The Instigator
vekoma123
Con (against)
Losing
3 Points
The Contender
whiteflame
Pro (for)
Winning
11 Points

Should Sex Changes Be Covered by Health Insurance?

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Post Voting Period
The voting period for this debate has ended.
after 5 votes the winner is...
whiteflame
Voting Style: Open Point System: 7 Point
Started: 3/16/2014 Category: Health
Updated: 2 years ago Status: Post Voting Period
Viewed: 664 times Debate No: 49249
Debate Rounds (3)
Comments (5)
Votes (5)

 

vekoma123

Con

This is a re-installment of my last debate that had to be cut short. I have decided to challenge my opponent because they expressed interest.

This is a debate regarding whether or not sex change operations should be covered by health insurance.

I will be taking the side that they should not be covered by health insurance.

First round: Acceptance
Second round: Opening Arguments
Third round: Rebuttals and closing arguments

I look forward to a great debate!
whiteflame

Pro

Thanks to vekoma for offering me the opportunity to debate this topic, and as requested, I will use this round to accept, allowing him to open the debate with his arguments against e coverage of sex change operations by health insurance. I will, however, add some minor clarification in order to ensure that this debate is as clear as possible. If there is any disagreement with said clarification, Con may express it in the comments.

First, some definitions. Rather than continuing to refer to them as "sex change operations," I will provide a more specific and appropriate terminology:

Gender (or sex) reassignment surgery (GRS): "a term for the surgical procedures by which a person's physical appearance and function of their existing sexual characteristics are altered to resemble that of the other sex. It is part of a treatment for gender identity disorder/gender dysphoria in transsexual and transgender people." <http://en.wikipedia.org...;

In order to understand that, we must also understand what gender identity disorder is:

Gender identity disorder (GID): "a formal diagnosis used by psychologists and physicians to describe people who experience significant dysphoria (discontent) with the sex they were assigned at birth and/or the gender roles associated with that sex." <http://en.wikipedia.org...;

And, lastly, a brief definition of health insurance:

Health insurance: "a type of insurance coverage that pays for medical and surgical expenses that are incurred by the insured." <http://www.investopedia.com...;

The burden of proof in this debate is shared. It is my responsibility as Pro to provide substantial reasons for health insurance to cover this particular operation. However, since this is currently an available option under some insurance plans, it is also my opponent's responsibility to define substantial reasons that it be removed, if only from future health insurance plans.

With that, I will leave it to Con to initiate this debate in earnest.
Debate Round No. 1
vekoma123

Con

I would love to thank my opponent for his involvement, so let"s get started. All definitions listed and defined by him are indeed what I am going for and will cover. In-depth, I will be arguing that such coverage should not be available because such operations are not emergencies or involve life-threatening illnesses.

Here are the arguments I will use for why sex changes should not be covered, and yes, they are the same arguments used in the other debate since they both involve my position:

1. Emergencies vs Personal Choice. Sex changes, like breast implants and hair transplants, are based on personal choices from the patient itself, and is therefore not an emergency. There is absolutely no physical harm or damage done to a person"s body if they don"t get the surgery, unless it"s self-harm by depression, dysphoria, or the like.

2. Expenses. It is a very costly procedure, reaching into the $7000-$50,000 marks or more [2]. That being said, even though it could potentially drain a great amount of a patient"s finances depending on income, it, again, is personal choice and should not have to rely on insurance unless an operation has been botched or has caused greater physical damage outside of gender realignment surgery.

3. Emotional health. Even though depression with pre-op can cause emotional stress or fear because of gender identification, there have been cases where people who have gone through surgery do not like their body or worse, feel like a monster.[3] That being the case, it"s sort of an issue where one could feel bad about gender identity and realignment regardless, but to prevent lawsuits or fault on others, such as the surgeons themselves, it should not have to be covered and by doing so, such issues will not be a problem, even though I cannot say I know enough about health coverage and how it is handled for people who wish to sue.

Sources:
[1] http://www.investopedia.com...
[2] http://www.surgeryencyclopedia.com...
[3] http://www.charismanews.com...

