Chelsea Manning to recieve Hormone Therapy

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KnightExemplar
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Chelsea Manning to recieve Hormone Therapy

Postby KnightExemplar » Tue Feb 17, 2015 4:07 pm UTC

http://www.usatoday.com/story/news/nati ... /23311813/

"After carefully considering the recommendation that (hormone treatment) is medically appropriate and necessary, and weighing all associated safety and security risks presented, I approve adding (hormone treatment) to Inmate Manning's treatment plan," Col. Erica Nelson, the commandant of the Fort Leavenworth Disciplinary Barracks in Kansas, wrote in a Feb. 5 memo.


The story comes as a win to LGBT community, it is the first case where the Army will pay for hormone therapy for an in-service member. Chelsea Manning (formerly Bradley Manning) was the Wikileaks leaker FYI. On the heels of this story, the Army ban on transgender troops seems to be weakening as well.

Officially declaring Chelsea Manning's condition as "medically appropriate and necessary" is a rather big deal. This would be the first hormone therapy treatment paid for by the US Army, and this case probably sets a precedent.
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Re: Chelsea Manning to recieve Hormone Therapy

Postby Derek » Tue Feb 17, 2015 5:44 pm UTC

KnightExemplar wrote:it is the first case where the Army will pay for hormone therapy for an in-service member.

Is Manning still considered in-service after being convicted?

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Re: Chelsea Manning to recieve Hormone Therapy

Postby Tirian » Tue Feb 17, 2015 7:16 pm UTC

Derek wrote:
KnightExemplar wrote:it is the first case where the Army will pay for hormone therapy for an in-service member.

Is Manning still considered in-service after being convicted?


Yes. Manning wouldn't be subject to military justice if she weren't in the military.

Of course, this isn't LGBT rights so much as military justice accepting what civilian justice has known for a decade: it is cruel and unusual punishment to deny essential medical care to prisoners and transition therapy is medically necessary for transgendered inmates.

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Re: Chelsea Manning to recieve Hormone Therapy

Postby Chen » Tue Feb 17, 2015 8:51 pm UTC

How ass backwards is the US healthcare system that prisoners can get this mandatory therapy but regular law abiding citizens get stuck with bills making it essentially impossible for some to get what they need?

Course the cynic in me says the only way this would get fixed is by limiting the prisoners from getting the treatment too. Cause socialized medicine is letting the communists win or something :roll:

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Re: Chelsea Manning to recieve Hormone Therapy

Postby BattleMoose » Wed Feb 18, 2015 2:50 am UTC

When you imprison someone you are responsible for their well being, that means medical care too.

The USA doesn't hold itself responsible for the medical treatment of its citizens, for reasons I cannot fathom to understand.

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Re: Chelsea Manning to recieve Hormone Therapy

Postby Lucrece » Wed Feb 18, 2015 10:35 am UTC

Chen wrote:How ass backwards is the US healthcare system that prisoners can get this mandatory therapy but regular law abiding citizens get stuck with bills making it essentially impossible for some to get what they need?

Course the cynic in me says the only way this would get fixed is by limiting the prisoners from getting the treatment too. Cause socialized medicine is letting the communists win or something :roll:


When they imprisoned Manning, they took away her opportunity to earn any money. It's really no different than providing food to prisoners or even clothing/beds.

I'm also wondering how you can have a healthcare system that can foot the bill for a 100k+ worth of cosmetic surgery and hormone therapy. If it is part of the psychological well being for trans people, then why don't we cover teeth, which can actually lead to diseases and infection not to mention social stigma and disadvantage in job interviews? And why don't we cover bald men, who no doubt suffer psychological and social effects just as well? Why don't we cover surgical procedures for obese people with image problems; many of these people kill themselves as well over such distress.

That money has to come from somewhere. Who are you convincing to cough up some money?
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Re: Chelsea Manning to recieve Hormone Therapy

Postby Derek » Wed Feb 18, 2015 11:16 am UTC

Lucrece wrote:I'm also wondering how you can have a healthcare system that can foot the bill for a 100k+ worth of cosmetic surgery and hormone therapy. If it is part of the psychological well being for trans people, then why don't we cover teeth, which can actually lead to diseases and infection not to mention social stigma and disadvantage in job interviews? And why don't we cover bald men, who no doubt suffer psychological and social effects just as well? Why don't we cover surgical procedures for obese people with image problems; many of these people kill themselves as well over such distress.

