If individuals can get surgeries to "affirm their gender identity" paid for by Medicaid, Medicare and, in some states, by private insurers mandated by law to cover all "gender affirming surgeries", then any female who wants breast, hip or buttocks implants or facial or other surgeries to "affirm" her sense of herself as a woman should be able to get those paid for by Medicaid, Medicare and by state mandated private insurance. Why not?
Sounds like just a matter of time before Ontario citizens can demand taxpayer-funded ear, nose etc piercings, and tattoos, on the basis of unbearable Fashion Identity "dysphoria" in not keeping up with extreme fashion, provoking suicide risk. Until a World Professional Association of Piercers and Tattooists (WPAPT, no qualifications required for membership) deem that "medical necessity" for extreme piercings and tattoos must be depathologised, and required Fashion Identity treatment be supplied On Demand.
I think the full Divisional Court decision went beyond the strict wording of the Schedule of Benefits in its ruling. It said the plain wording was sufficient. However in what I (perhaps incorrectly) think lawyers call an *obiter dictum*, the Court also said that even if the plain wording test had failed, it would still have required OHIP to pay on Charter of Rights and Freedoms grounds that guarantee personal integrity or some such. So tightening up the wording in the SOB may not be sufficient to spike the next request.
You mentioned the black art of medical necessity. Decades ago, medical necessity was what doctors sitting down to talk about something agreed was reasonable to improve a patient's health. Tissue audit committees at hospitals would scrutinize surgical operations to ensure "unnecessary" hysterectomies, C-sections, and tonsillectomies weren't being done by unscrupulous surgeons bilking patients out of their hard-earned money. Cosmetic surgery was never audited for medical necessity because if the patient wanted it for appearance, that was good enough. The audit committee would never say, "Her breasts looked fine before. What business did you have making them bigger?"
Nowadays of course, "medical necessity" means exactly, and no more than, what insurance payers are willing to pay for. ("Experimental" just means they aren't willing.) Something gets written as a benefit in the SOB (or on private insurance menus) as medically necessary when insurance becomes willing to pay. It is therefore logically unsupportable to argue that a procedure listed on the SOB as eligible for reimbursement (under whatever conditions specified) can ever be medically unnecessary. If it was medically unnecessary, or "experimental", it wouldn't be billable to OHIP at all. The Ministry removes obsolete procedures and services from the SOB all the time, meaning that doctors must charge the patient for them (or do them for free if they want to.) So the Ontario Ministry of Health made its bed. It can now lie in it while it figures out how to spend its tax money sensibly on actual sick people and deal with trans activists screaming at it.
A well written and reasoned argument. I’m reminded of similar issues over a rights based reason for men to be allowed into women’s sport vs ethical considerations of fairness and safety for the women. Just goes to show the Trans ideologues chose a winner in their human rights strategies in recruiting human rights lawyers to draw up the Yogyakarta principles.
Thanks for this summary. You do great work in getting to the legal details. I accept that the ruling is 'legally sound' as you describe, but it is also entirely unreasonable. We are at a place where our society and its various systems have enabled this to happen. The issue here, more deeply for society, is, do these kinds of decisions (even if 'legally sound') diminish faith in the legal system and institutions more generally? I think the answer is pretty clear yes. Ordinary tax-paying good faith citizens increasingly see institutions failing, and failing badly and at some point they are going to demand redress. This cant go on.
Since geneticist Baron Robert Winston denies being able to change sex, why is this even being considered? Canceled Glinner & Exulansic Death List inventory names of @ risk youth who are dying because of their elective "gender-affirming care".
The best part is when the damaged victims later sue the health care system for having provided obviously deranged and dangerous surgeries and treatments, the taxpayer will get to pay AGAIN in the form of legal fees to mount a defense and damages when the public health care system inevitably loses those cases, which of course it will because these surgeries are provably very harmful and the evidence for this is readily available right now. It is like a self- digging grave that gets deeper by the nanosecond. Whooooooosh there goes today’s taxes and tomorrow and tomorrow and tomorrow’s! Canadian generations to come will look at the shatterred husk of a once great public good and think: were those early 21st century peeps stupid or what?