I await your opening argument and we will do rebuttals in Round 3. Thank you!
whiteflame

Pro

Alright, I'd like to start by thanking my opponent, vekoma123, for inviting me to debate this topic. I was intrigued when I saw this topic, and I appreciate the thought he brings to his arguments. Don't worry, I don't mind seeing the same case again :)

With that, I'll launch into it.

Since this is a debate about whether or not something will be covered, we first have to define what is and is not considered to be worth covering. We can say pretty definitively what belongs on the list and off the list in many cases. Someone who develops a terrible illness that requires immediate and extended treatment is very likely to be on that list (even if health insurers try to keep them off). Meanwhile, someone who wants to increase the size of a particular part of their anatomy in order to court the opposite sex is probably off of that list.

However, we're really only interested in things that are similar to this situation. Someone with GID is not akin to someone getting breast implants. GID is a mental concern, and therefore when we make comparisons to similar situations, we must address the mental component. So which ones are covered? Well, we've got a long list that are now legally required to be covered: major depression, bipolar disorder, panic disorder, anorexia, bulimia, obsessive-compulsive disorder, autism or pervasive developmental disorder, schizophrenia, schizoaffective disorder, and children's severe emotional disturbances.

The point in mentioning this is that it showcases our society's concern with mental illness. GID is a similarly damaging mental disorder, and unlike with these other disorders, there is only one treatment that is effective: GRS. This has been established by the World Professional Association of Transgender Health, or WPATH.[4] And they're not alone in reaching this conclusion. The American Medical Association has advocated its necessity and its coverage.[5] So has the American Psychiatric Association.[6]

Why do they feel that way? Two reasons. The first is because it's absolutely integral to their being. Evidence suggests that those who suffer from GID may do so as a result of psychological, behavioral, and biological characteristics, with even the makeup of their brains and hormones being implicated.[7, 8, 9] As such, these people often have limited or no control over the gender they identify with, something that is rarely erased by any change in perception or therapy.

The second reason is because nothing else works. Electroshock therapy, anti-psychotic drugs, and conversion therapy have all been tried, but modern medicine has established that they don't work.[10] Moreover, they see the problem presented by removing their access to treatment. GID restricts their ability to function emotionally, physically, spiritually, economically, probably sexually, and can easily lead to committing suicide.[7] These alternative interventions usually result in suppression, suicide, substance abuse, or extreme anti-social behaviors.[11, 12]

Why this treatment? Because aligning body and mind is essential for many of them to feel valued and successful in society. This affects their ability to feel any sense of belonging in society, their capacity to engage in meaningful relationships, their esteem, and completely removes any possibility that they could ever self-actualize.[13] Their capacity to reach their full potential is completely removed when they simply don't have the funds to afford this surgery.

But it goes beyond just the emotional issues. The reality is that they cannot even set their gender as having changed without getting the surgery, which means there's no way that they can get legal recognition as the gender they identify with unless they get GRS. So they're not just required to live their lives in a body that doesn't represent them, but they live in a country that isn't willing to represent them legally as their actual gender identity. On many levels " medical, legal, and social " that gender identity matters a lot. In hospitals, gyms, prisons, spas, and even in their everyday clothes shopping, their identity affects how they're treated and who they are placed with. In some of these cases, it even creates potentially risky situations so long as they aren't permanently isolated, especially in the case of prisons, where they face actual violence upon discovery. Literally no other "cosmetic" issue so completely affects a person's rights and safety.

This loss of human life, of human dignity and rights, of basic sanity and self-identity, should not have to be suffered for decades solely because someone suffering from GID cannot afford the cost.

As Con has requested that I not engage in rebuttal in this round, I will abstain, and leave it to him to rebut my case and conclude his.

1. http://en.wikipedia.org...
2. http://en.wikipedia.org...
3. http://www.investopedia.com...
4. http://www.wpath.org...
5. http://www.gires.org.uk...
6. http://www.apa.org...
7. http://doctorsonly.co.il...
8. http://www.sciencedaily.com...
9. http://www.ncbi.nlm.nih.gov...
10. http://books.google.com...
11. http://www.yogyakartaprinciples.org...
12. http://www.averyjenkins.com...
13. http://en.wikipedia.org...
Debate Round No. 2
vekoma123

Con

I would like to acknowledge my opponent for his opening argument, and I feel they did a great job of making wonderful arguments. Because I don"t want to waste character space by quoting, I will cut to the chase by indirectly referencing his words for my rebuttals.

