Medicare... And it just gets worse.

[LittleFuzzy]

So... same thought process on boob jobs?

Y'know, Lewk, when I was 18 I had what you would apparently consider "elective" surgery. My upper and lower jaws were widened, at the recommendation of my doctors, by ~.8-1.2 centimeters as a so-far successful attempt to treat my sleep apnea which they predicted would end up causing a fatal heart attack before I turned fifty without treatment. It apparently doesn't matter that maxillofacial alteration is an acknowledged and recommended treatment for a number of medical problems (and my problem, in particular, is one whose incidence significantly increases with age), since it can be and is also done for cosmetic reasons then anyone over the age or 65 (or, y'know, any youth with a disability) should not receive any insurance coverage for it from the US government.

[littlelolligagged]

I was wondering if in Lewk's opinion reconstructive surgery after a mastectomy for cancer is also unnecessary (for the over 65 set). After all, it's cosmetic and vain for me to think I'd want to have my boobs restored in such a situation.

[LittleFuzzy]

I was wondering if in Lewk's opinion reconstructive surgery after a mastectomy for cancer is also unnecessary (for the over 65 set). After all, it's cosmetic and vain for me to think I'd want to have my boobs restored in such a situation.

I brought that up too. Lewk just keeps saying "boob job" like the phrase is some sort of magic talisman proving he's right.

[Lewkowski]

I brought that up too. Lewk just keeps saying "boob job" like the phrase is some sort of magic talisman proving he's right.

Because people won't directly support it. Making an argument about why a boob job shouldn't be part of medicare is one way the discussion can go but its pointless if the other side doesn't agree that a boob job should be covered.

Now if the position is that boob jobs shouldn't be covered then the discussion can be had on why this isn't much different then a boob job.

However simply not answering is annoying. My guess is that there is a knee jerk reaction to "ahhh I'm liberal so I support anything that helps groups who are 'discriminated' against." As opposed to an actual logical agreement with the medicare decision.

[littlelolligagged]

You're trivializing the issue by comparing gender reassignment to a boob job. If you're not going to take the discussion seriously, what sort of answer do you think you really require?

[Lewkowski]

You're trivializing the issue by comparing gender reassignment to a boob job. If you're not going to take the discussion seriously, what sort of answer do you think you really require?

I don't see why you think the comparison is trivial. Breasts are a big part of how women are rated on attractiveness. Various fashions from dresses to swimwear focus on this particular area of the human body. I'm fairly certain there is non trivial number of people who were born male and then 'turn' into women who have gotten boob jobs. This ruling opens the door to some doctor saying "for mental health reasons it is important that she has this procedure!"

And again... its MEDICARE. What someone does with THEIR dollars is fine but when you ask society to pay for it that'ts where you run into the problem. If it was so damn important why did they wait until now to bring up? While I don't know all the specifics I'm sure price was an issue.

[Veldan Rath]

Should reconstructive surgery be labeled elective Lewk?

[LittleFuzzy]

Because people won't directly support it. Making an argument about why a boob job shouldn't be part of medicare is one way the discussion can go but its pointless if the other side doesn't agree that a boob job should be covered.

Now if the position is that boob jobs shouldn't be covered then the discussion can be had on why this isn't much different then a boob job.

However simply not answering is annoying. My guess is that there is a knee jerk reaction to "ahhh I'm liberal so I support anything that helps groups who are 'discriminated' against." As opposed to an actual logical agreement with the medicare decision.

What you're trying to do is trick other posters in what you imagine is a logical or rhetorical trap that's based on your inaccurate framework on how to perceive and categorize coverage. We don't accept your framework, it's wrong. It doesn't matter whether "boob jobs" are covered because the gender reassignment we're discussing isn't like your "boob job". I'll tell you what, Lewk. Rigorously define your terms and I'll give you a direct answer.

[Lewkowski]

Should reconstructive surgery be labeled elective Lewk?

Its "elective" in the idea that it isn't required.

However I'm comfortable with allowing reconstructive surgery in most cases. (I'm sure there's an example out there that is absurd). I also don't think reconstructive surgery should be used to throw in extras that weren't there previously if they cost more money.

[GGT]

Its "elective" in the idea that it isn't required.

