AMA Supports Transgender Health Care

[Shana A]

 AMA Supports Transgender Health Care
GLAD Applauds Decision
William Henderson   June 16, 2008

http://www.innewsweekly.com/innews/?class_code=Ne&article_code=5603

The House of Delegates of the American Medical Association, meeting in Chicago today, June 16, passed a resolution for "Removing Barriers to Care for Transgender Patients," which states "Resolved, that our American Medical Association support public and private health insurance coverage for treatment of gender identity disorder as recommended by the patient's physician."
Getting appropriate medical care, from psychotherapy to hormone therapy to any range of surgeries, is a struggle for most transgender people due to prejudice, ignorance, and simple discrimination, said Jennifer Levi, director of GLAD's Transgender Rights Project. [See GLAD Launches Transgender Rights Project, Issue 1744, Page 3]. 

[lady amarant]

Oh wow! This smells like a real, actual *gasp* move in the right direction!

~Simone.

[Shana A]

also

AMA Supports Transgender Health Care

http://www.advocate.com/news_detail_ektid55961.asp

Gay & Lesbian Advocates & Defenders commended the American Medical Association's support for transgender health care Monday in a press release.

The AMA's house of delegates in Chicago passed a resolution titled "Removing Barriers to Care for Transgender Patients," which, according to GLAD, states, "Be it resolved that the AMA supports public and private health insurance coverage for treatment of gender identity disorder."
Getting appropriate medical care -- whether psychotherapy, hormone therapy, or a variety of surgical procedures -- is a struggle for most transgender people because of prejudice, ignorance, and simple discrimination, according to the release.

[LynnER]

for your continued education <thanks to Dan from chat staff for finding the link>

http://www.ama-assn.org/ama1/pub/upload/mm/471/114.doc

Posted on: June 17, 2008, 09:42:11 PMsorry, that link is off the actual American medical association website LoL

[Ell]

wull, OMGosh.  i give this news story a 10 out of a possible 5.

-Ellie

[Mnemosyne]

Shall be interesting if this ends up having any real impact. I lucked out in that everything except surgery has always been covered by the various medical insurance policies I have held over the years.

[Laura91]

Well, while this is good news. I will wait and see if this actually helps anyone.

[SusanK]

I'm not holding my breath the health insurance companies will have a change of heart and mind to cover GID. They've had the opportunity all along, and the statement by the AMA only emphasizes how remiss they've been to cover the costs of treatment for an existing recognized condition. The companies can change their policies quickly (with the next routine update, usually annually), and they haven't. I don't see anything changing when the balance the premiums versus the costs.

I guess while I see the positive side of the AMA's decision, I see it has a negative side, namely to be eligible, if they ever cover the condition, we'll have to be diagnosed with a disorder. While I'm one who favors insurance coverage, I'm not one who favors being called mentally sick in order to get coverage, that for now is imaginary outside of a few employers and fewer insurance companies.

In the end, it almost seems a step backward, where we have to be sick to be cured of something that is normal, being ourselves. And during our transistion we get the label of GID and having a psychological disorder tagged to our medical record for the rest of our lives (after all we will be cured but the paperwork will still be there).

The alternative is get out your checkbook, which most of us do now anyway. Overall I see it as positive IF the insurance companies do what they're obligated to do. Otherwise, it's just a piece of paper with good intentions, except we'll have a new name tag, "GID patient" to wear.

[NicholeW.]

A medical designation for GID allows GID to become something like cancer or TB. It's there in the ICD-10 but not used due to the socio-cultural prejudices and the dominance of the DSM-IV-TR listing. This move by the AMA is a step in the right direction and should, imo, be seen that way.

Many TS people have aversions to being termed "mentally disordered," but the fact is this. If a clinician wishes to be paid through insurance they will not place the GID code beside your name because BHO-insurance doesn't compensate for it. Instead you'll get a diagnosis closer to exactly what you do have, very likely, Depressive D.O., Anxiety D.O., Adjustment D.O., PTSD, etc. Things that generally are exactly true of TS/TG people.

Pain and the sense that one doesn't "fit in" causes a lot of mental & emotional dis-ease. A lot more than many of us have been willing to admit simply because we don't want to admit to having "mental" problems. It's a sad fact, but most of us struggle for greater or lesser periods of time and people pay a price for those types of struggles. Look at the members of any discriminated-against minority in any country around the world. One internalizes that feeling of guilt, shame, abandonment and inferiority.

If a strictly medical diagnosis were to take effect then it wouldn't simply affect insurance; it would, imo, also affect how therapy and emotional problems are handled. It would de facto remove therapists as gatekeepers and allow them to work with clients like they should be doing already.