My opponent mentioned mental concerns, and they have compared GID to a list of more topical mental disorders, and I will admit on my behalf that this is a relatively great point. However, after doing more research, I"ve found a great source where breast implants can actually do the same sort of thing where it boosts self-esteem and body image, which both can relate to mental disorders such as depression linked to image of self-esteem [1], and even eating disorders [2].

That being said, I found out that breast implants usually are not covered, but will for those who have had mastectomies due to cancer-related illnesses [3]. That again goes back to where it is about personal choice and not about medical emergencies, such as treatment for cancer.

"

This section is to give rebuttals for the "two reasons" argument they gave me.

With such characteristics and change, it seems like it"s being that such surgery is more-so a last resort, and not being that there is an emergency behind it that must be done now before a physical influence continues harming them. Now, if there is some level of private health care insurance that is regulated under, say, trans-only coverage for such surgeries that aren"t government or federally funded [4, 5], but possibly under the state or independent insurance agents, then maybe we could find middle ground here if it isn"t under taxpayers" expense.

As much as I sympathize for the rights of trans* folk to be able to have access to GRS, including the need for it for such folk to function in a positive manner, there still is no reason why it should be covered, especially after my more in-depth comment regarding the comparison of it with breast implants. Personally, either cover all of it, or don"t, but people should have a say, regardless of their views, on what should or should not be covered based on personal choice vs. emergency treatment. Now, would it be good to help someone before they sink to such a low point? Sure, but there"s treatment for such symptoms and behaviors, and sadly, it is true that not all of them work, but as far as I"m concerned, we don"t do surgery for such things.

"

I will relate my closing argument to the last few paragraphs.

Us a society are always going to find something to make us fit in, feel valuable, feel loved, and feel needed. The problem with it is that these people are not alone on that, because there"s always going to some form of external influence that will bring them down. Unfortunately, the only thing that one could do is to be proud of who they are with who they have, and not have to rely so much on an outside source to make them happy, unless they are able to financially meet them "halfway" on such a proposal. I feel that what should be done, and this is coming from an LGBTQ activist outside of personal choice medical coverage, is that there should be more open resources and alternative positions for trans* folk to have such legal recognition and physical tolerance, because it is nearly impossible for everyone to change their view all of a sudden no trans* folk. It"s a sad reality, and as much as I disagree with it, that also goes where people need to take the initiative themselves to pay for their own wants, not their own needs. Of course it"s wrong that such rights are denied, but that is because of social bigotry, not medical coverage initiatives.

...

Because I rebutted your opening arguments in the best fashion that I could, I feel it is only appropriate that because his arguments covered more about the basic idea of why such coverage is needed in comparison to other disorders, that they should further rebuttal my arguments if they wish, and I would love for them especially to also cover the "personal choice" aspect of it.

Sources:
[1] http://www.ncbi.nlm.nih.gov...
[2] http://www.nami.org...
[3] http://www.webmd.com...
[4] http://www.insurancecompanyrules.org...
[5] http://en.wikipedia.org...

Thank you very much for your involvement in such a difficult issue, and I hope that we can have another great debate in the near future. That being said, vote con!
whiteflame

Pro

Alright, I'd like to thank my opponent for his candor and for providing such strong arguments. With that, I'm going to launch into some rebuttal before concluding this debate.

Now, Pro cites three concerns in R2. I'd like to go back to those, and much of my response to Con's rebuttal in R3 will come into play here.

He starts by talking about health insurance funding emergency care versus medical choice. I would say that my argument at the start of my case is more than enough to deal with this. I've shown that insurers are concerned with other very significant mental harms. Con concedes that these are all reasonable things to cover via health insurance. Con drops my arguments that this is supported directly by WPATH, the AMA, and the APA. Extend those points. Extend my points about how this can very easily turn into an emergency situation, as these people are highly likely to attempt suicide (my [7]), and to face violence as a result of their legal and social perception. I'd say these do suffice as emergencies.

