Last week's court decision overturning Wisconsin law that precluded transsexual inmates from receiving transition-related care raised the age old question of equality.
Even fair-minded American tax-payers harbor conflicted feelings about subsidizing medical care for transgender inmates. I doubt I'm going out on a limb to speculate the majority do.
Likewise more than a few within the transgender community are at odds over the free lunch their incarcerated "cousins" receive on the tab of state taxpayers. Comparisons are made between the inequities of self-funded, transition-related medical care in the outside world and the assumed privilege of inmates receiving free transition care inside prison.
I'd argue there's a fundamental misunderstanding at play. It's based on a flawed system. That system has little to do with prison reform.
No Way Out
Transsexual individuals suffer a medical condition, defined by WPATH as "gender identity disorder" or "gender dysphoria". In the real world a transsexual's inability to afford hormone therapy can be excruciating. It delays and denies medically necessary treatment. The condition of gender incongruence, if unchecked, becomes an emotionally painful, psychologically debilitating and often life threatening reality.
Depression is a reality faced by many transsexuals lacking the ability to access medically necessary treatment. The vast majority of transitioning individuals, up to 88%--confront this profoundly disturbing economic fact-of-life and never surgically transition. Gender reassignment is the medical protocol recommended for treating Gender Identity Disorder by WPATH, the organization which governs transsexual Standards of Care.
In discussing Wisconsin's federal ruling, transgender and cisgender taxpayers alike may have an axe to grind, but it shouldn't be about prison "perks". The broader discussion should be about the inequities of fatally flawed health insurance coverage, a health care delivery system that leaves transsexuals no way out of GID by excluding transition care.
Not An Issue of Prison Protocol
This is a health care reform issue, not an issue of incarceration protocol. For many within the transgender community, the prison industrial complex offering free transition care is akin to pouring salt on a festering wound. "We can't afford it, why should you get it free, Ms. (or Mr.) Criminal?"
Similarly an uninitiated, uninformed mainstream--Mr. and Mrs. John Q. Taxpayer-- doesn't realize transition care is medically recommended protocol for transsexuals. They seethe at the notion of offering hormone therapy or gender reassignment surgery to transgender inmates. This segment of the population may view tax-funded medical services as an extravagance, akin to elective cosmetic surgery.
Suffice to say fundamentally far right taxpayers view transsexuality as a religious abomination. End of story. And since this group's sense of fair play is limited to "their own", I'm disqualifying their discriminatory viewpoint from an otherwise broad-minded discussion.
The Public Doesn't Grasp the Concept of Transsexual Medical Necessity
Gender Dysphoria, Gender Identity Disorder, Gender Incongruence--label it what you will--is a very real medical condition with troubling consequences for those who can't afford access to medical treatment. Let me reiterate: most Americans have yet to grasp the concept of transsexual "medical necessity". They do, however, grasp chronic conditions that affect them, their family and friends: Life threatening heart, liver and kidney disease, cancers of every kind; chronic conditions like asthma and arthritis to variant angina.
Some are acute conditions others less so. Each of them demands medical treatment. No one in their right mind would argue access--inside or outside of prison.
Most "conscientious objectors" argue that gender identity disorder isn't in the same life-threatening league as heart disease or the like. A heart (liver or lung) transplant is on a different plane of critical care than a sex change.
I maintain both medical conditions deserve treatment.
The former chronic condition may take a life sooner, but the latter has the proven capacity to claim a life, too. Depression caused by GID leads to medicating behaviors which do kill--like alcoholism, drug addiction and suicide. Transgender sources often cite a transsexual suicide rate of 31%, with 50% of all transsexuals attempting suicide by their 20th birthday.
Transsexuals aren't taking their lives because of depression over having sex-reassignment surgery. Only 1-2% of post-ops polled have transition regret. It's a lack of economic means that sends most "pre-reassignment" transitioners over the edge. The dire consequences of being unable to reconcile mind, body and spirit through a combination of cost-prohibitive HRT and gender reassignment procedures cannot be overstated.
Heart disease is a physiological condition. GID is both a psychological and physiological condition. Neither chronic disorder discriminates. Both kill if untreated.
Even the Tax Court Agrees
Recently, medical treatment equality for transsexuals was upheld in another court of law.
On February 2nd, the US Tax Court ruled in favor of transsexual woman Rhiannon O'Donnabhain in her case against the IRS. The court denied the IRS claim that hormone therapy and gender reassignment procedures were "cosmetic". The court's majority opinion declared GID to be a medical condition requiring medical treatment.
The O'Donnabhain verdict established precedent for deducting gender reassignment protocols, including HRT and SRS on tax returns.
The issue that underlies the conflict of gatekeeping health care benefits is health insurance--both behind bars and in the real world.
Health Insurance Disregards the AMA
The health insurance industry has yet to adopt the 2008 position of the American Medical Association to include treatment of GID. Had the insurance industry relocated medically necessary protocols like hormone therapy and gender reassignment from standard exclusions to policy inclusions the debate over the Wisconsin verdict would be moot.
Health insurance reform would enforce equality. It adds the health industry "seal of approval" to transition care. Tax payers and the transgender community alike would be served notice: life threatening conditions such as GID are to be treated like every other chronic condition.
Inclusion of GID in the standard package of health insurance benefits would signal an end to the onerous financial burden that drains the very life out of many transitioners. It would quell the uproar over tax payer funded "cosmetic procedures" and stop political spin that depicts a "travesty of justice" in the Wisconsin prison system and beyond.
A Final Note on Transgender Crime
As in the mainstream, transgender individuals are both victim and victimized. They are proportionately law abiding citizens and hardened criminals. A few commit violent crime, but more often transgender offense is non-violent.
Transgender inmates find themselves inside detention centers and prisons, not typically for committing hate crime or sociopathic violence, or white collar larceny, but as the result of crimes of desperation and destitution.
Prostitution, drug trafficking, transgender unemployment, transgender underemployment, transgender homeless youth, transgender hate crime, these are the major contributors to incarceration. This is the plight of the typical transsexual as the world turns today.
Until protections for gender identity & expression are federally mandated and enforced, until the health insurance industry is reformed to include transition care, the transgender community will continue to find itself desperate, misunderstood and often without hope--either in front of society or behind bars.
More trans will commit survival crime. Many more will take their own lives, unable to cope with a short list of unacceptable, unforgivable options.