The Cost of Right: A Bargain

June 7, 2008

There is a letter to the editor of the Niagara Falls Review in Niagara Falls, Ontario, published June 6, 2008, captioned “Money for sex changes, but not for diabetics.” It can be found at:

http://www.niagarafallsreview.ca/ArticleDisplay.aspx?e=1061878

The letter writer, a Type 1 diabetic, wasn’t diagnosed until age 25. Not being diagnosed until after age 18 means the writer was not eligible for a publicly funded insulin pump, which are available only for those diagnosed before age 18.

Early diagnosis “would prevent kidney deterioration and vision problems while promoting a longer life. This would result in fewer trips to the doctor or emergency room.”

I agree.

Early diagnosis of all chronic illness will save enormous amounts of money over the long term and “is not only better for the person with the disease but also less of a burden on the health system.”

I agree.

For transgendered people and especially transsexual people—the specific sub-group of transgendered people who seek surgery—surgery, after hormone therapy and gender transition, alleviates chronic problems including clinical depression, addictions, other self-destructive behaviours up to and including suicide and also the violence, resulting from prejudice and fear, that so often follows transgendered people.

All of these cost far more to society than a very, very small public investment in surgery—as I will detail later.

There is also the cost to society of the lost productivity of all those whose time, just like the writer’s, is taken up with managing, as best they can, their disability.

The letter writer then concludes, quite reasonably, “why wouldn’t they put the money toward an insulin pump program for people over 18?”

I only disagree with the article “the”—referring to the $200,000 a year Ontario Minister of Health, George Smitherman, has said will go to fund “sex-change” surgery.

At the end of the letter the writer proposes a list of what is worthy for public funding: “other lifesaving medical devices that would improve quality of life for anyone with diabetes, cancer, multiple sclerosis or other life-altering disease” or “the use of these funds could be to increase staff in the emergency room, rather than having one overworked doctor.”

“Sex-change surgery,” in the writer’s mind, is “not vital to the quality of a person’s health.” In the understandable challenge of his own life, the writer has dismissed the evils that beset the lives of transgendered people and that are certainly detrimental to the quality of their health—and cost society as a whole.

“Lifesaving medical devices” and “increase[ing] staff in the emergency room” are important and should be on the agenda of any health care ministry—and should have been on the agenda for the decade transex surgery has been unavailable in Ontario.

But for $200,000 a year none of the things this writer has legitimately asked for could ever be funded. This fact is not trivial, though the amount of money we’re speaking of, in the overall Ontario health care budget, is.

There is another point in the letter that strikes me.

The writer uses as justification for ‘lifesaving medical devices” that they “would improve quality of life” for people with “diabetes, cancer, multiple sclerosis or other life-altering disease.” But, for people with gender identity disorder, surgery is “not vital to the quality of a person’s health.”

Why the different test? Why must surgery for gender identity disorder be “vital to the quality of a person’s health” and not “improve quality of life”? For that matter, why isn’t it?

Why are transsexual people subject to a special test, a different test?

When we advocate for human rights we advocate for something not “special,” but simply to be treated with dignity and respect as all should—but transgendered people aren’t because of ignorance and the prejudice and fear that follow—especially when it comes to the allocation of public resources.

The writer accepts implicitly the judgment of medical and other “expert” persons when it comes to who has a “life-altering disease” but quite clearly will refuse to accept the judgment of the same personnel when it comes to gender identity disorder—the diagnosis for those who need transsex surgery.

Smitherman’s press secretary, Laurel Ostfield, was quoted in a Canadian Press story in the Toronto Globe and Mail on May 20, 2008:

“This sexual reassignment surgery is regarded amongst the mental health community as a necessary treatment for a very small number of individuals,” she said.

“It is listed in other provinces, such as Alberta. So, if Mr. Poilievre wants to play politics with people’s health, it’s really rather unfortunate.”

http://www.theglobeandmail.com/servlet/story/RTGAM.20080520.wsexchange20/BNStory/National/home

She is referring to the MP for Nepean-Carleton, Pierre Poilievre, who seems to have been the first to comment negatively on Smitherman’s proposal.

