Death By a Thousand Tweaks

The New York Times headline "Biden Administration Restores Rights of Transgender Patients" is not only misleading, it deflects attention from the overarching reality that the richest country on earth still does not provide guaranteed, single-payer health care to every single one of its citizens, regardless of race, color, creed, gender or sexual orientation. Even in the middle of a deadly pandemic, tens of millions of Americans are still forgoing care because of costs, or getting sued for their inability to pay for it because they either have inadequate insurance or no insurance at all. 

Moreover, the Health and Human Services Department's reversal of a Trump-era rule which had given health care providers the option to deny care to transgender people without fear of losing federal funding for their businesses paradoxically continues to punish this population by making them prove to the government's satisfaction that any denial of care is based solely upon their existence as transgender people. Since no other group of people is similarly required to submit evidence regarding denial of medical care, the Biden administration's restoration of their rights to "access" is punitive in and of itself. It might be said to deprive these patients of their rights by forcing them to jump through hoops that no other population group is ever forced to jump through to prove that their rights were, in fact, violated.

Rather than issuing a warning salvo to care-denying providers, the Biden administration is initially placing the onus directly on victims, merely "encouraging" affected patients to file complaints. Prosecution of bad actors, such as insurance providers, under existing civil rights laws is not guaranteed. Medical or surgical treatment for transgender people is not guaranteed, nor is monetary relief.

The verbal and ostentatious bestowal of "access" rights upon transgender patients is just one more example of the government nibbling around the edges of a massive social problem rather than addressing the problem in its entirety. They may just as well have declared "We feel your pain" for all the lack of urgency and remedies that the announcement entails.

The rule reversal and possible amendments to the law are - whether wittingly or not -  guaranteed to further inflame and perpetuate the "culture wars" which have become the centerpieces of modern political campaigns and legislative battles whose lack of any concrete policy solutions is guaranteed to please nobody. Conservatives and religious groups will howl on and on about government overreach and tyranny, while liberals will self-righteously defend "science" and make the interests of the oppressed group du jour the be-all and end-all of their artificially narrow discourse. 

These cultural provocations are, in fact, built right into the pathologically bloated Patient Protection and Affordable Care Act, one arcane section of which presumes to address health care rights. But for all its heft, it does not address them specifically enough, because the Biden administration will now have to spend all of its precious health reform capital on further "tweaking" the unnecessarily convoluted law, and enraging religious zealots and Trump cultists in the process.  Perhaps most importantly, it's a nifty way to delay discussing Bernie Sanders's own watered-down drive to "expand Medicare." 

From the New York Times article on the verbal restoration of transgender health rights:

Biden administration officials said they were working to write more complete new regulations on the civil rights provision of the law, known as Section 1557, that will specify which health care institutions are subject to the rules and what sorts of services they will be required to provide.

"We do anticipate engaging in further rule-making," said Robinsue Froheoese, the acting director of the Office of Civil Rights. She said the administration did not have a timeline for when a formal regulatory change would be announced. A formal rule will require reconsideration of a number of legal questions, such as whether the provisions apply to health insurers as well as health care providers. The Obama administration and the Trump administration also disagreed about whether the law's sex discrimination  language encompassed the treatment of patients who had had abortions.

Of course, transgender people could avoid being scapegoated and co-opted in the latest iteration of the culture war method of governing if the language of the ACA were simpler. For example, when the National Health Service law was enacted in England and Wales in 1948, every citizen received the following succinct letter from the ministry of health:

It will provide you with all medical, dental and nursing care. Everyone - rich or poor, man, woman or child - can use any part of it. There are no charges, except for a few special items. There are no insurance qualifications. But it is not a "charity." You are all paying for it. mainly as taxpayers, and it will relieve your money worries in times of illness.

Contrast that to the kludge of arcane minutiae and wishy-washiness that is the "Affordable" Care Act, which in its nearly one thousand pages (and tweakily counting) had already incorporated the word "waiver" 214  times in the original bill. This number does not include the various state waivers, many of which were implemented during the Trump years and which themselves will require further tweaking by Joe Biden. The law is a document of death by a thousand tweaks and a thousand deliberately manufactured potholes in the road to the single payer system supported by seven out of 10 Americans.

 It is also a massive blank check subsidizing private health insurers and other profiteers to the tune of billions and billions of dollars.

Can you imagine what would have happened to the 1935 Social Security Act if it had contained a thousand pages, rather than 37?

Rather than protecting transgender patients, the ACA itself is a loaded weapon which places them smack-dab in the middle of the culture wars crossfire.  Trans teens, already vulnerable and prone to self-harm and even suicide, are being targeted in ten states by reactionary legislatures which have directly barred providers from administering hormone therapy and other care.

If we had a single payer program that guaranteed care for everybody, trans people would not only be provided with necessary treatment, they would be saved from the additional trauma of politicians either demonizing them or deliberately delaying justice for them as they tweak their timelines, in the process merrily co-opting them as pawns in their identity politics game of thrones.

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*Update, 5/12: I'd like to make clear that in no way am I advocating any sort of therapy, including gender reassignment surgery. Those are medical issues that I am not qualified to discuss. The point of my post was to critique the "identity politicization" of this particular medical issue by the usual suspects in the Duopoly. The Biden administration seems to be trying to score more points with the liberal class, co-opting the trans population as a way to differentiate itself from the extreme right wing of the GOP, which is demonizing trans people from many different angles, including the bathroom controversy. I found the White House's self-congratulatory bestowal of medical rights on trans people to be just another smug way to both virtue-signal and dump on Trump. I also found it hypocritical in the extreme, given Biden's abandonment even of the public option in health insurance, thus breaking one of his campaign promises. He is only playing a progressive on TV; his statement that health care is a basic human right is a lie, and his co-optation of vulnerable people, many of whom are already traumatized enough, in order to score political points, is pretty damned gross. In my opinion, of course.

Hope that clears things up.