That money has to come from somewhere. Who are you convincing to cough up some money?

I don't understand the question. In the US, unless you are on medicare/caid, all of the things you listed above have to be covered by yourself, or through your insurance. This seems like a question for a national healthcare system, not a private one.

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Re: Chelsea Manning to recieve Hormone Therapy

Postby leady » Wed Feb 18, 2015 11:36 am UTC

The point is the typically overlooked one that healthcare is a scarce resource and as such regardless of how you do it, there is always "rationing". Every 100k operation is replacing 10 x 10k more simple but as critical procedures (roughly). No nationalised system magically solves this problem, hence the tabloid frenzy in the UK for people getting self esteem cosmetic surgery on the NHS etc

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Re: Chelsea Manning to recieve Hormone Therapy

Postby morriswalters » Wed Feb 18, 2015 11:58 am UTC

Lucrece wrote:When they imprisoned Manning, they took away her opportunity to earn any money.
No. She made a choice to do what she did. She surrendered her freedom by her choice.

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Re: Chelsea Manning to recieve Hormone Therapy

Postby elasto » Wed Feb 18, 2015 12:30 pm UTC

leady wrote:The point is the typically overlooked one that healthcare is a scarce resource and as such regardless of how you do it, there is always "rationing". Every 100k operation is replacing 10 x 10k more simple but as critical procedures (roughly). No nationalised system magically solves this problem.

The counterpoint typically overlooked is how much cheaper nationalized systems can be run at.

When my wife had our first child (cesarean section followed by days in hospital) it cost us less than $4k (even though we used the NHS we had to pay the bill in full as my wife is not a UK citizen). The same procedure in the US - there were about seven staff in the operating room I think - would have cost around $30k.

There are all sorts of reasons for the massive reduction in cost:
- the negotiating power of a single-payer model (the drugs she had cost 10x-100x less than they would have in the US) - and a concomitant refusal to purchase brand-new drugs that, eg., are allegedly 5% better but cost 500% more.
- the lack of an extra layer of bureaucracy (insurance industry) plus the profits it creams off worthlessly
- much lower doctor/surgeon wages through the education system similarly being publicly funded meaning most doctors left university debt-free*
- much lower malpractice payouts
- etc.

It's difficult to get a definitive figure but it seems like a sex change operation would likewise cost about 5x less in the UK than the US.



(*Unfortunately the misplaced policy of expanding the university system to 50% of school-leavers has made total public funding unaffordable, so debt and wages have already started rising rapidly. Would have been far more sensible to expand national trade/apprenticeship schemes instead - which all the political parties are committed to. But the damage has unfortunately been done here now :/)

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Re: Chelsea Manning to recieve Hormone Therapy

Postby gmalivuk » Wed Feb 18, 2015 12:43 pm UTC

morriswalters wrote:
Lucrece wrote:When they imprisoned Manning, they took away her opportunity to earn any money.
No. She made a choice to do what she did. She surrendered her freedom by her choice.
By which logic they shouldn't feed prisoners either?
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Re: Chelsea Manning to recieve Hormone Therapy

Postby morriswalters » Wed Feb 18, 2015 1:16 pm UTC

I didn't speak to the morality or the utility of helping her. I spoke to who was responsible for her incarceration.