My heart goes out to the writer, but I disagree with the premise of the letter’s argument, that if these public funds are denied to transsex surgery they will be enough to support the needs identified.

Now, while we’re talking money, there are two other classes of people who also deserve public compensation and are not yet part of the discussion: those who have been approved for surgery in the decade it has been unavailable in Ontario but have not had the resources to cover it themselves; and those, in this same decade, who have, say, taken out a mortgage, settled a human rights complaint, had a well-paying enough job to save and/or medical insurance to cover it and funded it themselves.

After all, if it is right to cover surgery for those who will be approved starting, well we don’t know exactly when, but let’s say January 1, 2009, why is it not right to cover those who have already gone through the same assessment criteria, the “standards of care,” set out by the World Professional Association for Transgender Health (WPATH), regardless of whether they have undergone the surgery or not?

The professional people who make the diagnosis in Canada are members of the Canadian Professional Association for Transgender Health (CPATH), a national section of WPATH, and very active.

Here are some ‘back of the envelop’ calculations.

I have used the cost of male to female surgery performed in the world class clinic of Dr. Pierre Brassard in Montreal—probably in the top three in the world today—because NONE of these procedures are available in any form in the Ontario public system. Various of the procedures that constitute female to male surgery are performed in the public sector—mastectomy and hysterectomy—and are available to trans men. The final procedure is very experimental, very expensive, does not always work and is not available in the public sector.

Smitherman’s own calculations are based on 8 to 10 persons a year at about $200,000 a year—or about $20,000 for each transsexual person starting whenever it will start. The fee in Montreal, including 8 to 10 days recuperation at the clinic, is $18,000 for the male to female basic procedure—breast augmentation, voice surgery are extra. There seems to be no provision for homecare in the most vulnerable week after arriving home.

Estimates are that about 200 people have been assessed according to the “standards of care” but have not yet had surgery. This is about 20 a year for the decade for all of Ontario; they are concentrated in the larger cities, especially Toronto.

Even more of a guesstimate, there are about half as many again who have been approved and funded surgery themselves—100 in total or about 10 a year.

For the first group the one-time cost is $3,600,000. On an annual basis for the decade this is only $360,000—a bit more than the $200,000 Minister Smitherman is proposing, but not much.

For those who have been approved and funded surgery themselves, the one-time cost is $1,800,000; over the decade it is $180,000 a year.

All together, if the province had funded these procedures ongoing, the annual cost would have been $580,000, but now a one-time expenditure of $5,400,000—remember, this is in a total annual health care budget of more than $40 billion. For the immense direct savings and untold amounts that would not otherwise be generated, this investment would have paid for itself MANY times over—and still can.

These estimates are extremely generous and is the absolute outside expenditure; what will actually be spent will be less.

This is the cost of right and its a bargain.

The Ottawa Citizen published an editorial characterizing Poilievre as a bully who picked on a population he believed so marginalized it couldn’t fight back.

Transgendered people are even more marginalized than drug addicts. . . . .Pardon us if we don’t admire his courage for taking on the all-powerful transgendered lobby.

The Courage of Poilievre, The Ottawa Citizen, May 21, 2008

http://www.canada.com/ottawacitizen/news/editorials/story.html?id=f68e086c-6a0e-48b2-b67b-d20d70ab04a7

The arguments in the letter to the editor are commonly used by those who criticize public provision of transsex surgery.

This writer sees something that seems to be being taken from him and it is an understandable concern.

But limitations on the availability of funds cannot be the reason for denying surgery “that would improve quality of life” of transgendered people.

There is another reason.

Its not a pretty one.

Full disclosure: I had surgery in the Montreal clinic of Dr. Pierre Brassard in February of this year.


More on Pierre Poilievre

May 26, 2008

Since publishing “Who is Pierre Poilievre. . . .” there have been two interesting things. An Editorial in The Ottawa Citizen and an email from Paul Dewar, my MP, the NDP MP for Ottawa Centre.

https://jessicalive.wordpress.com/2008/05/20/who-is-pierre-poilievre/

The courage of Poilievre

The Ottawa Citizen

Published: Wednesday, May 21, 2008

A mark of maturity is the ability to control the worst angels of one’s nature. Pierre Poilievre has for years struggled to restrain his worst impulses, and sadly the battle is not going well.