However I'm comfortable with allowing reconstructive surgery in most cases. (I'm sure there's an example out there that is absurd). I also don't think reconstructive surgery should be used to throw in extras that weren't there previously if they cost more money.

In other words, you're willing to let the Insurance Industry dictate medical necessity protocol, so long as they can make a profit by telling physicians what to do?

[Lewkowski]

In other words, you're willing to let the Insurance Industry dictate medical necessity protocol, so long as they can make a profit by telling physicians what to do?

I have no idea how you drew that conclusion.

[GGT]

I have no idea how you drew that conclusion.

The Insurance Industry has been "dictating" medical practices for decades, by deciding what care is reimbursed by third parties.

[Lewkowski]

The Insurance Industry has been "dictating" medical practices for decades, by deciding what care is reimbursed by third parties.

Are we talking about Medicare or something else?

[LittleFuzzy]

Are we talking about Medicare or something else?

Both private insurance companies and public insurance programs do it so I'm not certain how it matters.

[Lewkowski]

Both private insurance companies and public insurance programs do it so I'm not certain how it matters.

I feel it it does - I care far less about what private insurance companies cover (as long as its made clear beforehand) than I do about Medicare. Medicare is public funds - ie we all pay for it. A higher level of scrutiny must always be on how public funds are used because the users and authorizes of those funds don't have the same vested interest in those funds that private owners would. "Its other people's money so I don't care."

[LittleFuzzy]

I feel it it does - I care far less about what private insurance companies cover (as long as its made clear beforehand) than I do about Medicare. Medicare is public funds - ie we all pay for it. A higher level of scrutiny must always be on how public funds are used because the users and authorizes of those funds don't have the same vested interest in those funds that private owners would. "Its other people's money so I don't care."

All insurance is other people's money. That's how insurance works, why it's not just socking money away to pay for one's own care. You don't get any say in the plans and coverage your provider offers to anyone else, even though the coverage they're offering is provided with your money. Your concern is that the authorizers don't have a vested interest in not covering anything they can weasel out of, but in the real world, Medicare is regularly at the top of the list when it comes to under-covering and underpaying insurance providers. This debate is itself a good example, Medicare is significantly behind the bulk of insurance providers in recognizing that reassignment is a valid medical treatment option.

[Aimless]

Man, most of the cancer treatments available today weren't available when medicare was first conceived. Ditto for most of the treatments for cardiovascular diseases. Let's deny people those too, shall we?

The number of transgender people in the US who've happily waited 65 years before wanting gender reassignment surgery is likely vanishingly small. There's not much money to be gained or saved by denying that group treatment. What you can hope to gain is some progress on the road to a more just society. If you're still worried about money then just pretend that the money will come from the growing portion of the US population that's okay with giving transgender people medical treatment and your personal contribution will be reserved for helping straight white men of good standing.

You aren't opposed to this because of the monetary cost. You aren't even opposed to this because you oppose medicare. You oppose this decision because you have disgusting views about transgender people, views that are probably even more disgusting than your views on homosexual people. You're trying to cloak your despicable attitudes in phony arguments about cost and medical necessity and bias and desperately trying to justify them with solid arguments such as "other disgusting people agree with me in anonymous comments and ratings". No-one's buying it.

As for your repeated yammering about "boob-jobs", the answer is "maybe". For a lot of pople, having breasts--any breasts--is an integral part of feeling like a woman. This is of course partly due to social pressure from dickish male insurance-workers who believe woman should have larger breasts than they themselves do if they are to be viewed as attractive and of course women must be assessed on attractiveness

[Hazir]

Well, in my own circle of friends I know one transgender person who was so fed up waiting for the NHS to pay for her surgery that she decided to save up the money herself and fly to Thailand to have it done. Sounds to me like the urge to have it over with was quite strong. And if I am not entirely mistaken we had an American member on this board who also flew to Thailand for the same surgery.

As for equating this with boob-jobs; some boob-jobs indeed are paid for by health insurance schedules all over the world; those boob-jobs that are considered important in the road to full recovery for the persons who get them.

As for us being extremist or liberal; in Iran and Turkey you can get this on the tab of the government, once they are satisfied with you being in need of one.

[Lewkowski]

Man, most of the cancer treatments available today weren't available when medicare was first conceived. Ditto for most of the treatments for cardiovascular diseases. Let's deny people those too, shall we?

