As reported in the Des Moines Register, a jury recently found the State of Iowa guilty of illegal discrimination against a transgender man. He had not been allowed to use the men’s bathroom or locker room, and he had been denied health insurance coverage for gender re-assignment surgery. (See link below to Register article.)
It is morally correct and good public policy that our government not discriminate against a people based on their gender identity. But refusal by government or private employers to cover gender reassignment surgery under their health insurance plans should not be considered wrongful discrimination, unless the plans cover other types of cosmetic procedures for people who feel similar dysphoria. People may feel mental distress over their teeth being crooked, or their nose being too big, or many other aspects of their body, but that does not mean health insurance plans should be required to cover procedures to make people feel better about their appearance. We have already seen that requiring health insurance plans to cover almost everything makes the premiums unaffordable for many people. There is nothing inherently wrong with expecting people to pay their own way for cosmetic procedures.
Link to Register article: https://www.desmoinesregister.com/story/news/local/columnists/courtney-crowder/2019/02/13/transgender-prison-nurse-sues-iowa-alleged-discrimination-aclu-state-civil-rights-corrections/2863854002/
Thanks to Susan Voss for her thoughtful essay about the complexities of our health care system, and how difficult it is to reduce costs. (See link to Register essay below.) I don’t claim to have “the answer”, but I do suggest that the following cost saving ideas be given serious consideration.
- Medicare, Medicaid and private insurance should not be required to cover every new drug, product, or procedure that is approved by the FDA. Some are very high cost but provide only marginal improvement over alternatives that cost much less. Also, at least some covered products and procedures would likely be considered not medically necessary by most people.
- Consider shortening the amount of time that government grants a monopoly for patents. Patents are not natural property: humans have copied one another since the beginning of time. Our U.S. Constitution allows patents to be granted to encourage inventiveness, but there is no objective reason why a patent must be granted for 20 years. Why won’t five or ten years work? Maybe the length of the patent should be based on the cost to develop the patented item and whether or not government funds were used to help develop the item.
- Don’t require limits on out-of-pocket payments such as co-payments, especially for very high cost items. A person should have “skin-in-the-game” if they expect their insurance to cover very high cost items. Today, we see the opposite: drug companies offer to help pay people’s out-of-pocket costs so there won’t be so much political pressure on them to lower their prices.
- Allow both pharmacies and individuals to purchase drugs from sellers in other countries that are “deemed” to have sufficient safety procedures in place. If drug companies are free to charge lower prices in other countries, then pharmacies and individuals should be free to purchase the drugs from those other countries.
- Allow Medicare and Medicaid to negotiate with drug companies on prices they pay for the drugs that are covered by the programs. Right along with that, Medicare and Medicaid should be allowed to develop formularies (lists of drugs that are preferred over other therapeutically similar drugs), that give beneficiaries a financial incentive to use the preferred drugs and a penalty for using higher cost drugs.
Our health care wants are unlimited. Our ability to pay is not. We, as citizens, should not expect private insurance or our government health care programs to cover everything, regardless of cost. We should expect our government to NOT do things that increase costs, or reduce our choices.
What is often missing in much of the opioid crisis discussion is how our government’s policy of prohibition has made a bad situation even worse. When a person becomes physically addicted to opioids, they will do almost anything to get the drugs they want. If the drugs are not available legally, or if legal drugs cost too much, addicts will find illegal alternatives. According to the CDC, 60% of opioid deaths do not involve prescription opioids. That is, in 60% of opioid deaths the person who died was using illegal opioids. (See CDC reference below.) A significant problem with illegal drugs is that is no way to assure the quality and potency of the drugs. In the case of opioids, that leads to inadvertent over-doses because the illegal drug was much more powerful than thought.
If opioid addicts were able to readily get prescription methadone or other FDA approved opioids at reasonable costs, many deaths would be prevented. That would also take the profit out of the illegal opioid drug trade. If opioid addicts were treated under a medical model rather than a criminal model, it is likely that more opioid addicts would seek help to solve their addiction problem. But as it is, under our drug war, prohibition policy, addicts have good reason to not seek help.
CDC reference: https://www.cdc.gov/drugoverdose/data/overdose.html
A transgendered person should be eligible to serve in the military, just like just like every other man or women, and just like every other gay or straight person. If they are qualified to do the job, then government should not discriminate against them based on their transgendered status. That does not mean the military or taxpayers should foot the bill for sex change operations. Just as being transgendered is not a disease, surgery to to change a person’s sex is not a medical necessity. Transgendered folks will can be completely healthy without a sex change operation. So, sex change operations should be considered elective, and not be required to be covered by any insurance plan, including that of the military.
It is a proper role of government to regulate activities on public property. But, it is unfair that West Des Moines has banned both smoking and vaping in their public parks. There may be no safe level of second hand smoke or nicotine vaper, but there is also no safe level of car exhaust, or camp fire or barbecue grill fumes, but we don’t ban them. Life is not risk free. And really, isn’t it pretty easy for anyone who happens to be down wind from a smoker or vaper to avoid the situation by simply moving a little bit? Smokers and vapers pay taxes that fund public parks just like everyone else. This is simply a case of an intolerant majority oppressing an out-of-favor minority. I hope that other municipalities will not follow suit. p.s. – I don’t smoke or vape.
The Des Moines Register recently reported that the University of Iowa (UI) has decided to implement a policy next Fall to prohibit all forms of tobacco anywhere on its campus. (See link below to Register article.) UI already has a policy that prohibits all smoking on campus. The new policy would extend the ban to all forms of nicotine, including vapor and chewing tobacco. The new policy will apply to students, faculty, staff and visitors. It covers all university buildings and vehicles, plus all outdoor areas controlled by UI. UI is a government institution, and it is proper for governments to prohibit smoking inside or near entrances to government owned buildings because of the risks associated with second hand smoke. For the same reason, it also seems proper to prohibit nicotine vapor inside government buildings. But, smoking outside should not be prohibited. Our air is not and has never been perfectly pure. I would guess that automobiles, forest fires, power plants and volcanoes each put much more harmful pollution into our outdoor air than tobacco smokers. Even worse, prohibiting smokeless (chewing) tobacco is just mean spirited. It is not the proper role for government to prohibit us from legal activities that clearly harm no one other than ourselves. Living involves risks. As a person who does not use tobacco in any form, I have decided to not take those risks. But people who do no harm to others should be free to decide what risks they take with their lives, and neither I, nor any majority, should be able to force our decisions upon them.
Link to article: http://www.press-citizen.com/story/news/local/2015/04/07/university-iowa-go-tobacco-free/25420109/