Should gender reassignment surgery be covered by public health funding?

Ah come on now, this isn't the place for actual numbers..

These Trans threads are always great crack altogether. Same conversations same people etc etc. I'm sure one of the "reps" on the subject will have gotten the signal and will be in to educate the masses soon ha!

Inflation is high, but come on now..!

And if they don't have insurance, fvck them, right? Or if their disfigurement is due to to cancer or infection, then fvck them, tough sh1t, thems the breaks, right?

Grand, just wanted to see how low you'd go on this. Gotcha.

Thanks for that information.

Gender is all about perception - its a social construct not an absolute truth like sex.

So with that in mind, anyone who feels as though their gender is not affirmed by their sex organs has a perception issue of their own. Your sex is immutable, it is, it doesnt change. Gender is the fluid social construct, one which, as a social construct, you are not born with, but you attain as your grow. So if you start to identify as a gender that doesnt match your physical sex organs the mismatch is in your own perception.

I would imagine there is a variety of reasons:

1) Some GRS procedures are irreversible. It's prudent to make sure that a specific intervention is actually needed, irrespective of potential complications. Just because someone knows that they suffer from a gender dysphoria does not mean that they know exactly what they need to fix it. Talking to a professional is good. Of course, the psychologist must be specifically trained.

2) Tradition. https://www.scientificamerican.com/article/where-transgender-is-no-longer-a-diagnosis/

3) Gender dysphoria is not an illness, but if help is needed, who but a psychologist could help with coping mechanisms?

4) To scare away those who is not sure. Apparently, some trans people complain about pretty intense interrogations from their psychologists.

But I may be talking nonsense, the points above may not apply.

Nobody’s illness should be dismissed. Theres a mother on the RTÉ news this evening who’s autistic son has been given an estimated 5 year wait (in writing) for treatment for his compulsive eating. He’ll almost certainly have become even more ill then he is by then, if not dead.

By all manner and means make GRS available as a public treatment but as we can’t give life saving treatment to people already on the many lists there are, it’s hard to see how that will work in reality.

I saw that same report earlier alright, but the way you’re describing it isn’t how the healthcare system functions (or rather, doesn’t function, depending upon your point of view!). There are many more factors involved in waiting lists for any treatment than just financial considerations or budget constraints. In reality a patient who is recommended for GAS is unlikely to be on the same waiting list as a patient waiting for treatment for an eating disorder. A patient who is on a waiting list for a lung transplant is unlikely to be on the same waiting list as a patient on a waiting list for a wheelchair. There’s no waiting list for an abortion.

The reason I used the examples above is because of I know of a mother who’s son has intellectual and physical disabilities which require the use of an electric wheelchair, she was understandably resentful of the fact that abortion was being provided for under the public healthcare system, while her son was on a waiting list for a wheelchair. They’re two completely different circumstances. Same thing with gender affirmation surgery or a lung transplant - the waiting lists, and the costs of treatments just aren’t comparable.

To put the cost of gender affirmation surgeries into perspective, the cost of what was purported to be a wonder drug for cystic fibrosis patients was considered to be prohibitively expensive by the National Centre for Pharmacoeconomics, at €400m over 5 years for 600 patients. The HSE made the decision to go ahead with funding the cost of the drugs after campaigns by organisations like CF Ireland -

4. Budget impact

The F508del is the most prevalent mutation of the CFTR gene and it is estimated that some 505 persons are homozygous for the mutation and therefore potential candidates for the combination therapy of lumacaftor plus ivacaftor (Orkambi). The price to wholesaler for a pack including a 28 day supply of lumacaftor + ivacaftor is €12,144. The annual cost of lumacaftor + ivacaftor is €158,306 or €159,050 including the patient care fee. The manufacturer estimates the 5 year gross budget impact of lumacaftor + ivacaftor at €352,281,736. The NCPE estimate of the 5 year budget impact is €391,892,681.