The doctors are much better at medical "gatekeeping" they've been doing it for a century.

I'm all for the medicalization of GID.

Nichole

[lady amarant]

The doctors are much better at medical "gatekeeping" they've been doing it for a century.

I'm all for the medicalization of GID.

Nichole

Absolutely ... BUT.

There is the danger of just moving the goalposts here. Transsexuality is medicalised here in the UK ... excluding every other brand of gender-variation, such as androgyne or neutrois. The bigger threat here is that trans-people, all of a sudden being "on the inside", will just leave the rest behind. Already I see it amongst quite a few people in South Africa, who argue that transsexuals should not associate with TV, CD, androgyne, neutrois, etc. because they feel it impairs our own chances at acceptance.

On the one hand yeah, we need GID medicalised towards funding, social acceptance etc. but we have to be very careful that some external model of what we are supposed to be like to qualify doesn't take us back to the 60's and "you have to like guys or you're not trans!".

~Simone.

[NicholeW.]

I agree with the general direction of what you said, Simone.    BUT,

The bigger threat here is that trans-people, all of a sudden being "on the inside", will just leave the rest behind. Already I see it amongst quite a few people in South Africa, who argue that transsexuals should not associate with TV, CD, androgyne, neutrois, etc. because they feel it impairs our own chances at acceptance.

this already exists. You can see it on this board periodically until the flames get noticed and removed. The diagnoses do NOT, imo, end the sense among some people that "I am better than you." In fact, some of that comes from the very discriminatory practices that pervade our lives as "second-class" or third. Sometimes we feel like we need to be better than someone. Why not just pick on that person because they are as disenfranchised as I am and seem like an easy person to bully. Besides, that will 'prove' to the haters that I am really one of them.

Again, a rather common occurrence among minorities everywhere, trying to be part of the doms rather than the subs. 

Medicalization and even psychological pathologizing don't seem to affect that much at all. That's a matter for individual hearts, seems to me. The recognition that, as for them, different etiology doesn't mean less-than or not-human. My $2.50. 

Nichole

[lady amarant]

Again, a rather common occurrence among minorities everywhere, trying to be part of the doms rather than the subs. 

True - look at ALMOST every religious or racial minority that's ever risen to prominence. At some point they turn into the very monsters that persecuted them.

I just worry that medicalisation of one aspect of GID, for example trans, without acknowledging others, sorta kinda legitimises that sense of superiority and entitlement. To me, the only medicalisation that can truly work is acknowledging gender role, identity, sex, etc. as a spectrum of variations, instead of labelling individual expressions of it as 'conditions'. That's the only way I can think of that won't end up discriminating against somebody.

~Simone.

[NicholeW.]

But, some medical syndromes do discriminate the sort of individuals who suffer from them: Sickle-Cell Anemia comes readily to mind. I hardly think that that somhow makes those people worse than others.

I'll still argue that you cannot so well define everything to keep someone or a lot of someone's from recognizing the humanity and the value of each individual person, Simone. No matter how one tries. That is a matter of personal character and insight, if you ask me. No medical definition, psychological definition or legal punishment seems to prevent that, at best it goes underground until the stress gets large enough to bring it out.

A matter of changing hearts, not diagnoses.

N~

[Natasha]

American Medical Association: Stop discriminating against transgender patients

http://pageoneq.com/news/2008/ama061808.html
6/18/2008

"The National Center for Transgender Equality has hailed the
resolution. "America's physicians," said NCTE Executive Director Mara
Keisling, "are saying that transgender people, like all others,
deserve competent medical care based on what individual doctors and
their patients determine is healthiest for each person."

[SusanK]

A medical designation for GID allows GID to become something like cancer or TB. It's there in the ICD-10 but not used due to the socio-cultural prejudices and the dominance of the DSM-IV-TR listing. This move by the AMA is a step in the right direction and should, imo, be seen that way.

Many TS people have aversions to being termed "mentally disordered," but the fact is this. If a clinician wishes to be paid through insurance they will not place the GID code beside your name because BHO-insurance doesn't compensate for it. Instead you'll get a diagnosis closer to exactly what you do have, very likely, Depressive D.O., Anxiety D.O., Adjustment D.O., PTSD, etc. Things that generally are exactly true of TS/TG people.

I don't think anyone disputes it's a physical issue, but unfortunately GID isn't classified as a physical disorder like cancer or TB, but classified as a mental disorder. While it is a step in the right direction, it's a step in a medically controlled direction than a patient rights directions, which could easily put it back into the hands of the providers and insurers deciding who is who. And to get coverage, the physician will have to show the history of treatment, diagnosis, therapy and hrt to get srs, otherwise, they could easily deny coverage. It has the potential for gatekeepers, but also for pro-patient providers who understand the realities.