The number of transgender people in the US who've happily waited 65 years before wanting gender reassignment surgery is likely vanishingly small. There's not much money to be gained or saved by denying that group treatment. What you can hope to gain is some progress on the road to a more just society. If you're still worried about money then just pretend that the money will come from the growing portion of the US population that's okay with giving transgender people medical treatment and your personal contribution will be reserved for helping straight white men of good standing.

You aren't opposed to this because of the monetary cost. You aren't even opposed to this because you oppose medicare. You oppose this decision because you have disgusting views about transgender people, views that are probably even more disgusting than your views on homosexual people. You're trying to cloak your despicable attitudes in phony arguments about cost and medical necessity and bias and desperately trying to justify them with solid arguments such as "other disgusting people agree with me in anonymous comments and ratings". No-one's buying it.

As for your repeated yammering about "boob-jobs", the answer is "maybe". For a lot of pople, having breasts--any breasts--is an integral part of feeling like a woman. This is of course partly due to social pressure from dickish male insurance-workers who believe woman should have larger breasts than they themselves do if they are to be viewed as attractive and of course women must be assessed on attractiveness

Lots of things incorrect.

1. Medicare is a boondoggle. Its politically impossible to remove it now but it was a terrible idea that ran WAY over budget.
2. This seems like a gateway issue - if 65 year old gender reassignment surgery is covered under Medicare... WHAT ISN'T? Specifically tell me what procedures should be considered 'elective' and NEVER allowed regardless of doctor input. Because if you allow doctor input SOMEONE will find a doctor to say yes because the economic incentives will point that way.
3. I'll admit ignorance of transgender issues but are all transgender people homosexual? I hadn't made that assumption.
4. On that subject... homosexual activity is a sin just like adultery is a sin. As is worshiping other gods. I don't go out of my way to 'hate' non-believers, adulterers or homosexuals. I wish they would change but I would never attempt to mandate it via legislation. Thieves can fry though.
5. Answers that end in 'maybe' allow the door to be open for doctor shopping for someone who will say yes. That's why Medicare should be very clearly defined.
6. To be honest I don't get transgender people. If biological processes don't make you male or female then why do you need an operation? If biological processes make you a male and female then people are called he or she based on their biological selves as opposed to their preference. I don't see how those two views are compatible its like the ultimate cognitive dissonance.
7. Why stop as boob jobs? Its a slipper slope. What about liposuction? What about botox injections? What about other anti-aging plastic surgeries? Where do you draw the firm line where the taxpayer money is protected?

[Lewkowski]

All insurance is other people's money. That's how insurance works, why it's not just socking money away to pay for one's own care. You don't get any say in the plans and coverage your provider offers to anyone else, even though the coverage they're offering is provided with your money. Your concern is that the authorizers don't have a vested interest in not covering anything they can weasel out of, but in the real world, Medicare is regularly at the top of the list when it comes to under-covering and underpaying insurance providers. This debate is itself a good example, Medicare is significantly behind the bulk of insurance providers in recognizing that reassignment is a valid medical treatment option.

The fundamental difference is that I can stop paying my insurance company if I think they are charging higher premiums and covering shit that would never pertain to me. Well... at least in theory before the shit with Obamacare and prior to that employer insurance tax breaks. Nonetheless tax payer is much more sacred then private funds. Taxpayer money is taken via the point of a gun, private insurance dollars are not.

[GGT]

The fundamental difference is that I can stop paying my insurance company if I think they are charging higher premiums and covering shit that would never pertain to me. Well... at least in theory before the shit with Obamacare and prior to that employer insurance tax breaks. Nonetheless tax payer is much more sacred then private funds. Taxpayer money is taken via the point of a gun, private insurance dollars are not.

You're starting with ideology, making conclusions, and working your way backward. Health Care is fundamentally a private-public partnership. Tax dollars were/are used in almost every aspect, from R & D, to loans or subsidies for hospitals and universities....to care for the indigent OR uninsured.

You're deluded if you think the private sector built our modern medical care without government (tax payer) revenues and public policies. And it's either disinformation, or deliberate stupidity, to think that Health Care costs can be isolated to, or compartmentalized by "private payers".

[LittleFuzzy]

The fundamental difference is that I can stop paying my insurance company if I think they are charging higher premiums and covering shit that would never pertain to me.

