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Two studies which have recently hit the press reinforce a problem I have been considering for some time, namely the difficulties which transgender persons face in getting care. Herein, I will give an overview of these difficulties, the new studies, what they reveal about causes of provider’s behavior with respect to trans persons, and some brief recommendations for how providers can do better.
Transgender health advocates Sabrina Suico of the Couples Health Intervention Project and Brionna of the Mariposa project both work with services dedicated to improving the lives of transgender or gender-variant people of color. Image Credit: Aubrie Abeno, via mintpressnews.com
In 2012, I presented a paper at the American Society for Bioethics and Humanities, “She Walked Out of the Room And Never Came Back…”, in which I discussed the case of a patient who had been denied care by health care personnel while visiting the ER for a broken limb before finally being seen by another provider. The first provider walked out in a huff after the transgender patient’s trans status became clear as the patient’s anatomy was revealed during a diagnostic procedure. After leaving the patient alone, in pain, with no idea whether to leave and go to another facility or wait, another provider came into the room and professionally and compassionately provided the necessary medical care. This, I found, was not uncommon. Approximately 1 in 5 transgender patients have put off preventive medical care due to experiencing, or fear of experiencing, discriminatory behavior directed at the patient by clinical staff. According to some figures, this rises above 1 in 4 (28%), and transgender persons report being denied care across every demographic but worst for transgender women, who were assigned male sex at birth, than for transgender men who were assigned female sex at birth. The fact that transgender persons experience difficulties with access to health care should come as no surprise. In 2011, the Institute of Medicine released a report which addressed the many ways in which poor access to basic medical care for transgender individuals is “due largely to social stigma” and “fear of discrimination in health care settings” as well as lack of employer-provided health insurance due to employment discrimination.
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Note from the Editor: This is a guest post about the difficulties trans* people often encounter when seeking medical care. Medical care can be difficult to navigate in the best circumstances, but when your gender and documentation don’t agree, or your gender presentation and your body clash, it can be not only difficult but emotionally damaging to interact with medical professionals. Sayer Johnson is a run-of-the-mill Midwestern transgender man trying to navigate basic healthcare and share his human experience.
Reminded
Today I was reminded. Not in the sweet way that comes from a child fusing a new name with a new beard. Not in the quiet acceptance of a neighbor who, without skipping a beat, went from my old name to Papi. Not in the funny way that can come from the mouth of my always insightful six year old. Nevertheless reminded. Reminded in the bitter way that the media often reminds me. Reminded in the unfortunate way that humanity sometimes does. Reminded in my own community. Reminded why I continue to live my life out loud.
Canada’s single-payer health system is the envy of some Americans. Under Canadian Medicare, every province runs a single public health insurance plan with very low administrative overhead: in this sense, the system is efficient. It is also a natural fit for the goal of health equity: everyone is in the same plan; everyone has the same benefits.
A single-payer system is no panacea, however. Much rides on what the single payer covers and does not cover. For example, Canada scores poorly on international comparisons of health equity. This is largely, but not entirely, the result of what we exclude from Medicare: prescription drugs, as well as non-physician care (physical therapy, dental care, speech language pathology, etc.—any function not performed by physicians), in the community. As a result of these exclusions, Canada has a high rate of private health insurance for extended benefits, and one of the highest levels of private expenditure among universal health care systems. If you need rehab, or have on-going prescription drug costs, moving to Canada might or might not save you from American-style inequities in access to care.
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Sandhya Somashekhar’s recent article in The Washington Post, “States find new ways to resist health law”, provides a nice overview of some of the ways that states are throwing up obstacles to effective implementation of the Patient Protection and Affordable Care Act (PPACA). With the Affordable Care Act set to be implemented, blocking its effective implementation raises serious moral issues. Though it is an imperfect solution, I believe that these state-based obstacles to its implementation are deeply morally problematic because the costs of non-compliance fall on individuals while the politicians who have put these obstacles in place face little or no personal or political cost, and indeed stand to gain.
While I am arguing here that blocking implementation of the PPACA is deeply morally problematic, it is important to acknowledge that it is an imperfect solution to America’s glaring problem of uninsured persons and expensive, inefficient provision of health care. The PPACA or ACA, known colloquially as “Obamacare”, will work to get more Americans into the health care market and provide more access to preventive care for high- and low-risk patients, alike. Aside from the very valuable limitations on health insurers’ ability to refuse to provide coverage for high-risk patients and stop providing coverage for ill patients, it is still based on the for-profit health insurer model as evidenced in part by the early elimination of a government-based “public option” which would have competed with insurance industry plans. In addition, a large number of Americans who get insurance through their employers, yet find the premiums taxing and fall into otherwise-subsidized income ranges, will not have access to the federal subsidy system which is designed to give financial support to those entering the market through the health insurance exchanges.
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