And I don't see where diagnosing simultaneous conditions would help the patient except if it's noted as incidental to their GID. Otherwise, it risks denial over service and coverage for GID until the other disorders are "cured." After all, will any therapist approval transistion for someone diagnosed with another mental disorder?

I think, as noted, it's the slippery slope where it could work but also could create classes of transpeople, those with medical treatments and coverage and those who can't get it because of pre-existing condition(s), including GID itself, or other mental conditions. And it puts the patient back into the mental games routine to get the diagnosis to get the coverage for the treatment, but this time it will be in your medical record.

Personally, I like the support from the AMA and the possibility of pressuring insurance companies to do what they should have all along. I'm just not for the label to get it. But if it pays the bills, sometimes you have to accept the bitter taste of it. After all, some of it will be there anyway, adding more official medical stuff won't hurt as much.

As Rusty Wallace said, "Stay tuned, Hot Rod, we're just getting started."

[Cindi Jones]

Do you realize how important this is?  This is a landslide decision!  Oh my.  I can't believe how many positives steps forward we are making these days.  I never thought that I'd see it happen.  I've been through so many awkward situations and conflicts over the years.  I'm going to have to print out the resolutions and take them with me when I see a new doctor!

Cindi

[NicholeW.]

I don't think anyone disputes it's a physical issue,

Actually a number of people do. Some pretty influential. That's where much of the Clarke-Northwestern group draw their support and influence. And as this time the Free University of Amsterdam and the Tuebingen (I think) studies haven't been repeated enough times to actually clinch a biological etiology at this time. But, we are getting there fairly quickly.

but unfortunately GID isn't classified as a physical disorder like cancer or TB, but classified as a mental disorder. While it is a step in the right direction, it's a step in a medically controlled direction than a patient rights directions, which could easily put it back into the hands of the providers and insurers deciding who is who. And to get coverage, the physician will have to show the history of treatment, diagnosis, therapy and hrt to get srs, otherwise, they could easily deny coverage. It has the potential for gatekeepers, but also for pro-patient providers who understand the realities.

And what medical treatment that you can name, except perhaps laetrile for cancer or faith-healing and aromatherapy, that is not "a step in a medically controlled direction [rather] than a patient rights directions?" Do you have some notion that a cancer-specialist is gonna consult with me to decide how she is going to treat the occurrence? She may give me options and abide by my decisions  about her advice which has become more and more what happens already with gender-specialists.

If the AMA is leaning into this debate one might expect that there is some reasonable expectation that they are looking toward bio-medicine having some demonstrable proofs in regard to etiology sooner rather than later.

Any medical/mental health professional can refuse service at any time if I'm not in the ER and I do not decide the way they want to go with treatment is the way I want to go. Patient-rights are definitely important as far as treatment goes, or not treating something at all. But, to tell you the truth, if I needed a tumor extracted from my brain I would do research on my own and talk to as many people knowledgable about the matter as I could; but the final decision to operate and how to go about that I'll leave up to the experienced neuro-surgeon, not a patients'-rights advocate.

And I don't see where diagnosing simultaneous conditions would help the patient except if it's noted as incidental to their GID.

Actually there are reams of research that comprise "best evidence" in medical and psychological fields that conclusively show that simultaneous treatment of co-occurring pathologies is the most effective method for achieving both medical and psychological health. So, co-occurring treatment would be preferred, I suspect, unless it could be demonstrated reasonably that such treatment might compromise the patient's health and quality of life. It's like getting BAS & SRS simultaneously. 

Otherwise, it risks denial over service and coverage for GID until the other disorders are "cured." After all, will any therapist approval transistion for someone diagnosed with another mental disorder?

Insurance can deny coverage because they don't like the form the recommendation is written or typed on. Then one goes to various appeals processes which normally end with doctors speaking to one another.

As long as treatments are not considered "innovative" or "experimental" they generally get covered. I think the treatment of GID with surgeries, etc has a fairly well-noted sucess-rate and has been proven longitudinally to be efficacious. Co-ocurring treatment has been generally accepted in all health-related fields for the past ten or so years. The refusal of coverage, if a medical designation takes hold is unlikely to occur.

I think, as noted, it's the slippery slope where it could work but also could create classes of transpeople, those with medical treatments and coverage and those who can't get it because of pre-existing condition(s), including GID itself, or other mental conditions. And it puts the patient back into the mental games routine to get the diagnosis to get the coverage for the treatment, but this time it will be in your medical record.

