… and specifically, what kind of health care?
With Michael Moore’s Sicko out in theatres, everyone’s talking about the blindingly obvious need for universal health care in this country, and the “I got mine” mindset that seems to trip up many of us in the United States who are used to fighting tooth and nail for coverage. As Jill pointed out last week,
I also found myself having the occasional knee-jerk individualist reaction to the idea of universal health care. That individualism is also so deeply ingrained in Americans — the idea that I can do it on my own, that personal freedom and independence trumps all — that a system wherein we all contribute in order to help each other is a hard sell.
Pam Spaulding over at Pandagon had some similar thoughts, noting that “We are very much a “me” culture, with an acceptance (as well as envy and disdain) of the ability of those with money to be able to buy services they want and need.”
So… these were some of the thoughts in my head as I started looking back at discussions from the last five years about whether the woman above, Michelle Kosilek, is eligible for health care that’s been prescribed by her doctor. There are a number of complications, in Kosilek’s case. First, she’s incarcerated; that means she’s certainly not paying for her own medical care, but that the government is responsible for keeping her healthy–at least to some degree, most everyone would agree. Second, she’s trans, and the health care in question is genital surgery. If it were practically anything else, you’d hardly have any fodder for controversial news stories. Third, the crime she’s been put in prison for is particularly heinous and repulsive: she was convicted for strangling her wife.
Seems to me that Kosilek’s case has been the nexus for a whole bunch of different knee-jerk reactions about health care, prisoners, and trans people.
One thing most non-lunatics seem to agree upon is that yes, people do need SOME way of getting health care, even the poor, even the incarcerated, sometimes even (*gasp*) immigrants. It would be inhumane to suggest, at least openly, that some people can do without health care, right? (I’m sure one of you will kindly link me to some wingnut who’s declaring otherwise.)
Unsurprisingly, there are some big blind spots in this least-common-denominator agreement; one of them has to do with trans people, and the kinds of “controversial” health care we often need. The conventional wisdom, I’m sure a lot of you can guess, is that the kind of health care Michelle Kosilek’s been prescribed isn’t “really necessary.” That’s why mainstream and conservative media outlets, from coast to coast, can have a field day trumpeting about how the sky is falling because “tax dollars are being used for sex changes” whenever any government health care funds are used for trans health care. That story about San Francsico employee benefits, from six years ago, is the first time I remember seeing the reactionary backlash–from sources other than the New York Times, although I wouldn’t call “another minority flexes its muscle” an objective headline by any means–and it hasn’t stopped since.
So… here’s something that’s very difficult for most people to grasp: for a whole lot of trans people (although not all), some kind of trans-related health care is a medical necessity. Sometimes this means hormones; sometimes it means surgeries, or other procedures. The exact details are not that important — and indeed, are often used to distract and sensationalize. They’re not as important as they’re made out to be in part because good trans health care, just like good health care in general, is individualized. There aren’t any one-size-fits-all solutions.
A quick and dirty history of trans health care, before I go back to the media and Kosilek:
Trans health care was first pioneered more than a century ago, and has been recognized by the medical establishment for decades. Despite this, a lot of courts, government agencies, and insurance companies persist in calling it experimental or untested, and generally treating trans health providers and servics like sketchy red-headed stepchildren of the medical industry.
Trans health care used to be concentrated in a few large institutions here in the US, with Johns Hopkins being the most famous… or I should say, infamous, for forcing trans people to jump through all sorts of ridiculous, misogynist, stereotypical hoops. (Check out How Sex Changed: A History of Transsexuality in the United States by Joanne Meyerowitz, for more.) Interestingly, the two experts paid by the government in Kosilek’s case are both from the Johns Hopkins unit that used to treat trans people before shutting its doors in 1979 and more or less declaring trans people untreatable.
In the last few decades, trans health care in the United States has become much less centrally controlled, and probably significantly more accessible than it was… to those with enough money. Not too dissimilar to a lot of “quality health care” in this country, I’m afraid–and as usual, insurance companies bend over backwards to avoid having to pay. There has never been a shortage of cultural prejudice and exploitative shock to help insurance administrators out with denying trans health care; it’s often mentioned explicitly in insurance policies, in terms like “any treatment related to change of sex is excluded.” Go check your own policy, and see what kind of creeped-out language some bureaucrat wrote in. to foil us devious trans people from getting any monetary assistance whatsoever!
The parallels with Sicko come up again when you look at other countries. In many nations where the government funds universal health care, trans health care is part of the funding. It hasn’t been easy to achieve–in Canada, coverage went on a province-by-province basis, and access is still tightly controlled in some places by large clinics, similar to Johns Hopkisn, that I’ve heard horrific stories from. And the right wing still protests that trans health care is covered in the UK all the time. But increasingly, in nations with universal health care, that also means health care specific to trans people.
So it’s been interesting to see how Americans react to situations here where federal, state, or local government money pays for trans health care — just as it does in Canada, the UK, and many other nations. Part of the tragic absurdity of ambivalent-about-welfare-states health care in this country is that since the system has to recognize that we’d be flat-out killing our citizens if there was no government-funded health care, the government DOES foot the bill for some people’s health care: people who wouldn’t be able to get it otherwise. People who are in the care of the state, like foster kids and orphans and incarcerated prisoners. Poor people who are eligible for Medicaid, and the elderly and disabled folks who get Medicare benefits. Of course, it would outrage conservatives if any of these people actually got equivalent or better services than what more privileged people have to pay for, so it seems sometimes like some effort is made to ensure that they only get crappy, crappy health care.
