I want to offer a suggestion, of sorts, that is born out of decades of research. Well, not really research so much as a lifetime of experience with front-line medical staff, the stories from my friends, and the reading I’ve done as an adult about where our health care system is weak, and who falls through the cracks in its tired structure. No way is any of this scientifically stated, and hopefully I won’t rely on generalizations to make my points, but I’m sure if I do, someone will point it out to me. So let me just jump in with my suggestion.
Health care and health insurance ought to be the next priority for the queer community.
I advocate this not just because Don’t Ask Don’t Tell is on its last legs, and not just because I think we’ve begun a march to the end of forbidding same-sex marriage, but also because I was never a big fan of those issues anyway. And yes, I’m glad to see headway for them. I also am not opposed to the expansion of the hate crimes act to include sexual orientation, but I have misgivings there, too, namely because I don’t think our criminal justice system is an inherently fair one, and I don’t want to contribute to the long-term imprisonment of people of color and working class people. I’m not a “lock ’em up and throw away the key” kind of guy.
But health care has seriously failed me, and many people I know, in its cultural incompetence. I have been offered therapies that would, if followed, be dangerous for my health, because they would conflict with my hormone therapy. I’ve seen doctors give me a less than cursory exam because they were so uncomfortable with my body or gender identity, with frank relief painted on their faces because I told them I wouldn’t insist on getting a PAP smear that day. Hey, it’s only cancer, right? I’m sure your discomfort trumps my health. It’s in the oath doctors take, right? What was that about preventative medicine saving the country bajillions of dollars? I know trans women who’ve left their provider because they refuse to use the correct pronouns, and there is a particular kind of anxiety reserved for sitting in a doctor’s waiting room, with all the other patients, only to be outed in front of everyone as a transgender person. It’s not the doctor or nurse’s right to reveal our status like that.
I had my chest reconstruction surgery in a strip mall in a Maryland suburb. The surgeon was lovely, and well meaning, and very good at her job. But I wasn’t in an outpatient center, I wasn’t inside a facility that had lots of resources if something had gone wrong while I was unconscious on a table. I’m sure the Jenny Craig people two doors down would have had ample amounts of sympathy, but not a lot of know-how for this situation. It also meant they didn’t have a lot of bedspace for my recovery; 30 minutes after coming out of the operation, I was shuffled into my street clothes and out the door. All this after paying $8,000 from my own pocket, because this procedure wasn’t covered.
And see, that’s where the fight really begins. This was an “elective” procedure in name only, but certainly not in reality. Most of my costs related to my trans status—the hormones, the blood work to ensure the hormones are at optimal levels, any reassignment surgery—are not covered. If I find a practice that knows how to select the right billing code for something, I can slip in a lab here and there. But not my PAP smears, because I’m a male legally, and those aren’t covered for men. I feel like if I’m going to give my insurance provider a break and never require a prostate exam, they can cover a test for cervical cancer. I also will never get breast cancer now, never need a mammography, and there’s got to be a benefit to the insurance folks because of that. But if I want to also get a hysterectomy, I’ll have to pay for it myself.
Even more ludicrous, the way many insurance plans are written, even if an FTM were to get ovarian, cervical, or uterine cancer, he may have to fight the insurance provider to pay for the surgery, chemotherapy, or radiation. Because computer systems are written in stone, and can’t process such things for men. This is a quandary that is simply inexcusable.
Okay, I’ve been lecturing about the poverty of trans-related medical care and insurance. Let me assure everyone that it’s a morass for lesbians and gay men as well. Anyone remember AIDS? The Reagan Administration couldn’t even admit there was a crisis until the very end of the second term, and by then thousands of people had passed away. Lesbians have had such a terrible history of receiving bad medical care that they have created whole organizations to advocate for them, like The Mautner Project. Bisexuals feel so disenfranchised as a community that they often don’t tell their providers about their actual lives, playing the odds that it won’t matter. We are not served well when our doctors don’t know our whole story.
I laugh about it in my memoir, but on another level it lacks any sense of humor whatsoever. To ask what kind of birth control I’m on is to assume a lot of things about me, and sure, maybe it’s a valid question for the majority of female-bodied people who come into a physician’s office on a given day, but when that minority member is there, what has medical school done to prepare the doctor or nurse or physician’s assistant? Why do doctors tell me and the trans people I know that they need to do research before they can answer a simple medical question? I don’t expect them to know every disease under the sun, but trans is not that situation. Neither is being gay or bisexual.
I think we can tackle this as a community. We need to start by seeing it as the crisis that it is—because we queers love to have a big glut of crisis to respond to, let’s face it—and looking at how we can come together from our disparate sub-communities, to improve all of our lives. Medical education, Medicaid rules, regulations changing insurance coverage so that transgender people receive appropriate and acceptable care commensurate with who we are, improved networks for sharing information about gay, lesbian, and bisexual health, all of these areas are in dire need of attention. We live sicker, shorter, and more painful lives than we ought to be.
Let’s start advocating for ourselves and our health. I can’t think of a more basic human right than survival.