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Re: Chelsea Manning to recieve Hormone Therapy

Postby leady » Wed Feb 18, 2015 2:52 pm UTC

At worse the per captia savings on NHS vs the US system is 50%, but in any event making the aggregate cheaper doesn't change the choices, 50% more healthcare for your buck still leaves the same decisions (everything scales)

I wouldn't take the cash comparison too seriously, the NHS is pretty terrible both practically and idologically at recouping its costs. The reality is that you were nice in paying :)

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Re: Chelsea Manning to recieve Hormone Therapy

Postby gmalivuk » Wed Feb 18, 2015 4:36 pm UTC

morriswalters wrote:I didn't speak to the morality or the utility of helping her. I spoke to who was responsible for her incarceration.
But you responded to a quote about who actually took away her ability to make money. Which wasn't her.
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Re: Chelsea Manning to recieve Hormone Therapy

Postby leady » Wed Feb 18, 2015 5:12 pm UTC

Surely manning in becoming a soldier explicitly agreed and signed up to a set of rules that essentially says "keep your fecking mouth shut", regardless of the rights and wrongs. Does it not follow that deliberately reneging on your commitment with a known penalty is pretty much your fault?

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Re: Chelsea Manning to recieve Hormone Therapy

Postby morriswalters » Wed Feb 18, 2015 5:47 pm UTC

gmalivuk wrote:
morriswalters wrote:I didn't speak to the morality or the utility of helping her. I spoke to who was responsible for her incarceration.
But you responded to a quote about who actually took away her ability to make money. Which wasn't her.
What you are trying to point out to me is technically correct in terms of language, but in terms of causation we are in disagreement. She bought it, she paid for it, now let her eat it. Which again is not to say that I agree or disagree with treating her. To argue that point would require me to make a judgement as to how important the biological aspects are to trans women, versus the appearance that they see in a mirror. And I have it on good authority that the question is none of my business. Danglies and all that.

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Re: Chelsea Manning to recieve Hormone Therapy

Postby setzer777 » Wed Feb 18, 2015 7:31 pm UTC

Lucrece wrote:stuff


You live in Spain, right? How does the healthcare system there draw the line?
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Re: Chelsea Manning to recieve Hormone Therapy

Postby Tyndmyr » Wed Feb 18, 2015 8:15 pm UTC

BattleMoose wrote:When you imprison someone you are responsible for their well being, that means medical care too.

The USA doesn't hold itself responsible for the medical treatment of its citizens, for reasons I cannot fathom to understand.


To a degree. Life saving care, etc is of course a given, but elective surgeries are subject to some limitations. Military medical also does not cover all elective options, even outside of prison.

I do agree that it seems odd that prison military would cover something that a normal military person, not imprisoned, would lack access to.

morriswalters wrote:I didn't speak to the morality or the utility of helping her. I spoke to who was responsible for her incarceration.


She is responsible for the offense that resulted in imprisonment. This isn't exactly the same thing as being responsible for the standard of living in prison.

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Re: Chelsea Manning to recieve Hormone Therapy

Postby setzer777 » Wed Feb 18, 2015 8:28 pm UTC

morriswalters wrote:I didn't speak to the morality or the utility of helping her. I spoke to who was responsible for her incarceration.


Well, she was responsible for incurring the retribution of the military. Other people are responsible for the specifics of what that retribution consisted of. Including the fact that it precludes earning legal income.
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Re: Chelsea Manning to recieve Hormone Therapy

Postby Derek » Wed Feb 18, 2015 8:52 pm UTC

I do agree that it seems odd that prison military would cover something that a normal military person, not imprisoned, would lack access to.

Is it that military healthcare doesn't cover hormone therapy or SRS, or that by requesting them you would be coming out as trans, which in the US would be grounds for discharge?

Plot twist: Wikileaks was all a plan by Chelsea Manning to get the US government to pay for her therapy. (I'm joking, of course)
Last edited by Derek on Wed Feb 18, 2015 9:50 pm UTC, edited 2 times in total.

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Re: Chelsea Manning to recieve Hormone Therapy

Postby morriswalters » Wed Feb 18, 2015 9:47 pm UTC

This was easy enough to look up.
The Uniform Code of Military Justice and Title 10 of the United States Code are the foundation of U.S. military law. Article 58b of 10 USC addresses the pay of military personnel being confined as the result of a court-martial sentence. Normally, if you're convicted at court-martial and your sentence includes confinement, your pay and allowances are stopped. However, there are situations when military servicemembers confined due to courts-martial can keep receiving pay once their confinement begins.
If she didn't know she could have. It's part of the punishment. I'm sympathetic to her plight, but it is what it is. She made a choice. If I were going to supply a rationale for her treatment it would be based on the assumption that her condition, requires treatment if her condition of imprisonment is to be humane. How humane they need to be would depend on the needs of her condition. I refuse to be obligated because I, as part of society, imprisoned her without pay. I accept my responsibility for maintaining her in a humane fashion while she is confined. Do you see the distinction I'm making?

