, at least as far as the Presidency was concerned. There were at least three physicians who ran – Rand, Carson and Stein.

    The voters rejected them all.

    And as the three examples I gave illustrate, physicians can disagree over a whole range of public policy issues.

    If you’re going to turn VA funding decisions over to physicians, do you consult Dr. Paul, Dr. Carson, or Dr. Stein?

    1. Not that it’s illegitimate, but that it’s a) pushed as the only or the best treatment, and b) so politicized as to be rendered suspect regardless of its legitimacy.

      1. And in general, think of what we’re saying if we let physicians decide when the government will reach into the Treasury to pay for medical procedures.

        Isn’t there a slight conflict of interest there?

        1. Isn’t that essentially how Medicaid/care was passed in the first place? Getting doctors on board by letting them weigh in on pricing?

  3. I’m deliberately avoiding trying to speculate too much what might happen here because of the lack of clarity from Trump on LGBT issues. Trump is clearly not anti-gay and not anti-transgender, but his catering to populism makes it difficult to ascertain whose attitudes toward transgender accommodation are going to win out in his administration.

    Very well-stated, Mr. Shackford. Thank you.

  4. Let’s all refrain from “nothing left to cut” jokes here, shall we? Show some class.

    1. What you did there, I saw it,

  5. This whole trans-es (?) in the military has been a farce, at least on the active duty side. Leaving aside the considerable fitness for duty questions that inevitably follow, it was dropped like a Friday evening press release. There was no guidance or amplifying policies, leaving even the most trans-sympathetic scratching their heads.

    Some guidance eventually followed, e.g. you had to be diagnosed with Gender Dysphoria by a doc to start wearing your “true” gender’s uniform and having your fitness tests graded using your preferred gender’s grading scale, but it was and still is a mess.

    I realize that this is not exactly what the author brought up.

    1. The whole idea that there is some “right to serve” is dangerous horseshit. There is no right to serve. The military should serve one function; to fight and win wars. Anything that doesn’t contribute to that has no business being there. If it is the case that transgenered fight better, I will happily support putting them all in skirts. Otherwise, people like Scott can fuck off and keep his fucking SJW paws off the military.

      1. That is one thing that is never explained, how will female infantry people and trans folks make the military better at killing people and breaking stuff? Of course that is not the purpose, the progressives had a captive audience that they could order under penalty of law to enact their harebrained agenda, which all they have ever wanted and they did so.

        1. …which *is* all they have ever wanted…

        2. If I squint hard enough I can see the justification for gender integrating combat arms. Different perspectives, different leadership styles, we’re not in all situations in all time rucking gear that’s 125% our bodyweight.

          I can’t do it for trans. This is something that can ultimately lead to long-term incapacitating surgery plus dependence on a cocktail of hormones that might not be readily available in an austere environment rendering you non-deployable at the time when your capabilities are the most needed.

          As a person I empathize with trans folks, wish them the best, imagine I’d be supportive of a friend or family member whose transitioning. But as a Soldier and a Leader they need to get out; this is not a job for you.

          1. +1 Compliance with the Army writing style (capitalized Soldier)

            I am right with you, if you are not comfortable with the genitals you have, you may want to find another line of work and you may want to especially avoid the Infantry where every one is extremely comfortable with their own genitals and the genitals of everyone around them.

      2. I absolutely agree with you about the function of the military. If providing treatment for transgender people doesn’t contribute to that very specific mission, it doesn’t belong.

        Still not sure why you think that Scott is pushing an agenda here. I certainly don’t see him doing so in this article.

        1. My point is tangential to the article, I am knowingly not speaking to the main point, i.e. the fiscal concerns of paying for trans related medical expenses. It just lead me think about how I question the wisdom of the current administration’s recent policies.

      3. And if we could start making Black Watch style skirts part of the uniform, I’d be down for it.

      4. ^ THIS

        Not that I have any problem with women or transgenders serving in the military, but I have a problem with fitness standards (mental and physical) being reduced and I worry that more time will be spent on counseling and “let’s understand everyone’s diversity” talks instead of needed training. If you can’t hack it, you don’t get a participation trophy to carry you through. This is the one part of our society, if nothing else, that should never be distracted with politics and SJWness.

