ZIMMERLY: The real costs of sex reassignment surgery

The online response to last week’s article regarding Yale Health Plan coverage for sex reassignment surgery (SRS), (“Yale Health considers sex change surgery,” Feb. 25), has been mostly disappointing and occasionally repugnant. Many of the most negative comments have roots in xenophobia or bigotry. I am ashamed of the hatred and discrimination expressed by these members of my cisgender cohort. What should I say to people who aren’t moved by considerations of justice or equality or fairness?

However, a few individuals instead attempt to justify their opposition with objections based on costs and obligations. They argue that covering an “unnecessary” medical procedure would be a misallocation of Yale’s resources, and that including SRS in the health plan would negatively impact both tuition bills and the University’s reputation. But the numbers disagree. Adding SRS to the health plan is in Yale’s best interest.

First, there seems to be a fear that including SRS in the health plan will result in an onslaught of Yalies rushing to transition to the opposite sex. This is unreasonable and entirely contrary to statistics. Transgender people make up an estimated 2–5 percent of the population. Of this tiny minority, an even smaller percentage seeks out SRS. Studies place the rate of male-to-female surgical transitions at 1 in 12,000, and that’s nearly three times the prevalence of female-to-male surgeries. So even if the number of surgery-seeking transsexuals in Yale’s undergraduate and graduate programs were twice that of the general population, we would still expect fewer than two surgeries each year.

Spread over all of Yale’s students, the monetary increase to Yale tuition is negligible. The total cost of procedures for a single individual can vary from $7,000 to $50,000, although average male-to-female surgery costs only $23,000 over two years. Still, let’s consider the absolute worst-case scenario, two $50,000 surgeries each year. That comes out to a tuition hike of about $8.40 per student. As a comparison, the senior dues fee raises $75,000 per graduating class, and that’s if 20 percent of students opt out. Congratulations, class of 2013: You spent the equivalent of three male-to-female surgeries on open bars.

Another argument is that Yale has no obligation to cover a procedure that isn’t medically necessary, especially given that it would benefit such a small number of students. This line of reasoning falters twice. Both physicians and major insurance providers recognize the medical necessity of SRS. Gender identity disorder is listed in the Diagnostic and Statistical Manual of Mental Disorders, granting it the same legitimacy as depression, dementia or anorexia. Health care insurance provider Aetna considers genital reconstructive surgery to be medically necessary as long as the individual meets certain criteria, chiefly diagnosis of persistent gender identity disorder by a qualified mental health professional. Secondly, when has the size of the affected population ever prevented Yale from catering to the needs of a minority group? The decision to abstain from all animal products is far less medically necessary than addressing a serious health disorder, yet our tuition dollars pay for vegan options at every meal in every dining hall on campus.

We should be much more concerned with the cost to Yale if SRS is not included in the health plan. Remember that we stand to lose not only potential students and faculty members who identify as trans, but also all of the cisgender and cissexual individuals who want to align themselves with institutions that reflect their values.

It is true that we may lose support from some conservative donors, but the long-term effect on fundraising efforts can only be positive. We have a reputation as one of the most progressive institutions in the world. Our alumni take pride in that distinction. But Yale loses some veritas and dims its lux every time another university embraces equality first. Harvard, Stanford, Penn and Brown already cover SRS. While we’ve lost our competitive advantage on this front, we should at least attempt to remain on par with our peer institutions.

Not for the first time in recent years, Yale stands frozen by discrimination while the rest of the country moves forward. We must include sex reassignment surgery in the health plan if we want to keep up. Doing so will promote acceptance, support equality and signal to the world that Yale accords the same importance to the rights and concerns of all its students and faculty members. It’s morally right and politically smart, and the price tag is less than two Wenzels per capita.

Grace Zimmerly is a senior in Pierson College and a first year MPH student. Contact her at grace.zimmerly@yale.edu .

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