He does, however, place one rebuttal here that warrants response. He talks about how breast implants are another type of surgery that is used to address mental concerns, essentially stating that we should cover every problem along these lines and not take action hypocritically by affording that funding to one group and not to another. I have multiple responses here:

1) Con never states why hypocrisy is problematic. There's no impact of increased hypocrisy whatsoever here. This point is moot.

2) Con says we should extend this coverage to every such situation if we're going to extend them to any, but ignores the fact that we have already extended health insurance to deal with multiple mental issues. So long as that is true, this is making it less hypocritical than status quo, so if there are any benefits to reduced hypocrisy, I garner them.

3) Con's own [3] hurts him a lot here. When it says that a mastectomy is sufficient reason to cover an implant, what is it actually saying? It's saying that these women no longer feel that they have the characteristics that define their gender. These implants aren't affording them any benefit aside from restoring a semblance of normalcy to their appearance. That's exactly what those with GID want, and that's exactly what this surgery would provide. It's not an augmentation, but rather, and opportunity to bring them to a state of normalcy, though in this case, their normalcy has been absent their entire lives!

4) It's not hypocrisy. Con ignores much of my analysis on why GID is a special case.
Extend my arguments about it not just being psychological or behavioral " I gave three separate links on how brain chemistry, structure, hormones, and genetics can all play a role in this. That in no way equates to a woman's perception of her body without breast implants.
Extend my argument about how treatment is completely ineffective with these patients, whereas anti-depressants and therapy can solve for the problems involved with a woman's body image.
Extend my arguments about recognition by society, and how those suffering from GID cannot even be recognized as their actual gender, something that, again, is absolutely unique to this case. No other issue of appearance so completely affects a person's rights and safety.

Next, Con discusses expenses. I have a number of responses here as well.

1) This is never impacted. Con never states what harm it does to the general population to have these surgeries covered at this cost, nor does he state any harm to health insurance companies or governments

2) Con is essentially stating a cost without realizing that a cost exists no matter what. If these patients don't get this surgery, they will instead have their health insurance companies afford them anti-depressants and psychiatric therapy, at the very least. Getting these for the rest of your life isn't cheap. Neither is the loss of work hours that result from them, nor the loss of productivity. That means that their contribution to our economy goes down and stays down. Worse still, since many of these people commit suicide, their entire contribution to society is completely lost. That's not to mention the funerary costs involved in this.

3) This entire argument seems very superficial. I never see a reason to prefer increased finances over the lives and well-being of these people. I'll repeat what I said at the end of my last post: this loss of human life, of human dignity and rights, of basic sanity and self-identity, should not have to be suffered for decades solely because someone suffering from GID cannot afford the cost.

Lastly, Con discusses emotional health. The fact that some people are upset with the results doesn't change the fact that most people are completely cured of GID as a result of this surgery. Look back to those links I provided from the APA and AMA " they both state that it's an effective treatment. The reality is that every form of treatment has a certain failure rate. It doesn't change their importance, nor does it make it unreasonable to offer them as an option. Informing these patients of the possible harms is sufficient. If a surgeon botches the surgery, then they deserve the lawsuit they get. If they did everything right, then they're likely to win any such lawsuit they face. That's not to mention that, since anti-depressants and psychiatric therapies can fail (and will with these patients), you're moving from a large likelihood of lawsuits to a much smaller one.

Now, moving into arguments stated solely in R3.

Con talks about how this is a last resort treatment. First off, that purports that there can be an emergency situation with these patients, which supports its usage given his own arguments. Second, no, it's not last resort. It's entirely preventative. Again, look to my links on the APA and AMA " they make it quite clear that this is supposed to prevent the horrible mental and physical strains of suffering from GID.

Con states that it's fine if it's covered by some private insurers, but doesn't state why a private insurer is more appropriate, nor why taxpayers shouldn't foot the bill. In the case of private insurance, other people are also paying for their care. So why is public insurance for this procedure so problematic? He doesn't say.