        1. Referring to John’s post

        2. The training piece is the part that bothers me, we already spend an inordinate amount of time doing things like ‘teach men not to rape’ training. More of this nonsense already takes away from time that would be better spent doing, oh I don’t know, learning how to do our jobs.

    2. Leaving aside the considerable fitness for duty questions that inevitably follow

      Let’s not leave them aside. It raises a really good question.

      If we’re going to be completely honest, then we all have to acknowledge that trans people have a high rate of suicide. Especially post-op, if my memory serves me correctly. Why would the taxpayer be asked to foot the bill for all that training (which is expensive in itself), and the procedures and drugs, only to lose the soldier to a suicide?

      Crass? Yes. The question is still important even if it’s insensitive.

      Wouldn’t the regimen of drugs (hormones, etc.) afterwards needed to maintain everything be yet another thing that logistics people need to transport? Wouldn’t that necessarily limit a soldier’s deployments?

      We already disqualify people who have diabetes. It doesn’t make them lesser people. It just makes them unfit for duty as a soldier. Is there a difference here?

      1. I neglected to mention why I chose diabetes as an example. It’s infeasible to make sure that insulin gets where it needs to be or that a soldier couldn’t be cut off from a supply of it.

  6. The official President Elect: “Grab whoever by the pussy/soontobepussy.”

  7. OT:
    If you have a twitter account, start following Donovan Paisley.

    1. Of the Kennebunkport Paisleys?!?

      1. Why that has me cracking up, I know not.

        +X, Citizen.

        1. Capital! [sips martini]

    2. Donovan Paisley ?@DonovanPaisley Nov 10

      I just ordered 400 pairs of New Balance shoes off Amazon and will be burning them tonight.

      It’s time to teach them a hard lesson.

      Donovan Paisley ?@DonovanPaisley Nov 10

      My trans friend broke down & cried when I told her she would be captured and imprisoned. I’ve had it up to here with Trump’s fearmongering.

      Donovan Paisley ?@DonovanPaisley Nov 8

      I tweeted.
      I created some great hashtags.
      I called white people racists.

      What did I do wrong? How is Trump winning?

      #ElectionNight

      1. Don’t forget:

        Donovan Paisley ?@DonovanPaisley Nov 9
        Donovan Paisley Retweeted New York Daily News
        This Muslim New Yorker avoided Trump’s wrath by taking off her hijab, then wore a hat in order to avoid Allah’s wrath. Smart thinking.

        Indeed.

        1. Really hard to tell if that’s a very, very stupid SJW or a clever non-SJW doing great parody.

  8. I don’t think the VA should be doing boob jobs or face lifts either. It is as free society points out above, elective surgery. How the hell can a libertarian publication support using tax dollars to pay for elective surgery?

    1. I know, because a retired veteran with an extremely loud voice used to share a cube-wall with me, that the VA had no problem funding viagra prescriptions. If we’re talking about elective, quality of life treatments, I think some consistency is in order.

      1. I think the ability to have sex is less elective than indulging a mental illness. If you want to cut of viagra, have fun. But the fact that they do fund viagra doesn’t in any way justify or excuse funding this.

      2. I actually tend to agree with you Brett, Viagra isn’t a necessary medication and ergo it should not be included in the VA system. It would mean more money could go towards things like Rehab and surgery to recover from actual wounds. You know, the shit the military actually does owe you and actually does consistently fuck up.

    2. How the hell can a libertarian publication support using tax dollars to pay for elective surgery?

      Especially based on the thin veil of evidence that, at best, it *might* do the patient some good. Might as well lower the weight requirements, allow anorexics to join and cover their liposuction costs while we’re at it.