5. Conclusion

The manufacturer has failed to demonstrate the cost-effectiveness of lumacaftor + ivacaftor (Orkambi) for the treatment of cystic fibrosis patients aged 12 years and older who are homozygous for the F508del mutation in the CFTR gene. In addition, the budget impact is significant with an associated opportunity cost. We do not recommend the reimbursement of lumacaftor + ivacaftor (Orkambi) at the submitted price.

https://www.ncpe.ie/wp-content/uploads/2015/12/Website-summary-orkambi.pdf

https://www.irishtimes.com/news/health/one-year-on-has-orkambi-improved-cf-patients-lives-1.3481443?mode=sample&auth-failed=1&pw-origin=https%3A%2F%2Fwww.irishtimes.com%2Fnews%2Fhealth%2Fone-year-on-has-orkambi-improved-cf-patients-lives-1.3481443

Elaborate - what pschology is at play here?

...

What part of this sentence did you not understand exactly?

They’re two completely different circumstances.

One set of circumstances has no impact on the other. There are plenty more reasons besides financial issues that there are waiting lists for various conditions. Funding gender affirmation surgeries on the public healthcare system has no impact whatsoever on waiting lists for patients waiting on a diagnosis of autism. Funding for patients with autism has no impact on patients on waiting lists for scoliosis surgeries, etc.

It’s why a public healthcare system exists - for those patients who cannot afford private healthcare.

Ah the old, "We shouldn't do X until Y is better". Completely aware of course that X & Y can both be fixed in parallel, but when you're opposed to something humanitarian, it's always better to play the "Oh I'm just concerned about someone else" rather than admit straight out that you oppose humanitarian supports.

We give €90m to the horse and greyhound racing industries every year, which is basically just a cash gift to bookies and horse owners. There is no good reason for it. A €90m backhander to already wealthy people.

There you go lads, not only could we fund the public treatment of GRA 90 times over, we could do that AND increase funding to a load of other areas.

But that's not good enough of course, because it's not about the money for most of you. It's about anti-trans bigotry and the need to get the boot in at every possible opportunity.

If it's so successful, it doesn't need that 90m. It's a nonsense talking point that the industry uses as a defence of it's backhander.

I have a gangrenous arm. Should I have it amputated? Or should I just have counselling? After all, arms are immutable, right?

A person can change how they look. Just look at dragon lady a few years ago.

But they cannot change their chromosomes, which determine their biological sex.

Rather than pandering to an ideology these people need mental health care not an publicly paid kow towing to an ideology.

What’s coming from what budget?

Funding for gender affirmation surgeries doesn’t come from the same funding for mental health services for example. They’re completely separate areas in the HSE and other organisations involved.

Just recently, by way of tackling the waiting lists for medical care, Stephen Donnelly announced a €350m action plan with focus on high volume areas -

There will be a particular focus on 15 high volume inpatient day case procedures so that every person waiting for over 6 months who is clinically ready will receive an offer of treatment. These are:

• cataracts
• cystoscopies
• hip replacements
• knee replacements
• skin lesions (general surgery and plastic surgery)
• varicose veins
• angiograms
• tonsillectomies
• laparoscopic cholecystectomy
• septoplasties
• dental
• hysteroscopy
• laparoscopy (gynaecology)
• total abdominal hysterectomy
• inguinal hernia repair

https://www.gov.ie/en/press-release/28b86-minister-for-health-launches-350-million-2022-waiting-list-action-plan/

Gender affirmation surgeries, are not a high volume area. That’s just one of the reasons the surgeries are provided for, and have been provided for at least the last 10 years under the Treatment Abroad Scheme (which is a separate budget again) -

https://www.irishexaminer.com/news/arid-40292789.html

It’s nothing more than a ridiculous attempt at a false dilemma to suggest that patients on waiting lists for other treatments, or funding for mental healthcare, or whatever else you wish to use by means of distraction, is at all affected by providing healthcare for patients who are transgender under the PUBLIC healthcare system. I think some people forget that ‘public’ means that people who are transgender who require medical treatment are also eligible to be covered under the public healthcare system as anyone else, up to and including gender affirmation surgery.