Con states that he sympathizes with this group, yet doesn't feel it necessary to provide them an affordable and effective treatment that many of them simply cannot access in status quo. He's ignoring too much of my analysis here for why GID is different from breast implants, as well as my arguments regarding belongingness, esteem, and self-actualization, all three of which are impossible to reach in the absence of this necessary treatment.

Con closes with a point about external influence. In doing so, he ignores every point I've made about how these people feel internally, and how the influence of others doesn't matter when their biology is telling them they don't belong in their own skin. He talks about how we can solve for this problem by including "more open resources and alternative positions for trans* folk," never defining what those resources or positions would be, how they would solve for the problems I've discussed, and how this resolves issues of legal recognition and physical tolerance, let alone all of the others I've presented.

Concluding Statement

Looking back on Con's arguments, he seems to be stating that their problems won't go away, no matter what we do. Society will continue to demean them, the legal system will continue to deny them, nothing will change. What he fundamentally misunderstands is just how important this surgery is to them, and just what it is meant to do. Even if the only thing that changes is their perception of themselves, that is sufficient for every voter currently reading this to vote Pro. It's not a "personal choice," it's not something they ever decided, just as schizophrenia is not something someone decides to have. This is outside of their control, on any level.

Let's return to Con's example about mastectomies. These are women who have lost a piece of their sexual characteristics. In the physical sense, are they in any mortal danger if they don't get the reconstructive surgery? Probably not. But that doesn't make their desire to receive the breast implant(s) any less validated. They feel lost, they feel as though a piece of them is missing. There is something biological telling them it should be there, and it is not. Those with GID suffer the same plight, except it didn't result from surgery " it resulted from something integral to them, something they cannot change. They are harmed, both internally and externally, by what they've been deprived of since birth. And the pain won't stop until they get access to surgery that is outside of their basic means.

It is not right or reasonable to deny them that balm, especially not because those who don't live with that pain view it as a "personal choice." Living that pain, every minute of every day, is no choice. Vote Pro.
Debate Round No. 3
5 comments have been posted on this debate. Showing 1 through 5 records.
Posted by bluesteel 2 years ago
bluesteel
re: jifpop's RFD

While I understand that the personal choice argument might be persuasive if you haven't seen argument in favor of mental health parity, but I discounted this argument because Pro showed that when you have GID, the surgery isn't really a choice. There is massive body dismorphism if your brain thinks your female, but you have a penis. That causes serious mental issues.

The same "choice" type arguments were used to argue that clinical depression shouldn't be covered. People said, "they should just snap out of it." If you buy the choice argument, you have to reject Pro's definition of GID as illegitimate, i.e. you have to think that trans people just wake up one day and decide to be the other gender, rather than that they have a rare affliction where their DNA causes their brain to develop into one gender and their body to develop into another. Since Con never argued that GID isn't a legitimate disease, you'd have to rely entirely on your own personal bias to get there. So if you judge the debate without taking your personal beliefs into it, you couldn't really vote on the personal choice argument.

Not that you have to change your vote. I think judges should stick with their first impression and not be swayed by arguments in the comments. But I think it's useful to be made more aware when you let your own beliefs about something influence how you vote on a debate, which is purely a jousting match using words instead of lances. All that matters is who performed better in the debate, not what you believe about the subject.
Posted by bluesteel 2 years ago
bluesteel
RFD: wow, Pro face-crushed Con. And that's not even saying Con did a bad job. Con did quite a good job. Pro just did a phenomenal job.

Pro successfully shows that being trans is like having the brain of a man trapped inside a woman's body - or vice versa. Pro showed that only surgery solved this problem - that no other treatments worked. Pro showed that if we cover mental illnesses, we have to cover the only GID treatment that has proven effective.

Con has a pretty good rebuttal by bringing up how we might have to cover cosmetic surgery for other people who feel "out of place" in society. But Con hurts his argument by saying that breast augmentation for cancer patients is okay. Pro tears this apart in the next round, showing how if GID is the same as cancer patients, who don't feel like "women" anymore without their breasts, and we deem this psychological factor serious enough to cover a surgery normally deemed cosmetic. I think Pro successfully proves that it's different to feel "out of place" in your own skin than to feel out of place in society in general (because you're not as attractive as other people, say).