Personally, I like the support from the AMA and the possibility of pressuring insurance companies to do what they should have all along. I'm just not for the label to get it. But if it pays the bills, sometimes you have to accept the bitter taste of it. After all, some of it will be there anyway, adding more official medical stuff won't hurt as much.

As Rusty Wallace said, "Stay tuned, Hot Rod, we're just getting started."

As noted previously, as well, what intervention can you recommend that ensures itself against misuse? USA has murder statutes that apply the death-penalty. Those are pretty drastic means to keep people from killing one another. Yet, what evidence can you or any of us muster that deaths are actually deterred due to the punishment?

The current reason doctors want psych evals doesn't have anything to do with 'the good of the patient.' It has to do with 'the good of the surgeon.' If they are going to alter and/or remove live, healthy tissue they need to have some back-up that says the patient is sane and informed. That protects them, not me. They will often enough already not operate for various pre-existing conditions. I don't see how medicalization will change any of that.

As for the tissue-changes, changing the legal and indemnity system would do that much better than a patients'-rights approach. Without the legal framework for that the surgeon would need informed consent only.

Bigotry and the sorting of people into groups for various purposes will not be stopped or curtailed by any definition of TG. If the practitioners include all sorts, that'll be about the best we are able to do. Looking for 100% or even 75% acceptance of all by all seems like a good method of making sure there is no treatment etc for all.

I'm still for hearts and minds; I don't know of any other foolproof way to change how people act.

You make some very good points, Susan. But I'll dance with the person who brought me to the dance.

Nichole

[Keira]

If GID is almost certainly multi-factorial (with gene and environment
interacting), which expresses in multiple ways. There is a risk
that even if they find one cause, many others could slip through
because the physical cause has not yet been found.

Those could then been denied treatment because there is yet
no physical cause found for them (then saying that its all in their head).

[SusanK]

Actually a number of people do. Some pretty influential....

I guess I didn't clearly state what I was thinking.

First, with respect to GID, I'm not concerned with what a therapist (of any flavor) thinks they know about me. That's their opinion, albeit sometimes based on extensive experience and knowledge for which I will listen and take into account in my decisions. As has been said, there are no tests or exams that can clearly establish if one has or has not GID, it's a self-proclaimed diagnosis. The best the therapist can do is agree and agree with your transistion to provide the necessary medical stuff to get it done.

Second, it's a physical issue in that the "cure" for GID isn't about changing the mind to live with one birth sex/gender but overseeing the necessary medical procedures to change the body to fit the mind, eg. hrt and srs. Everything else is available without letters or psych. exams. This has been a long held view of many in the transcommunity.

Third, I'm a patients rights advocate in that the patient, ourside of emergencies, makes the final decision if to have some treatment or not. No medical professional can make you take something or agree to something without you agreeing and doing. But medical professionals can refuse to do something or agree with you that something is necessary as a treatment.

Fourth, comorbidity is a problem with GID and many transpeople. I'm not arguing simultaneous treatment is useful and helpful. I was suggesting some psychologists and psychiatrists may focus on the non-GID issues, dismissing GID as secondary, and missing the whole issue they have it reversed.

Fifth, there are very few insurance companies which covers any facet of GID treatments, and many simply explicitly exclude it by name. This is clearly in violation with medical ethics and, to me, is more about their morality than their interests in patients. As noted in the GLAAD statement, many aspects are approved for non-GID patients, so what's their issue with GID if it's not about ethics and morality than good medical practices?

This is what needs to be changed. If it could, and the AMA's pressure succeeds, great. It's long overdue. In the end, I agree, we have to dance with the partner we're with, and that is the AMA and the rest. My concern is that it can put the whole issue back into the control of therapists than patients because it's medically recognized disorder than just normal human being, expression and behavoir.

This is more a discussion I'd like to have on a Friday night at a Tavern, open, alive, interesting, funny, fluid, and everything else we think and say around the food and drink. Thanks for listening, er, reading.

[NicholeW.]

I'll be happy to have that discussion with you.

You might wanna read Transgender Emergence by Arlene Istar Lev and check on the 'guidelines' followed by more and more therapists.

Also, I think we're confusing 'psychological' treatment with the 'medical treatment.'  Trust me, if the physicians make it a purely medical diagnosis at some point, the APA will remove it from the DSM and start treating patients for what they are actually psychologically treatable for: depression, PTSD, etc.

And insurance may or may not pay any attention to any of it. More and more behavioral health providers are opting out of insurance altogether anyhow. If medical docs start to do the same perhaps the insurance companies will actually start paying attention.

So, where do we meet for beers? I'll have wine, but you can have beer. Know a good place?

Nichole

N~