Saturday, 31 May 2014

DAB No. 2576 - NCD 140 3 Transsexual Surgery

DAB No. 2576 - NCD 140 3 Transsexual Surgery by EvanMcSan

A follow-up to a previous post on the issue.

Reading between the lines, there are some very damning comments about how the original decision was arrived at - such as the dismissal of studies with follow-up over many years as "not long-term" without defining what "long-term" meant; or the citing of treatment as "controversial", not in a scientific sense, but a political one.

We note that in addition to stating that transsexual surgery was experimental, the NCD and the 1981 report stated that transsexual surgery was "controversial." NCD Record at 18(1981 report stating that "[ o ]ver and above the medical and scientific issues, it would also appear that transsexual surgery is controversial in our society"). The AP and the new evidence dispute the relevance of this statement. The AP objected that this point relies on two "polemics" that are "are either completely unscientific or fall far outside the scientific mainstream," and Dr. Ettner stated that the views expressed therein "fall far outside the mainstream psychological, psychiatric, and medical professional consensus and call into question the objective reasonableness of the NCD. AP Statement at 15-16; Ettner Supp. Decl. at,;,; 17-18. CMS has not asserted that the Board's decision may be based on factors over and above the medical and scientific issues involved. Considerations of social acceptability (or nonacceptability) of medical procedures appear on their face to be antithetical to Medicare's medical necessity inquiry, which is based in science, and such considerations do not enter into our decision that the NCD is not valid.

One of those appears in this post, 50,000 deaths. I'll try to find the source of the other one, a religious tract. Though the first one is a religious tract too, or at least, ideological.
Neither Religion nor Ideology have any place in medicine, or indeed, science generally.


WSR Photography said...

A similar review has been conducted by the US Government Office of Personnel Management (OPM), the agency responsible for the management of active and retired federal employees and the Federal Employee Health Benefit (FEHB) plan which oversees the health insurance program for above employees, and a similar ruling is expected to not just remove the exclusion clause almost all the health insurance providers have in the plans for transgender healthcare and explicitly SRS but to require inclusion of transgender healthcare with SRS. This would likely take effect in January 2015.

The key now is that while current medical providers can provide the transgender healthcare, some of which is already available, the surgeons peforming SRS will have to apply to OPM/FEHB to become providers for the service for patients to have a co-pay or reimbursement cost. Currently one surgeon in California is approved for the plans currently providing transgender healthcare with SRS for patients under health insurance plans for California or nationally.

beneficii said...

I think this and what WSR Photography mentioned could lead to is a bill being passed that would prohibit federal funding for sex reassignment surgery, which would affect Medicare, Medicaid, Indian Health Service, and the plans sold on the state exchanges (which receive federal subsidies, so those can be construed as being recipients of federal funding as well).

I think that if the Republicans (equivalent to European Conservatives, Christian Democrats, and Liberal Democrats) push the point, there is enough indifference among Democrats (equivalent to European Labour, Greens, and Social Democrats), even hostility toward such federal funding--they will tell you that it gets in the way of treating more "important" conditions,--that such a bill would have a high likelihood of passing, ending up on the President's desk, and being signed by him. As for the bill, its name would Legion: for they would be very many topics.

When PPACA was first being proposed, controversy over SRS being covered occurred, and even did a piece on it, declaring false statements that PPACA would cover SRS:

Now that SRS is starting to be covered at the federal level, Republicans are going to look back at and call them liars. There are many changes in the PPACA that need to be made, and Republicans are poised to take control of Congress next year. Republicans could put such wording in any health reform bill, to "not waste the taxpayers' money."

So there you have it, a still inimical society.

Anonymous said...

Exactly why should other people pay your medical bills? Insurance takes away personal responsibility and pride in yourself.

I rather have less but know I earned it rather than government be my nanny.


Sara said...

Medicare should be for all health issues - physical, emotional, mental, biological...

Sara @ simpleNewz