But. . . they are. They're doing both of those things. Right now. They were doing them twenty years ago too. And so is/was every single other provider out there. And we ALL pay for the uninsured and we all pay for overuse, regardless of any public insurance program.

Nonetheless tax payer is much more sacred then private funds.

Nope. You may choose to consider them such but that carries about as much weight as a social-progressive's expansive views of basic human needs.

[Veldan Rath]

Your blade sir, is sharp and quick indeed.

[GGT]

But. . . they are. They're doing both of those things. Right now. They were doing them twenty years ago too. And so is/was every single other provider out there. And we ALL pay for the uninsured and we all pay for overuse, regardless of any public insurance program.

It's been done longer than 20 years. Indeed, it's part of our US 200 year history.

Nope. You may choose to consider them such but that carries about as much weight as a social-progressive's expansive views of basic human needs.

Or basic human rights, relative to modern, scientific, educated, civilized, and democratic societies?

[Lewkowski]

But. . . they are. They're doing both of those things. Right now. They were doing them twenty years ago too. And so is/was every single other provider out there. And we ALL pay for the uninsured and we all pay for overuse, regardless of any public insurance program.

Nope. You may choose to consider them such but that carries about as much weight as a social-progressive's expansive views of basic human needs.

You can't have it both ways. I hate when liberals bring up this argument. Another fine example of cognitive dissonance. How can both be true?

"The uninsured get healthcare already so Obamacare just makes them pay their fair share"

"The uninsured can't get healthcare oh the tragedy!"

Either uninsured people have access to health care or they don't. You can't have it both ways. So were the uninsured not able to get sex changes without paying for it themselves or were they able to? If they were able to than why does it matter if Medciare covers it?

And sure the level of sacredness in private and public funds are a matter of opinion but I'd think most people would want GREATER oversight of the money that they were required to pay. I don't care if my bank is wasteful with their money - I could always move banks. I do care if the government is wasteful with their money because I can't voluntarily choose to stop paying taxes.

[LittleFuzzy]

You can't have it both ways. I hate when liberals bring up this argument. Another fine example of cognitive dissonance. How can both be true?

"The uninsured get healthcare already so Obamacare just makes them pay their fair share"

"The uninsured can't get healthcare oh the tragedy!"

Because the first is some measure of care and the first is a proper/adequate measure of care, both statements can be true at the same time. In the set-up in the US right now, or before the ACA anyway, the uninsured received the care they could pay out of pocket and also received emergency/life-saving care₁ whether they could pay for it or not. Which usually meant they did not receive preventative care which might have obviated those costs. An anti-depressant prescription is often cheaper than the recovery from a violent suicide attempt. The uninsured won't get the former but they'll get the latter if they survive. To pick one random example.

Either uninsured people have access to health care or they don't. You can't have it both ways. So were the uninsured not able to get sex changes without paying for it themselves or were they able to? If they were able to than why does it matter if Medciare covers it?

Reassignment is, most certainly, not something which would fall under emergency care. So no, it's not something the uninsured have ever been able to get except out of pocket. I'm not entirely sure what the relevance is though seeing as Medicare [i]is[i] insurance.

[GGT]

You can't have it both ways. I hate when liberals bring up this argument. Another fine example of cognitive dissonance. How can both be true?

"The uninsured get healthcare already so Obamacare just makes them pay their fair share"

"The uninsured can't get healthcare oh the tragedy!"

Either uninsured people have access to health care or they don't. You can't have it both ways. So were the uninsured not able to get sex changes without paying for it themselves or were they able to? If they were able to than why does it matter if Medciare covers it?

And sure the level of sacredness in private and public funds are a matter of opinion but I'd think most people would want GREATER oversight of the money that they were required to pay. I don't care if my bank is wasteful with their money - I could always move banks. I do care if the government is wasteful with their money because I can't voluntarily choose to stop paying taxes.

That might be because you only think of money as personal "profit", and exclude the value of Public Goods. And you're so preoccupied by that.....you can't see how previous generations, and their tax dollars, meant you didn't have to die or be disabled in childhood from polio or small pox. Or that every time you drive a car, cross a bridge, fly in an airplane, use your microwave oven, computer, or cell phone....federal funding helped make that possible.

Cognitive Dissonance, huh.