Mr. Poilievre is the Conservative MP for Nepean-Carleton, but he surfaced the other day to denounce a provincial decision to reinstate funding for the small number of Ontarians who suffer legitimate gender identity disorders and whose health requires them to have a sex-change operation.

Maybe eight Ontarians a year would meet the criteria, and the cost involved is a pittance in the context of the provincial health budget. But the savvy Mr. Poilievre can spot an opportunity as well as any populist. The “McGuinty sex-change program” doesn’t deserve funding, he says. He’s promising his constituents that he’ll personally lobby federal Finance Minister Jim Flaherty to make sure Mr. Flaherty is aware of this outrage.

Usually politicians looking to score easy points will rail against needle exchange programs, but transgendered people are even more marginalized than drug addicts, so they make an even safer target to beat up on. This is on the same level of cheap politics as whipping up anger because an academic somewhere received a grant to write a thesis on, say, snail reproduction.

This isn’t to say that people can’t ask whether same-sex operations are medically necessary. This is a fair question. But Mr. Poilievre’s smarmy quip about the “McGuinty sex-change program,” suggesting that the government is promoting sex reassignment, shows he is simply being opportunistic.

Pardon us if we don’t admire his courage for taking on the all-powerful transgendered lobby.

http://www.canada.com/ottawacitizen/news/editorials/story.html?id=f68e086c-6a0e-48b2-b67b-d20d70ab04a7

Email from Paul Dewar, MP

Dear Jessica,

I apologize for not getting back to you sooner but, I am out of the country travelling with the Parliamentary Defense Committee and, communications have been sporadic.

I was appalled at Pierre Poilievre’s remarks and his position on government funding for gender reassignment surgeries. His position, unfortunately, further demonstrate the ignorance of this government about transgender issues. Gender identity is not a choice. It is not a lifestyle. It is a recognized medical condition for which the treatment is gender reassignment surgery. For a person suffering from gender identity disorder medical procedures can significantly reduce the feelings of discomfort caused by one’s birth sex and social rearing in that sex. Withholding such surgery can lead to severe psychological problems and, in extreme cases, suicide. It is unfortunate, that Mr. Poilievre is capable of demonstrating such a lack of understanding about the seriousness of this condition. A condition that was recognized by our military over a decade ago when then, Lt.-Gen. Romeo Daillaire, approved funding for gender reassignment surgery by the Department of National Defence.

Under the Canada Health Act, it is the role of our government to guarantee access to medical care. It is the role of this government to see that all provinces get in line with this long-delayed decision by the Provincial Ontario Government to fund gender reassignment surgery.


Sincerely,

Paul

Paul Dewar, MP | Député Ottawa Centre
NDP Foreign Affairs Critic
Porte-parole du NPD pour les affaires étrangères
519 Confederation Building
Tel: 613.996.5322 http://www.pauldewar.ca
CEP 232


Post to Rainbow Health Network Email List

May 23, 2008

This is something I posted to the Rainbow Health Network this morning.

I would like to take up Linda’s couple of questions” though first a few disclaimers.

Please bear with me because I’ve learned through bitter experience, even on this list, that formal credentials and qualifications, of which I have none—other than my entire life’s experience and struggle as a transsexual woman, through transition, human rights complaint, surgery and on into the rest/beginning of my life—have in my own community made me something of a pariah.

Not universally, but enough to render despair, even in the face of success, a lifelong companion who is reluctant to leave.

I do not pretend to understand all the lengthy tracts posted in response to current events or even the strength to read all of them, though I did read Drescher’s response and was, at first, mystified as Linda.

But then I realized, in many quarters of the various “communities”–in quotes because I’m unconvinced there are such things between and among GLBTTQ peoples—what happens to transgender and transsexual people really is an adjunct to the “larger” question. And with respect to surgery, we are, by definition, speaking of transsexual people.

I have written about some of these issues—and the way they impact organizations that purport to be allied with us here:

https://jessicalive.wordpress.com/2008/05/19/inconvenient-divisive-and-ultimately-unnecessary/

and here:

https://jessicalive.wordpress.com/2008/05/13/marginal-among-the-marginal/

It is really quite simple, Drescher is not speaking to trans “communities” at all; he is speaking to the “community” he believes matters—the gay and lesbian community.