Pro also straight turns cost by showing that other treatments would be more expensive in the long run because they don't work very well, so we have to keep applying them for no reason, meanwhile losing a productive member of society (who supposedly pays back the insurance costs if he or she is ore productive and can pay premiums for longer).

Pro is an awesome debater, and I look forward to reading more of Pro's debates in future.
Posted by whiteflame 2 years ago
whiteflame
Jifpop, I don't mean to sway your vote - my intention with these questions is solely to understand - but, why did you find the argument that we currently cover instances of major depression, bipolar disorder, panic disorder, anorexia, bulimia, obsessive-compulsive disorder, autism or pervasive developmental disorder, schizophrenia, schizoaffective disorder, and children's severe emotional disturbances to be lacking, especially since it was agreed to by vekoma? Is it that you disagree that those things should be covered, or do you believe that they are sufficiently different from GID to warrant different standards?
Posted by vekoma123 2 years ago
vekoma123
In closing on my behalf, I think that pro did make great points and I apologize for not being more in-depth for my explanations. I still stand that sex change operations should be allowed to be covered when it is under independent insurance companies, and I feel a better debate topic may've been:

'Should sex change operations be covered by non-independent insurance companies?'

Thank you again to my opponent for his involvement and like the usual, it's up for the voters to decide.
Posted by whiteflame 2 years ago
whiteflame
Heh, well, your previous opponent also challenged me, so I guess I'll be doing two of these. That's fine, though, just means I'll have the same opening argument.
5 votes have been placed for this debate. Showing 1 through 5 records.
Vote Placed by bluesteel 2 years ago
bluesteel
vekoma123whiteflameTied
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Reasons for voting decision: RFD in comments
Vote Placed by Wylted 2 years ago
Wylted
vekoma123whiteflameTied
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Reasons for voting decision: Pro, just brought a better all around case. Con really needed to attack GID, show it to be some B.S. Type of disease that the psychology/psychiatry profession likes to make up and exploit. Not sure that it's even possible to do that, but I felt that's what was needed.
Vote Placed by kbub 2 years ago
kbub
vekoma123whiteflameTied
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Reasons for voting decision: Con continued to compare the surgery to breast implants, but that analogy didn't get him anywhere. Pro gave enormous amounts of evidence for the psychological harms relation to transgender persons (WHICH, by the way, is not a disorder in the DSM V. Just thought you should know). Anyway, Pro pointed out quite effectively that this surgery can save lives and illnesses. He made an effective case about the social-acceptance that would be gained, suicides that would be prevented, psychological distress that would be prevented, and eating disorders that would be prevented. Con never impacted any of the economic issues he brought up. This was a very clear win for Pro.
Vote Placed by Jifpop09 2 years ago
Jifpop09
vekoma123whiteflameTied
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Reasons for voting decision: I did not know a lot about some of the things you guys were talking about, but Con definitely had me more convinced. His main argument is that it is a personal choice, and he reaffirmed that health insurance is just that, an "insurance" that you will be covered in emergency's. Sex changes are not an emergency, and they are causing no immediate harm to the person, and can be exploited many times. Pro strayed away from attacking this point, but made mention briefly on the person who wants a sex change is facing immediate psychological harm. I was not very convinced, as he provided little hard evidence on an immediate and dangerous harm to the person in question, and that is a big no for me. Anyways, I will acknowledge his superior sources.
Vote Placed by Krazzy_Player 2 years ago
Krazzy_Player
vekoma123whiteflameTied
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Reasons for voting decision: Firstly I'm massively biased for this case on Con side. The Resolution was, "Should Sex changes be covered by Health Insurance?". Con's main stance against the Resolution is Sex change is not an emergency, heavy cost and some arguments for emotional health. This was quite sufficiently refuted by Pro. But I didn't find convincing arguments by either side so I'm keeping it a complete tie.