Editorial

by Katherine Cummings

(The Gender Centre advise that this article may not be current and as such certain content, including but not limited to persons, contact details and dates may not apply. Where legal authority or medical related matters are cited, responsibility lies with the reader to obtain the most current relevant legal authority and/or medical publication.)

What justification is there for creating a sex division in the Medicare items?

Issue Number Eighty-Two of Polare was devoted in large part to young (under eighteen) transgenders and I featured Kim Petras on the cover. This issue is largely devoted to mature transgenders, who are approaching old age in significant numbers for the first time since the concept of transgender reared its beautiful head at the end of 1952, when Christine Jorgensen was outed. Which is why Phia Leselle, one of our senior citizens, graces the cover. She is a remarkable woman, with many talents, and her story appears on page 6. There is also an interesting and well-thought-out article by Jessica Williams, on the need for specialised care for ageing transgenders. It is good to know that the problems are being recognised and planned for, and that we have reason to hope that appropriate training will be put in place for the next wave of ageing transgenders needing care.

Moving on from the theme of this issue I must say that Polare 83 brought me an unexpected shower of brickbats. What a feisty lot we are! In Polare 83 I included a Q. & A. column for the first time, as I am often asked questions which I look into and answer. Sometimes these questions and answers may be of interest and help to other members of Polare's readership. I also wrote a piece on norrie-mAy-welby's stoush with the authorities over the right for an individual to have themselves declared of unspecified gender. And I included some information I received from Medicare which stated that both parts of gender affirmation surgery (removing one lot of sex markers and then installing the other set) could be claimed despite the fact that some procedures are restricted to females and others to males. This could be circumvented by claiming for one part of the operation as soon as it was carried out, and the other part after one's legal gender had been amended.

Goodness! The complaints and corrections were deafening. I was told my facts were wrong, that I should have verified everything before I put it in Polare and that my informants were dishonest and/or mistaken. I was even threatened with legal action, to which my response would, of course, be, de minima non curat lex (the law does not consider trifles). I should also add that some of my critics were, as always, polite and measured in their comments (hi, Kathy).

I shall now mount what is known in journalistic circles as a spirited defence. First, I am virtually a one-woman band when it comes to Polare, since I not only find almost all the stories for Polare, and seek permission to use them where this is appropriate, but often need to edit them, re-keyboard them, and lay them out in page format. This takes many hours (including around an hour a day sifting through approximately forty transgender stories which turn up in my in-box each morning). I know that in the ideal case I would check and double-check each story, but sometimes all I can do is cite my source and hope for the best. In the case of my brief telephone interview with norrie I was told, and wrote up, her belief that various people were supporting her case against the State Attorney-General. The list I was given included Georgina Beyer, whom I was told might be recruiting Helen Clark (former Prime Minister of New Zealand and now with the United Nations) to assist the case. One of my complaining correspondents told me this was ridiculous as I would have known if I had only consulted the New Zealand Transgender Bill on which Georgina had worked, before she withdrew it (the New Zealand Solicitor-General decided that transgenders were already covered by the Human Rights Act).

All very well, but I do not see why norrie's human rights are not worth defending and I would have assumed Georgina would have been among the first to defend them. Georgina is my friend so I set out to verify what I had been told. None of the contacts I had for her were up-to-date but I finally heard that she was working at a certain establishment and tried to phone her. I was told that she would call me back. So far she hasn't and since time, tide and editorial deadlines wait for no woman, I have pressed on without Georgina's input. I verified with norrie that what I thought I had heard was what norrie had said, and was informed that the information she gave me was based on what a Sydney journalist had told norrie in the course of an interview on the topic of norrie's unspecified sex. So there you have it. Chinese whispers strikes the journalistic media. Not a huge surprise, and hardly enough to justify the passion and accusations of lying which resulted.

The next topic concerned the internal administration of Medicare. I had been informed back in 1986 when I transitioned, that when the time came for my affirmation surgery I would only be allowed to claim for the procedures which were open to males, since at the time I would be legally male. I thought this unfair at the time and whinged about it in my book and from time to time wrote to Medicare on the topic, without success and often without response. When I revived the subject recently I received a very different answer, as I was told that one could claim for the item numbers appropriate to one's assigned gender at the time of the operation and then, after having one's sex legally changed, could go to the Medicare Tribunal and request rebates for the procedures restricted to members of the innate gender. Cumbersome, but better than losing rebates completely for the procedures in question, as I did in 1989. I printed this information and was told by some of Polare's readers that the information was wrong and that I should retract it immediately and apologise for misleading the readership.

I knew what I had been told and could not have invented it because until I received the advice I had never heard of the Medicare Tribunal. I gave out the information in good faith and, as I said, was threatened with legal action if I did not produce the untruthful document from Medicare and print a revised version of the facts. I refused to acquiesce to the first demand (apart from any recalcitrance on my part, I have mislaid it) but I set out to obtain a new document to verify whatever the actual situation might be. I contacted Medicare, who passed me through to their media section, when I said I intended to publish whatever they told me. After a few days I received an emailed document from Medicare, which I have placed on page 17.

This document seems to have two bob each way. It says, in effect, that you can claim for any procedures covered by an existing item in the M.B.S. if the service is clinically relevant, but goes on to say that although claims can be lodged immediately after a service is rendered, "in some circumstances claims processing may require review and approval where, for example, a person who is legally a man claims for an item that is restricted for use by women." It then says that "a patient must have undergone gender reassignment surgery before they are legally considered to have changed gender. The medical practitioner is required to provide Medicare Australia with a letter for the patient's gender to be updated on Medicare records."

There are a couple of problems here. First is the lack of clarity about a person claiming for an item that is restricted for the other gender. Is it suggested that the "review and approval" is separate from the patient achieving gender change on Medicare records? In other words can a person be given the appropriate rebate in advance of receiving approval for a gender change in Medicare records, or is the "review and approval" process the one I was told about earlier, where the gender change must be recognised in advance of benefits being paid?

The other problem is simply the necessity of having this gender divide. Although my body has undergone a number of changes in transitioning from male to female, there are still parts of my body which remain male and should remain treatable under Medicare, just as there are parts of an F.T.M.s body that remain female. I am reminded of the case of American F.T.M. Robert Eads, who died of cervical and ovarian cancer because doctors refused to treat a man for these diseases.

What justification is there for creating a sex division in the Medicare items? If a sex-related item is prescribed for someone, and he/she undergoes the procedure, what point is there in denying medical benefits to him or her because she/he is an anomaly of any kind? A person is a person and should be entitled to medical service according to need, not according to some bureaucratic idea of the way humankind is to be classified.

And we must not (and nor should Medicare) overlook the fact that some people are unable to undergo complete reassignment, because of health, financial or other problems. Why should they be penalised because they do not fit into neat boxes built for the average punter? Surely the time is long past for that, or any other kind of discrimination. It is high time for the nexus between medical treatment and documentation revision to be broken.

Polare is published in Australia by The Gender Centre Inc. which is funded by the Department of Community Services under the S.A.A.P. Program and supported by the N.S.W. Health Department through the AIDS and Infectious Diseases Branch. Polare provides a forum for discussion and debate on gender issues. Advertisers are advised that all advertising is their responsibility under the Trade Practices Act. Unsolicited contributions are welcome, though no guarantee is made by the Editor that they will be published, nor any discussion entered into. The editor reserves the right to edit such contributions without notification. Any submission which appears in Polare may be published on our internet site. Opinions expressed in this publication do not necessarily reflect those of the Editor, The Gender Centre Inc.I, the Department of Community Services or the N.S.W. Department of Health.