It certainly does. But in all of our “communities” gay and lesbian people make up the overwhelming majority and in the majority/minority dynamic—which is inescapable—take on, and their organizations take on, even when they purport to be LGB(T), the very thing gay and lesbian people have struggled with—privilege.

When I discovered this at Egale Canada some years ago—when it was of some relevance to all of our “communities”–I was quite shocked. No longer.

The ‘complicated’ theory, journal reports and statistical support Zucker has amassed regarding the future development of gender-variant male-bodied children, leading to his assertion that most of us end up as gay, certainly leads me to believe his apparent fear—certainly the goal of his “therapy”–has little to do with us—i.e. transsexual people. Rather in his homophobia he has, as it seems Blanchard also has, completely erased our existence.

As I have pointed out elsewhere (link above) our lives, issues and struggles are just “inconvenient, divisive and ultimately unnecessary.”

All struggles for human rights and medical access are inconvenient, divisive and ultimately absolutely necessary—as long as one’s commitment to equality and dignity for all is profound and steadfast.

I exist.

We exist.

Deal.

And if these two “respected” clinicians, their supporters on the Clarke-Western axis–“axis of evil”(?)–cannot see us, well, this remains the problem it always has.

But, of course, they do not deal as so many others do not deal.

Totally excluded from the organizing taking place in Toronto on behalf of trans communities—as with ALL Toronto based “province-wide organizations”—I only know by report, rumour and word of mouth of the work the THLG/THRC, Susan Gapka et al, and the Trans PULSE Project have done. I’m grateful for their work but continue to wonder at how inconvenient the participation of someone who lives north of Steeles Avenue remains.

My point remains that despite good work being done by such organizations and individuals in Toronto and elsewhere, these things happen, when you get down to it, without our input–and not for trying.

In Ottawa, I’ve watched in some amazement as the Ottawa Citizen has called “transgendered people”–I truly HATE that umbrella term–“more marginal than drug addicts” as a passing swipe at Poilievre:

The Courage of Poilievre
http://www.canada.com/ottawacitizen/news/editorials/story.html?id=f68e086c-6a0e-48b2-b67b-d20d70ab04a7

My own comments on Poilievre:
https://jessicalive.wordpress.com/2008/05/20/who-is-pierre-poilievre/

And despite my own efforts over recent years, it is simply inconvenient to establish even a “table”–which I believe is the term now current in social service circles for bodies to discuss matters of concern to various marginal populations. In Ottawa we have, for example, the Gay Men’s Wellness Initiative. A ‘trans services initiative’ is simply not yet in the cards.

On Tuesday, I emailed the office of my MP, Paul Dewar, Ottawa Centre NDP, to ask that he speak out against the absurd idiocy of Poilievre, not only as one of his many trans constituents but because the NDP, as a party, remains one I have worked with—I have worked with Bill Siksay for a number of years, whose response Gapka recently posted to this list—and, like many, assume it is the one most resonant with our issues, needs and struggles.

It is Friday morning and it is still silent.

As of this morning, the Egale Canada website remains silent, nor have we heard a word out of Helen Kennedy, Executive Director, who recently, gratuitously and in error indicated transgender and transsexual people in Canada have formal human rights. Only in North West Territories is this the case..

We may have human rights for LGBTQ people in Canada, but you’d never know it based on these results,” said Helen Kennedy, executive director of Egale.

Two-Thirds Of Canadian LGBT Students Feel Unsafe At Schoolhttp://www.365gay.com/Newscon08/05/051208bul.htm

(Previously in the St. John’s Telegram)

Helen, you know better. Shame on you.

The Mikki Gilbert op-ed in yesterday’s Ottawa Citizen, at:

http://www.canada.com/ottawacitizen/news/opinion/story.html?id=e7e297f9-9f2b-40fd-ad9d-4c64277f984c

is quite curious.

The picture at the center of the piece in the printed edition is the mirror reflection of a Thai katooey putting on her lipstick. Those of you who have read Namaste certainly know the classic error/diversion of such a display. And while I’m more than happy to accept the positive support of anyone, I can only wonder at the choice of someone whose situation in the transgender-transsexual spectrum is as a self-declared crossdresser, and as such a transgender not transsexual person, to speak for us.