Which ultimately comes from the national budget? What’s your point? It makes no sense. Of course the money to cover the cost of surgeries comes from somewhere. Where it doesn’t come from, is money which is budgeted for other areas in the public healthcare system. That’s why the Minister for Health announced the additional €350m recently to address the waiting lists in high volume areas.

Where do you imagine that additional funding came from, found it down the back of the couch? Of course not, no more than anyone with a medical necessity of needing their mickey chopped off is denying anyone else brain surgery.

I’m not contradicting myself at all. The additional €350m hasn’t been taken from anywhere yet, it’s been budgeted for as part of a plan to reform the current healthcare system and reduce waiting lists. It was all there in the article -

This Plan details how the Department of Health, the Health Service Executive (HSE) and the National Treatment Purchase Fund (NTPF) intend to ensure that an even higher number, 1.7 million, are treated and removed from waiting lists. This will bring our waiting list figures to the lowest number in the past five years.

This ambitious Plan identifies 45 actions as part of a comprehensive twin-track approach of investment to reduce and reform waiting lists. Targeted investment aims to get many more people treated as quickly as possible. At the same time, reforming and investing in our public health service will eradicate the gap between demand and permanent capacity by addressing long-term reforms like improving patient pathways of care, enhancing data collection and information sharing, and revising waiting-list management protocols.

Speaking at the launch, Minister Donnelly said:

"I am delighted to launch the 2022 Waiting list Action Plan, an ambitious, comprehensive, and targeted approach to significantly reduce waiting lists and waiting times. We know, the number of people on waiting lists was already too high before the pandemic and now, following months of disruption to services, there are over 730,000 waiting for care in Ireland.

"This Plan allocates €350 million to the HSE and NTPF to reduce waiting lists by 18 percent this year which will bring the number of people waiting to their lowest point in five years.

"While this Plan focuses on significant numbers and targets, it is fundamentally about ensuring people receive the right care in the right place, at the right time - reforming our health service through the fundamental principles of Sláintecare."

730,000 patients currently waiting for care in Ireland, which the Minister plans to reduce over a number of years, by eliminating waiting lists not just for the 700k, but also for the extra 1m patients that are expected to need treatment in that time.

There’s no taking from Peter to pay Paul or any of the rest of it. Peter and Paul have different needs and different priorities as regards their healthcare, which is determined following an assessment of their needs and recommendations of the medical professionals involved, who also have to be paid.

It comes from the Oireachtas, which is where all public funding comes from, which comes from income from the Exchequer. Public healthcare is provided for as part of an obligation of the State by Government.

There’s plenty of different services people are free to disagree with, but there’s a lot more involved in these decisions as to whether or not to provide them than individuals own personal feelings on the matter.

Sexual Reassignment Surgery (SRS) used to affirm ones gender identity involves castration in the case of mtf.

The same surgery for ftm trans involves a mastectomy.

Giving hormones to "transition" is not the same as reassignment surgery, which is the topic of this thread.

It does. That still doesn’t mean all gender affirmation surgeries are covered under the public healthcare system. There are only some surgeries are covered, and others that aren’t. I know you know there’s no surgeries involve chopping off mickeys, but y’know, reality just wouldn’t be as heeeeeelarious 😒

The procedure, called an orchiectomy, may be involved. In layman’s terms it’s castration, hardly worth arguing over the terminology.

There’s a good insight into the workings of the National Gender Service here -

https://www.irishtimes.com/life-and-style/health-family/the-function-demand-limits-and-future-of-the-national-gender-service-1.4755189

Gender affirming surgery is another option. Most people attending the NGS decide not to have surgery. For those that do, we have surgical pathways for all of the major gender affirming surgical options including gender affirming chest surgery (mastectomy or breast removal and mammoplasty or breast enhancement), and gender affirming genital surgery (including reconstructive surgery of the genitals to form a vagina or phallus). Sadly, given a lack of public sector access to these operations in Ireland, most people travel abroad for surgery with funding support via the Cross Border Directive (for chest surgery) or the Treatment Abroad Scheme (for genital surgery). There is very limited private sector access to chest surgery in Ireland and no access to genital surgery.