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Re: Chelsea Manning to recieve Hormone Therapy

Postby TheGrammarBolshevik » Wed Feb 18, 2015 11:11 pm UTC

morriswalters wrote:I refuse to be obligated because I, as part of society, imprisoned her without pay. I accept my responsibility for maintaining her in a humane fashion while she is confined. Do you see the distinction I'm making?

No.
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Re: Chelsea Manning to recieve Hormone Therapy

Postby Izawwlgood » Wed Feb 18, 2015 11:18 pm UTC

morriswalters wrote: She made a choice.
Lets be specific - she made a choice to whistleblow. Her decision to go ahead and identify as a woman is not, perhaps, based on things she was in control of.

I'm glad she's getting treated, just like I'd be glad someone imprisoned with angina decided to go on ACE inhibitors, and the prison system provided them.
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Re: Chelsea Manning to recieve Hormone Therapy

Postby morriswalters » Thu Feb 19, 2015 12:08 am UTC

TheGrammarBolshevik wrote:
morriswalters wrote:I refuse to be obligated because I, as part of society, imprisoned her without pay. I accept my responsibility for maintaining her in a humane fashion while she is confined. Do you see the distinction I'm making?

No.
Ok.
Izawwlgood wrote:Lets be specific - she made a choice to whistleblow. Her decision to go ahead and identify as a woman is not, perhaps, based on things she was in control of.
Correct. However if she had not decided to commit a criminal act, then we wouldn't be having this conversation. Instead she would be out trying to raise money. And not confined.

And for the record, you call it whistle blowing, others would call it something else. I don't care either way.

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Re: Chelsea Manning to recieve Hormone Therapy

Postby TheGrammarBolshevik » Thu Feb 19, 2015 12:29 am UTC

morriswalters wrote:
TheGrammarBolshevik wrote:
morriswalters wrote:I refuse to be obligated because I, as part of society, imprisoned her without pay. I accept my responsibility for maintaining her in a humane fashion while she is confined. Do you see the distinction I'm making?

No.
Ok.
Were you going to clarify, or were you just asking for the sake of asking?
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Re: Chelsea Manning to recieve Hormone Therapy

Postby morriswalters » Thu Feb 19, 2015 2:00 am UTC

Well, I guess if pushed I would say it's a perspective I choose. Whatever she might have done, I choose to see her welfare as a moral obligation that I owe to me, rather than an obligation I owe to her. The fact that she made bad choices doesn't give me the right to make bad choices. This perspective allows me not to resent the fact that in addition to the damage she did to institutions important to me, I now must pay for her upkeep for the duration of her punishment. I understand this is a fine hair to split, and that the effect is almost exactly the same. I really can't make it any clearer.

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Re: Chelsea Manning to recieve Hormone Therapy

Postby Lucrece » Thu Feb 19, 2015 2:39 am UTC

setzer777 wrote:
Lucrece wrote:stuff


You live in Spain, right? How does the healthcare system there draw the line?


I don't live in Spain.
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Re: Chelsea Manning to recieve Hormone Therapy

Postby setzer777 » Thu Feb 19, 2015 3:55 am UTC

Lucrece wrote:
setzer777 wrote:
Lucrece wrote:stuff


You live in Spain, right? How does the healthcare system there draw the line?


I don't live in Spain.


I should probably lay off the drugs, then.
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Re: Chelsea Manning to recieve Hormone Therapy

Postby rath358 » Thu Feb 19, 2015 5:52 am UTC

Lucrece wrote:When they imprisoned Manning, they took away her opportunity to earn any money. It's really no different than providing food to prisoners or even clothing/beds.