Or above us. Or without us.

His life and struggle, certainly a part of any transgender/transsexual coalition—trans coalition—are not mine and I can no more understand his than he can mine. Make no mistake, I have always worked towards the human rights of all transgender and transsexual people though when it comes to questions of surgery—the goal of those whose lives from birth are dissonant in the extreme—the question raised by Smitherman’s recent announcement, where is the commentary from a transsexual person in anything other than a subsidiary manner? Letters to the editor, interviews, etc.

Too many do not see our lives and struggles when they consider the question of surgery, rather they see impacts on what gay and lesbian people have achieved—which certainly show us what can be achieved—but in their cissexual privilege do not see us.

This also raises issues of professionalization—discussed on this list—privilege, oppression, exclusion and alienation. All the daily fare of transgender and transsexual people.

I write today in great anger at my exclusion from these debates that have governed my life from the moment I was born—if not long before. I also write in great relief that now, post-op, there is little that bigotry, privilege, ignorance, prejudice, hate and even inconvenience can do to me with regard to the question of surgery, at least.

I am not certain about the future and wait for the time our voices are heard on matters that concern us, not others–except in their commitment to equality and dignity for all–and are positively responded to.


Who is Pierre Poilievre. . .

May 20, 2008

and why is he saying these things about transsexual people?

And does it really matter?

In reaction to last week’s announcement of George Smitherman, the Ontario Minister of Health, that Ontario would again fund transsexual surgery, Pierre Poilievre, the Conservative Member of Parliament for Nepean-Carleton, declared:

“People are waiting too long for basic cancer treatment and MRIs and the Liberal government found money for the (Dalton) McGuinty sex-change program instead.” http://www.ottawasun.com/News/National/2008/05/20/5613551-sun.html

He has also said:

“I think if people want this medically unnecessary treatment, they have that right. But taxpayers should not have to pick up the tab for it,” http://www.theglobeandmail.com/servlet/story/RTGAM.20080520.wsexchange20/BNStory/National/home __._

It is always nice to be caught in a political crossfire, especially by one of the Conservatives’ pit bulls. There is an interesting entry in Wikepedia at:

http://en.wikipedia.org/wiki/Pierre_Poilievre

He never misses an opportunity to take partisan or personal advantage, especially when he thinks no one will notice or that those he attacks are so marginal that no one will care–or notice.

He was one of those MP’s who opposed equal marriage, though in his speech to the House of Commons he espoused “the Canadian way: respect and tolerance” calling for all the trappings of marriage for gay and lesbian people but not the name. The rest of his speech can be viewed on the Canadians for Equal Marriage website at:

http://www.equal-marriage.ca/resource.php?id=322

Though I wonder where his ‘respect and tolerance’ is for those of us who are even more marginal than gay and lesbian people that even today there is nothing on the Egale Canada website on any aspect of this. But then, the Executive Director of Egale Canada has recently declared that transgender and transsexual Canadians have formal human rights–when she knows this is simply not true, except in the North West Territories.

It is clearly in this void that statements of such ignorant hate and prejudice can be spoken.

It is darkly amusing that Poilievre calls it the ” McGuinty sex-change program” considering McGuinty really wants nothing to do with transsexuals either. In 2003, Dalton McGuinty announced that SRS was “not a priority,” said Susan Gapka, the head of the Trans Human Rights Campaign and the Trans Health Lobby Group on the Xtra.ca website, and would not be re-listed. See:

http://www.xtra.ca/public/viewstory.aspx?AFF_TYPE=1&STORY_ID=4786&PUB_TEMPLATE_ID=2

It is even more interesting that in 2004 Smitherman was on the verge of announcing the relisting of transsexual surgery when Dalton McGuinty, the Premier got wind of it through a story on the Osprey News Service Wire and issued a press release only hours before his Health Minister was to make his announcement.

