Necessary Medicine: Reframing the Insurance Argument for Transition-Related Care

• In Event: Emergent Technologies in Biomedicine and Healthcare: Boundaries, Tensions, and Possibilities - III

Abstract

For many transgender and gender nonconforming people, transition-related care is vitally important to well-being. The prevailing argument for access to transitional care – its provision and insurability – rests on its “medical necessity.” However, the argument’s narrowness reinforces harmful norms, while its logic lies on an appeal to the authority of medicine. We ought to reframe transitional care as simply “necessary” – that is, necessary for achieving well-being, rather than proscriptively “medically necessary.”

Historical analysis shows that the “medical necessity” argument has been instrumental to gaining access to needed transition-related care, largely because it matches how other ceare is legitimized and financed. Review of the evolution of this argument mid-twentieth century through recent changes to the Diagnostic and Statistical Manual of Mental Disorders is illustrative of this point.

However, the “medical necessity” argument also pathologizes gender nonconformity when pathology may be neither accurate nor necessary. It fortifies a deficit model of the practice of medicine – i.e. that medicine exists primarily to “fix” broken bodies, despite an ongoing shift in the goals of medicine toward promotion of well-being and away from the deficit model. Picking up on this trend, I will situate transitional care alongside reproductive technologies and basic social services: all necessary and characterized by some relationship to medicine, but not best defended as “medically necessary.” In this way, like transitional care, they sit at the intersections of illness and wellness, health and health care, and identity and pathology, and demand an ethic of care provision and well-being that accounts for those tensions.

Author

• Elizabeth Dietz, Arizona State University