I'm also wondering how you can have a healthcare system that can foot the bill for a 100k+ worth of cosmetic surgery and hormone therapy. If it is part of the psychological well being for trans people, then why don't we cover teeth, which can actually lead to diseases and infection not to mention social stigma and disadvantage in job interviews? And why don't we cover bald men, who no doubt suffer psychological and social effects just as well? Why don't we cover surgical procedures for obese people with image problems; many of these people kill themselves as well over such distress.

That money has to come from somewhere. Who are you convincing to cough up some money?

The article stated only that Manning is receiving hormone therapy, which is not that expensive. The last time I looked, even surgery doesn't necessarily approach that price tag. AFAIK, lots of trans* folk pay for surgery out of pocket because insurance policies that cover it are rare. So it really isn't a huge burden on the system at all.

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Re: Chelsea Manning to recieve Hormone Therapy

Postby gmalivuk » Thu Feb 19, 2015 12:37 pm UTC

Except possibly for the most insecure few people imaginable, I somehow doubt that being bald poses quite the same suicide risk as being denied hormones.

(Also yeah, Lucrece is the only one talking about cosmetic surgery here.)
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Re: Chelsea Manning to recieve Hormone Therapy

Postby KrytenKoro » Thu Feb 19, 2015 5:06 pm UTC

gmalivuk wrote:Except possibly for the most insecure few people imaginable, I somehow doubt that being bald poses quite the same suicide risk as being denied hormones.

(Also yeah, Lucrece is the only one talking about cosmetic surgery here.)

And I would hazard that anti-depression meds, hair regrowth, or similar would be determined to be medically necessary for people that insecure over their going bald.

How hard is it to understand for some people that gender reassignment isn't some joke surgery for rich debutantes? The people seeking it, almost entirely, are measurably traumatized by their condition. Like, doctors can tell when you're transgender, it's not just something a fifteen year old on tumblr decides and starts yelling about.
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Re: Chelsea Manning to recieve Hormone Therapy

Postby Chen » Thu Feb 19, 2015 5:55 pm UTC

Who was saying anything about it not being medically necessary or that it was a joke type thing? There is a cost associated with it that prisoners will have paid for them and regular citizens will not. That just seems absurd. Not that prisoners are getting medically necessary treatment but that regular citizens cannot have it guaranteed to them, if they are not financially capable of paying for it themselves.

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Re: Chelsea Manning to recieve Hormone Therapy

Postby Tyndmyr » Thu Feb 19, 2015 7:46 pm UTC

Indeed. Though in the interests of a more apples to apples comparison, a soldier in jail is getting treatment that a soldier out of jail would not generally get.

A soldier outside of jail might indeed have access to private medical care, but the life of a soldier is such that this cannot be guaranteed to always be true. After all, that's why we have military medical, isn't it? To care for soldiers, because they are sometimes in locations where timely private care is not a realistic option, thanks to the nature of war.

So, we still have a sort of strange discrepancy.

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Re: Chelsea Manning to recieve Hormone Therapy

Postby KrytenKoro » Thu Feb 19, 2015 9:35 pm UTC

Chen wrote:Who was saying anything about it not being medically necessary or that it was a joke type thing? There is a cost associated with it that prisoners will have paid for them and regular citizens will not. That just seems absurd. Not that prisoners are getting medically necessary treatment but that regular citizens cannot have it guaranteed to them, if they are not financially capable of paying for it themselves.

Lucrece.

Who also brought up the "bald men" analogy I was responding to.

I was responding to Lucrece.
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Re: Chelsea Manning to recieve Hormone Therapy

Postby Lucrece » Sat Feb 21, 2015 10:27 am UTC

KrytenKoro wrote:
Chen wrote:Who was saying anything about it not being medically necessary or that it was a joke type thing? There is a cost associated with it that prisoners will have paid for them and regular citizens will not. That just seems absurd. Not that prisoners are getting medically necessary treatment but that regular citizens cannot have it guaranteed to them, if they are not financially capable of paying for it themselves.

Lucrece.

Who also brought up the "bald men" analogy I was responding to.

I was responding to Lucrece.


