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Trans Surgeries Are Not Cosmetic

Image result for trans rightsI wish I didn’t have to be writing this in 2017, but there’s still disagreement, even among those who vocally support trans people, around whether trans surgeries are really medically necessary. To me, this is an obvious “yes,” but perhaps it’s harder for those who don’t experience dysphoria to understand, so let’s try an analogy.

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This Isn’t About Michelle Kosilek or Trans Murderers, It’s About Human Rights

It’s a blessing and a curse.

One of the issues I’m most passionate about–the rights of trans people in prisons and detention facilities–has been in the news lately.  It should be a chance to raise awareness around this important issue and to use media to push forward the tide of increasing respect for prisoners’ fundamental rights that was evidenced in several recent events, including successful lawsuits in Wisconsin and Massachusetts around transition-related care in prison and the issuance of a final ruling on the Prison Rape Elimination Act that incorporates many of trans advocates’ recommendations regarding trans prisoners.  But it was evident from the start that this would be a tricky story to bend in the direction of education and advocacy on the issues, because this is a story that most people just can’t pull past Us vs. Them.

The headlines that started rolling in last week range from more-or-less balanced to fear-mongering on the conservative opinion side:

  • Judge rules in favor for inmate’s sex change operation (Boston Globe, Sep 4)
  • Judge orders Mass. to pay for inmate’s sex change surgery (Boston Globe, Sep 5)
  • Ruling on prisoner’s sex-change a matter of principle (Boston Globe, Sep 6)
  • Judge goes too far in sex change ruling (Boston Globe, Sep 7)
  • Is denying treatment to transsexual inmates “cruel and unusual?” (The Atlantic, Sep 7)
  • Free sex change for prisoner is distasteful, but justified (Boston Globe, Sep 10)
  • The real war on women–rewarded for killing his wife (, Sep 10)
  • Inmate’s sex change: humane or insane? (Santa Maria Times, Sep 11)

The facts of the case make it tempting, even for transgender people and those engaged in trans rights work, to focus on the individual involved and how heinous it seems that the state would give someone convicted of killing her wife a “free sex change.”  It’s entirely understandable that those who can’t access necessary transition-related health care due to the cost of that care and the lack of insurance coverage would find it frustrating when a prisoner is allowed access to the same care on the state’s dime.  But to focus on Kosilek’s crime, or on the idea of “free benefits” for prisoners, is entirely missing the point.

Yes, it’s strange that someone in prison would have better access to healthcare than someone who hasn’t been convicted of a crime, but the problem here isn’t that a prisoner does have access, it’s that many others don’t.  Prisoners should have access to healthcare as a fundamental human right, and so should everyone else.  True, many people don’t have that access right now, but access to human rights isn’t about ranking people by how much we think they deserve a right and doling it out accordingly.  Healthcare access in this country depends on a lot of things–structural inequality, economic opportunity, whether you can get insurance coverage, and whether your insurance covers the treatment you need, to name a few.  The Kosilek case was about a specific legal determination under one specific standard that gives prisoners in a particular jurisdiction access to health care.  The judge made the right call in this case.  There are many other cases, many other standards, that impact trans people’s right to transition-related care in different situations, and many people don’t have care yet.  That sucks, but it doesn’t mean we should wait until all those cases are solved before we provide healthcare to trans prisoners.  It means that we need to hold our country to a standard of basic human rights in all areas.

I also want to remind folks in general, but particularly some of the commenters on Lesley’s xoJane piece who are heavily focusing on the idea of “free surgery” or “rewarding prisoners,” that it’s the prison system itself that leads to this situation.  When people commit crimes in the United States, we handle it through incarceration.  We incarcerate people in facilities where if they are allowed to work, they can’t make very much money and they certainly can’t afford to pay for their own healthcare.  One of the consequences of that system is an enormous burden on the state, but that has nothing to do with the question of what necessary healthcare is.  There are other solutions to criminality, solutions that experts on prison abolition and reform can speak to far better than me.  If we provided some means for criminals to work and pay to access rights such as healthcare, then the argument might fly.  But we don’t, and so it’s the state’s responsibility to pay for care.  The state is failing in other areas–we don’t provide adequate health care for the young, the old, the sick, non-citizens, or those with disabilities–but again, the answer to failure in one area is not to fail in another.

If this case pisses you off, if you’re outraged, then great.  Excellent!  Join the fight for rights to transition-related care through Medicaid, Medicare, the VA, private insurance, and other programs.  Fight for expansion of the Affordable Care Act.  But don’t spend your time arguing about this one trans woman who did a terrible thing and later won a petition for her human rights.  Frankly, it’s a waste.