Michelle Kosilek’s story isn’t new, but it’s been showing up again in the news recently because of the lengths that the state is trying to go to in order to avoid responsibility for trans people’s health care: $52,000 is the tab so far, and this is just one of the battles against trans health care that federal, state, and local governments have been trying to wage over the last few years (at least). Kosilek herself has been a subject of a lot of disagreement and name-calling in trans communities. Although Kosilek claims she killed her wife in self-defense, the facts of her case are ugly, and the jury didn’t buy her claims. Although I hate to take the word of the criminal justice system about someone’s merits, it’s altogether too likely that Kosilek is at the very best a person with some very serious mental health problems, who shouldn’t have ever been married to her own psychotherapist. At worst, she’s a psychopathic wife-killer, one who’s now “paying her debt to society.”
Even I have to admit that the fact that Kosilek is trans weighs heavily on my evaluation of her case, and not in a positive way. I can’t help but realize that I would be looking at this story very differently if I wasn’t aware that Kosilek was trans. The nature of her crime has understandably made a lot of people recoil, including other trans people–some of whom refuse to believe that she’s really trans at all, who prefer to just label her as a man–it’s safer in some ways. But you know, trans people come in all shapes and sizes. There are republican trans people, and trans hip-hop artists, and trans CEOs of large corporations, and there are trans murderers, thieves, liars, and crooks. At a stretch, Michelle Kosilek might confirm some of the worst “Silence of the Lambs” stereotypes that make trans people cringe or rage or ache. Does that mean she doesn’t deserve health care?
I’ve read a lot of arguments about Kosilek’s health care over the last five years. (Here’s a recent discussion on livejournal and half of a debate from 2002, between two trans women.) A lot of the discussion strikes me as having a unique flavor: the tang of a country without universal health care. I’ve seen it argued that someone who would kill a woman can’t possibly be a woman herself and therefore can’t be trans and shouldn’t have access to trans health care. I’ve also read arguments that her crime is so heinous that she doesn’t deserve the usual goal of trans health care: a body more consonant with one’s gender identity, that can be lived in without dissonance and pain. It’s trans people arguing this, people who know what it’s like to be denied a gender, who’ve experienced that same pain. But the most recurring theme I’ve seen is, “why should she get to have what I can’t have / what I can’t afford?” But can any of us really afford to stay in this mindset, with the state of health care in this country, with Michael Moore shaking it with his mixture of sarcasm and weary hope, right in our faces?
Even this specter has been raised: “what if trans people start committing heinous crimes just to get into prison, where their surgeries will be paid for?” It breaks my heart to hear this for so many reasons: the unbearable ache of dysphoria that so many trans people are all too aware of; the naivete of anyone who doesn’t know how many trans women are raped and prostituted in the American prison system; the blunt awareness that no, there isn’t much assistance in this country for a trans person who needs hormones, surgery, any trans-specific care. You have to pull yourself up by your bootstraps, in that good old-fashioned independent American way, grit your teeth, and go get your own health care. The story isn’t that much different from the SNAFU’d story of the rest of American health care–just with the addition of conservative media pundits spitting contemptuously on the very idea that any help would be offered, and everyone else sitting on their hands, not sure what to think.
As for Michelle Kosilek, it seems pretty simple to me, at least at the level of what principles we should bring to bear:
If you listen to innumerable trans people and almost all of the health professionals who have treated and provided care for trans people, you’ll hear overwhelmingly that trans-specific health care is not only well-established but necessary. That it improves the well-being of individual bodies and lives. That in many cases, it saves lives.
Everyone wants to get in on the act, but ultimately it has to be a patient and their doctor who decide what care is appropriate, in each individual case. Bureaucrats shouldn’t be the ones deciding. Politicians shouldn’t be the ones deciding. Media pundits shouldn’t be the ones deciding. Livejournal users certainly shouldn’t be deciding, regardless of whether they’re trans or not.
If you accept that trans health care is neither experimental nor unnecessary, and a doctor has prescribed it to a patient, then you have to provide it to those patients who the state has an obligation to provide health care for. Whether that’s a murderer or a city employee or a young woman in foster care.
Mariah Lopez’s case, previously mentioned here on Feministe when Jack at AngryBrownButch started her campaign to respond to the New York Post’s intensely transphobic reporting, is noteworthy because Lopez too has been described by the media as a “sociopath.” The Post called her that based on her criminal record, without bothering to check up on the fact that Amnesty International has been chronicling her harassment and arrests by the NYPD for years, as a striking example of police brutality against trans people.
But no–when “tax dollars for sex changes” are at stake, one of the easiest ways out is to label trans people as insane, sociopaths, deviants, etc. It almost makes me question how the media has treated Michelle Kosilek. Almost. I can’t find it in my heart to have sympathy for someone who strangled a woman from behind, apparently in a premeditated way, then stuffed her body in the back of a car before leaving it in a mall parking lot.
But there are more important principles at stake here than a single murderer, a single victim who should have lived, a single heinous crime. Who deserves health care? Does a murderer deserve health care? Even if the rest of us have to keep struggling uphill, in this land of pay-for-it-yourself medicine? What do you think?
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