It's nice to see you dismissing people's identities as frail or insecure. I suppose when women suffering from cancer suffer from hair loss, you'd happily call them insecure as well. I didn't say surgery for trans people was a joke or even frivolous (unlike you, who feel the right to determine what people should and should not experience depression and anxiety over and how much importance we should assign it).

All I said is that full transition IS expensive, and in a system where they won't even pay for the psych costs of prisoners, it's not unreasonable to find that our system will not cover other procedures related to psychological health. I made the point specifically about dental issues often not finding coverage for that reason (people don't see the objective benefit, as they don't with therapy and other psychological treatments, so they don't want to foot the bill for it).
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Re: Chelsea Manning to recieve Hormone Therapy

Postby KrytenKoro » Mon Feb 23, 2015 3:11 pm UTC

Lucrece wrote:It's nice to see you dismissing people's identities as frail or insecure. I suppose when women suffering from cancer suffer from hair loss, you'd happily call them insecure as well. I didn't say surgery for trans people was a joke or even frivolous (unlike you, who feel the right to determine what people should and should not experience depression and anxiety over and how much importance we should assign it).

All I said is that full transition IS expensive, and in a system where they won't even pay for the psych costs of prisoners, it's not unreasonable to find that our system will not cover other procedures related to psychological health. I made the point specifically about dental issues often not finding coverage for that reason (people don't see the objective benefit, as they don't with therapy and other psychological treatments, so they don't want to foot the bill for it).

Um.

Bullshit?

Yeah, bullshit's the right word.

You specifically the gender reassignment a cosmetic surgery, expressed incredulity at the system footing the bill for it, and compared it to the issue for bald men in general. You even talked argued about it being "if" it's for their psychological wellbeing, as if that wasn't settled science. Your tone was pretty clearly denigrating the gender reassignment surgery as "cosmetic", and your final line was "Who are you convincing to cough up some money?", which, excuse me, doesn't really sound like you saying "this is something that should be funded!"

As for "dismissing people's identities as frail an insecure", you were the one talking about people having image problems due to common ailments:
And why don't we cover bald men, who no doubt suffer psychological and social effects just as well

(Notice you said "men", so drop the act about me going after "women suffering from cancer")

And I replied that, well, yeah, if a doctor deemed that the person was dangerously insecure over their going bald ('cause that's what it's called when you feel so ashamed over something that you are suffering from it, "insecure"), they probably would prescribe either therapy, medication, or surgery to help that, so whence all this false outrage. If "cosmetic" surgery, as you call it, is what's required for someone's psychological wellbeing, most doctors would recommend it unless it was an addiction or something.


So: that is absolutely not what you said, as you expressly called it cosmetic and expressed incredulity at the "system" paying for it.
And: I replied that, contrary to your slippery slope arguments, if someone was suffering no matter the condition, their doctor is likely to help even if society would consider it "frivolous", and added that gender dysmorphia is absolutely a real condition whose sufferers should not be treated as just getting "cosmetic surgery".
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Re: Chelsea Manning to recieve Hormone Therapy

Postby Choboman » Mon Feb 23, 2015 5:00 pm UTC

Medical care is not a necessary/frivolous binary value, but more along the lines of a sliding scale, and the government health care refuses to give treatments all the time that are arguably necessary, but as urgent/important as their other priorities. We're talking about a system that regularly refuses all kinds of things that will make a huge impact on quality of life but aren't immediately life-threatening.

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Re: Chelsea Manning to recieve Hormone Therapy

Postby KrytenKoro » Mon Feb 23, 2015 9:45 pm UTC

Choboman wrote:Medical care is not a necessary/frivolous binary value, but more along the lines of a sliding scale, and the government health care refuses to give treatments all the time that are arguably necessary, but as urgent/important as their other priorities. We're talking about a system that regularly refuses all kinds of things that will make a huge impact on quality of life but aren't immediately life-threatening.

That is absolutely correct, but it seems to me that that's a problem we should fix, rather than something we should use as an excuse to deny needed medical care to anyone else. "We're fucking over your neighbor Bob, too" doesn't really cheer me up in regards to my own being fucked.
From the elegant yelling of this compelling dispute comes the ghastly suspicion my opposition's a fruit.


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