    1. UP YOURS EUGENE

  9. Have they done some kind of surgery on the PM links?

    1. Seriously. Somebody get me a subscription to Reason so that i may cancel it.

  10. Yeah, if you see an article posted after 4:00 which is NOT the PM links, then you may assume Robbo is going to be late with the links.

    1. It better end with an embedded tweet of Robby apologizing to us.

  11. In no sane world should the VA be focused on gender transitions. Nor should our military be paying for personnel to have them. The idea is so absurd and the administrations choice to do this is purely to signal to their mouthbreathing base that they are enlightened overlords.

    This is not the role of the VA. It is not the role of the military’s own health system. It’s an abuse of the taxpayer for political gain.

    1. Yes. But Scott wants his fucking Tranny Pony, so fuck you pay him.

      1. Tranny Pony killed at the 2001 SXSW. I was there, man.

        1. I saw them open for Black Moth Super Rainbow a couple years ago, but i was on so much mescaline i don’t remember the show at all.

        2. I have the live record they did from that tour “Rural homos”. They owned it back in the day.

    2. It depends on what you believe transgenderism to be.

      1. No, it doesn’t. Even if it’s a legitimate psychological issue, it has nothing to do with being in the service. It has nothing to do with the military. It IS an entirely elective surgery. And it is a very expensive one at that.

        The VA is likely providing other things it doesn’t need to provide. It shouldn’t be doing so.

    3. The VA is single-payer health care.

      1. Well, to be fair, it’s single-everything healthcare.

        #ThanksFedGov

  12. Dammit. Nick or somebody needs to bring Robby some hair spray so he can get back to the links.

  13. I’m pretty open minded about the whole transgender thing.

    But it is elective surgery. You aren’t going to die because you don’t feel good about your genitals. Bigger tits are probably an effective way for some people to feel more comfortable in their own bodies too. I don’t think the VA or the Army should be doing breast augmentations.

    And I question whether someone dealing with a gender dysphoria problem should really be serving in the military in the first place.

    1. I don’t think the VA or the Army should be doing breast augmentations.

      Please tell you have an exception for post-mastectomy reconstruction for breast cancer patients.

      1. What about prosthetic testes for testicular cancer patients? 😉

        1. Why do you want them on your chin?

        2. Those, too. They are very cheap and can be inserted when the testicles are removed. Basically, nylon marbles. I first learned about those because some people have those implanted into their dogs after neutering – which is a bit silly, but whatever.

      2. Sure, why not? Reconstruction is a bit different from augmentation.

    2. They may not die, but they will literally die if they don’t get the surgery.

      1. Literally? Literally? Literally die?

        1. *forcibly narrows John’s gaze*

  14. “If we as Americans are going to fund medical treatment for veterans, it’s hard to justify excluding this treatment just because people outside the medical profession don’t think it’s legitimate”

    No, it really fucking isn’t. Not when the VA can barely provide actual life-saving treatments to veterans who need them.

  15. sex-change surgeries

    Are they doing chromosome transplants now?

    1. GMO humans for the win!

    2. Gosh, if only someone had pointed out the correlation between X/Y chromosomes and sex before we could have avoided this whole controversy. I’m glad it’s so simple. I’m sure that it will comfort the people who don’t feel at home in their own bodies to know that their sex chromosomes are the only thing that matters.

      1. Unfortunately “people who don’t feel at home in their own bodies” does not just describe people with gender dysmorphia.

        It often just means “whackadoodle”,

        1. Fine. But whatever it is, pointing out facts about human genetics doesn’t make the psychological problems go away. And that’s what transgenderism looks like to me. A psychological issue. If people think that changing the body is the only way to deal with it, that’s their business. I don’t know any better.

          Anyway, the point is that very few if any transgender people are under the delusion that their genes are other than what they actually are. And smugly pointing out that humans have sex determining chromosomes doesn’t address the issue at all. It’s a strawman. Just tearing down an argument that no one is making.

          1. But whatever it is, pointing out facts about human genetics doesn’t make the psychological problems go away.

            I don’t think cutting off their balls is going to help the psychological problems either.