If individuals can get surgeries to "affirm their gender identity" paid for by Medicaid, Medicare and, in some states, by private insurers mandated by law to cover all "gender affirming surgeries", then any female who wants breast, hip or buttocks implants or facial or other surgeries to "affirm" her sense of herself as a woman should be able to get those paid for by Medicaid, Medicare and by state mandated private insurance. Why not?
"...no equality but a position of exceptional privilege." Exactly. Great article!
Sounds like just a matter of time before Ontario citizens can demand taxpayer-funded ear, nose etc piercings, and tattoos, on the basis of unbearable Fashion Identity "dysphoria" in not keeping up with extreme fashion, provoking suicide risk. Until a World Professional Association of Piercers and Tattooists (WPAPT, no qualifications required for membership) deem that "medical necessity" for extreme piercings and tattoos must be depathologised, and required Fashion Identity treatment be supplied On Demand.
I think the full Divisional Court decision went beyond the strict wording of the Schedule of Benefits in its ruling. It said the plain wording was sufficient. However in what I (perhaps incorrectly) think lawyers call an *obiter dictum*, the Court also said that even if the plain wording test had failed, it would still have required OHIP to pay on Charter of Rights and Freedoms grounds that guarantee personal integrity or some such. So tightening up the wording in the SOB may not be sufficient to spike the next request.
You mentioned the black art of medical necessity. Decades ago, medical necessity was what doctors sitting down to talk about something agreed was reasonable to improve a patient's health. Tissue audit committees at hospitals would scrutinize surgical operations to ensure "unnecessary" hysterectomies, C-sections, and tonsillectomies weren't being done by unscrupulous surgeons bilking patients out of their hard-earned money. Cosmetic surgery was never audited for medical necessity because if the patient wanted it for appearance, that was good enough. The audit committee would never say, "Her breasts looked fine before. What business did you have making them bigger?"
Nowadays of course, "medical necessity" means exactly, and no more than, what insurance payers are willing to pay for. ("Experimental" just means they aren't willing.) Something gets written as a benefit in the SOB (or on private insurance menus) as medically necessary when insurance becomes willing to pay. It is therefore logically unsupportable to argue that a procedure listed on the SOB as eligible for reimbursement (under whatever conditions specified) can ever be medically unnecessary. If it was medically unnecessary, or "experimental", it wouldn't be billable to OHIP at all. The Ministry removes obsolete procedures and services from the SOB all the time, meaning that doctors must charge the patient for them (or do them for free if they want to.) So the Ontario Ministry of Health made its bed. It can now lie in it while it figures out how to spend its tax money sensibly on actual sick people and deal with trans activists screaming at it.
A well written and reasoned argument. I’m reminded of similar issues over a rights based reason for men to be allowed into women’s sport vs ethical considerations of fairness and safety for the women. Just goes to show the Trans ideologues chose a winner in their human rights strategies in recruiting human rights lawyers to draw up the Yogyakarta principles.
Thanks for this summary. You do great work in getting to the legal details. I accept that the ruling is 'legally sound' as you describe, but it is also entirely unreasonable. We are at a place where our society and its various systems have enabled this to happen. The issue here, more deeply for society, is, do these kinds of decisions (even if 'legally sound') diminish faith in the legal system and institutions more generally? I think the answer is pretty clear yes. Ordinary tax-paying good faith citizens increasingly see institutions failing, and failing badly and at some point they are going to demand redress. This cant go on.
Since geneticist Baron Robert Winston denies being able to change sex, why is this even being considered? Canceled Glinner & Exulansic Death List inventory names of @ risk youth who are dying because of their elective "gender-affirming care".
The term is genital mutilation.
If you’re not a surgeon then you are in criminal violation of the law under unauthorized practice of medicine.
If you’re a surgeon and performing genital mutilation then you would normally lose your license and insurance be revoked.
The best part is when the damaged victims later sue the health care system for having provided obviously deranged and dangerous surgeries and treatments, the taxpayer will get to pay AGAIN in the form of legal fees to mount a defense and damages when the public health care system inevitably loses those cases, which of course it will because these surgeries are provably very harmful and the evidence for this is readily available right now. It is like a self- digging grave that gets deeper by the nanosecond. Whooooooosh there goes today’s taxes and tomorrow and tomorrow and tomorrow’s! Canadian generations to come will look at the shatterred husk of a once great public good and think: were those early 21st century peeps stupid or what?