See: http://www.ctv.ca/servlet/ArticleNews/print/CTVNews/20040527/ont_sexchange_040527/20040527/?hub=Health&subhub=PrintStory

Rumour certainly had it that, unlike the bare bones program expected from the current initiative–simply a return to the way it was in 1998 when Mike Harris’ reactionary Conservatives first delisted electrolysis and then surgery completely–the 2004 initiative, developed in part in discussions with Gapka and the Trans Health Lobby Group (THLG), was much more.

Long standing demands of the THLG state the program must be community based and include coverage for hormones, hair removal and counseling.

See: http://www.rainbowhealthnetwork.ca/transhealth

Also see the website of the Trans Human Rights Campaign at: http://www.transhumanrightscampaign.org/

The former program seemed to make the same assumptions Poilievre makes, that transsexual people are well enough off to afford much of their treatment for their own disability–unlike most other marginal people.

Some transsexual people are indeed well off and can afford, on their own, significantly more than the basic surgery. Many transsexual people live in abject poverty. Transsexual women, according to the AIDS Committee of Ottawa are at the highest risk for HIV/AIDS, surpassing even gay men. It is evidence of this greatest marginalization that this fact is quite ignored and raises gales of indignant rebuttal from those who certainly ought to know better.

Some of us are in the middle and in some ways are even more invisible.

In my own case, I spent over $5000 on beard removal and hormones in one year–it was a great financial burden, though I was able to claim a tax credit for all of it which helped some.

I was only able to afford surgery because of the settlement of a human rights complaint.

But to return to Pierre Poilievre and his typically ignorant bravado declaring he will write to Jim Flaherty, the Federal Finance Minister–and a member of Poilievre’s Conservative Party–asking for assurances the federal government won’t fund this ‘medically unnecessary’ procedure.

There is even the possibility Flaherty might also indulge in his own bravado–as part of an ongoing criticism of the Liberal party that makes up the Ontario government. But bravado and bluster is all that it will be.

The Canada Health Act which is the federal legislation governing the way federal money moves to the provinces simply does not define what “medically necessary services” are and despite this great achievement of former federal Liberal Health Minister Monique Begin it is unlikely this government, any more than any previous one, would actually infringe upon a province’s discretion.

In my conversations with Bill Siksay, the NDP MP who is the author of a private member’s bill to amend the Canadian Human Rights Act to include gender identity and gender expression (GI/E) and another private member’s bill to amend the Criminal Code provisions on hate crimes and sentencing directives also to include GI/E, he has made it clear it is not within longstanding tradition to dictate to provinces either to include something as “medically necessary” or to exclude it. And is not something he will attempt.

Sadly.

Smitherman’s press secretary, Laurel Ostfield, is quoted in a Canadian Press story in the Toronto Globe and Mail today:

“This sexual reassignment surgery is regarded amongst the mental health community as a necessary treatment for a very small number of individuals,” she said.

“It is listed in other provinces, such as Alberta. So, if Mr. Poilievre wants to play politics with people’s health, it’s really rather unfortunate.” http://www.theglobeandmail.com/servlet/story/RTGAM.20080520.wsexchange20/BNStory/National/home __._,_._

fresaffcxc

For those even slightly in the loop–such as myself–there is little question the current initiative will be nothing more than what was and that hopes for the positioning of the Sherbourne Clinic–which specializes in trans health, is trans-positive and employs many trans people–as the gatekeeper instead of the old Clarke, now the Centre for Addiction and Mental Health (CAMH) and the home of both Kenneth Zucker and Ray Blanchard, are unlikely to be answered.

There are more than a few ripples going through our communities today and there will be some response in the media in coming days.

However, as with so much concerning us, this seems not really to affect the inevitability of things–even, in this case, the inevitability of something positive.

But then that is the definition of marginalization in society. Whether the stupid statements of someone like Pierre Poilievere or the Executive Director of Egale Canada.ttle

Quite frankly, I’m so glad I’m now beyond what a Ken Zucker, Ray Blanchard, Pierre Poilievre, or the Executive Director of Egale Canada can do–or not do.

Even though it still mightily offends my sense of what is right and what is wrong–and if anyone actually asked for my help, I would be glad to give it. Though in these communities, that is a long shot at best.

————————————————————————

More on Pierre Poilievre

https://jessicalive.wordpress.com/2008/05/26/more-on-pierre-poilievre/