      2. Will it comfort them post operation, during the time many transgender people who are not on military bases commit suicide? I don’t see any issues whatsoever by placing a group of individuals with far above average odd’s of committing suicide on a base where live grenade training is a thing.

        Why, that would be insane!

  16. Paging Mr. Injun (as in from India). Mr Injun, please pick up the courtesy phone, Mr Injun…

    1. In case he doesn’t show up. I have it bookmarked. I loves me some Injun.

        1. No thank him. I’m just a fan.

          1. I’m one of his biggest fans, and he knows it, but I didn’t have the link handy.

  17. there is support among medical professionals that sex reassignment surgery is potentially an effective, valid form of treatment

    A treatment for what condition exactly? What is it effective and valid at treating?

    Maybe you’re being deliberately vague in wording there to avoid raising that question.

    I’m not against anyone choosing gender reassignment, but from what I understand of it, there are usually multiple procedures involved and a regimen of hormones and other therapies, and that it’s all very expensive. Why should the taxpayer foot the bill for it? A trans person undoubtedly felt the way they do before joining the military. What other body modifications should we be asked to pay for as well? Breast implants for our soldiers who are unhappy with their body image? Penile surgery for men who feel underendowed? Plastic surgery unrelated to injuries sustained in the course of their duty?

    Lots of people have body image problems. If you’re never quite happy with your nose, a la Michael Jackson, join the military and keep working at it until you are on someone else’s dime?

    1. Penile surgery for men who feel underendowed?

      I thought that’s that the shooting range was for.

      1. Insert joke about driving HMMWVs.

        1. My tank laughs at your puny HMMWV!

    2. Breast implants for our soldiers who are unhappy with their body image? Penile surgery for men who feel underendowed?

      This also inserts a false analogy into the mix. A man who goes through height increasing surgery ends up empirically taller and people who go through liposuction end up empirically thinner and lighter. Somewhat less empirically, women with bigger breasts and men with larger penises are more manly/womanly. Some trans people desire to convert, some aspire to be trans and some just want to obliterate themselves and/or the social constructs imposed upon them and the ability to tell the difference (if there is any) is poor.

      1. I’m not sure I follow on the “false analogy” part. One way or another, body image is at the core of it; surgically changing one’s body to fit the mental image one has of oneself. It’s not an analogy, it’s the same thing.

  18. re: the plaque photo =

    My thought (*the darkest, most cynical alt-text) was…. “beats recognizing them individually”

  19. Trump people should bundle funding for transgender surgeries with funding for penile enlargement and breast augmentation surgeries. The bill discussion will be entertaining. Are you against helping the vets?

  20. Shackleferd musta trussed Robby up in the closet so’s his Trans Article could double up on some hits.

    1. Shockfjord would never do that. He never leaves survivors after a raid.

  21. So. Robby or ENB are on duty today?

    1. Gotta be Robby. ENB handles the morning lynx.

  22. Anyone who wants to serve can serve. No problem whatsoever there. There’s no reason whatsoever that the US military should be paying for the surgery. None. Additionally, such an elective surgery affects one’s duty status. How long would one be on the shelf, and thus non-deployable, after the surgery? What are the ancillary costs from that?

  23. If I were working for Reason, the links would always be punctual, and the links would always be great. Okay, they’d be great links.

    1. Maybe the server squirrels keep eating the links like they’re eating our comments.

  24. OK, since I am grimly resigned to no PM links today:

    Washington Post: Neo-Nazis have declared New Balance the ‘Official Shoes of White People’. Pants-shitting ensues.

      1. Well-played.

    1. Wait – they weren’t already the official shoe of white people? Why the hell have I been buying them all this time then?

    2. Huh. I just kinda figured irony would dictate that Rockport or Timberland would make a trendy, mid-calf laceless boot and Neo-Nazis would be justified in calling SJWs out on their cultural appropriation.

    3. Great. So my choice in footwear is now a political statement.

      Progs – is there anything they can’t do?

      1. Leave people alone.

    4. Great. Now what the fuck am I going to do with all my shiny leather jackboots?

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