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CNN Talkback Live

Should Government Money Pay for Sex-Change Operations?

Aired May 02, 2001 - 15:00   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
(BEGIN VIDEO CLIP)

MARCUS ARANA, SAN FRANCISCO HUMAN RIGHTS COMMISSION: It is about looking in the mirror and seeing a reflection staring back at you that's congruent with the identity that you hold inside.

(END VIDEO CLIP)

BATTISTA, HOST: For people like Marcus, it's about living in the wrong body, about being the wrong gender.

(BEGIN VIDEO CLIP)

UNIDENTIFIED TRANSGENDER: I just to be normal, like anybody else.

(END VIDEO CLIP)

(BEGIN VIDEO CLIP)

UNIDENTIFIED TRANSGENDER: Whether you are transgender or non transgender, we all share in the fight for equality.

(END VIDEO CLIP)

BATTISTA: But sex changes are expensive, anywhere from 40 to nearly $80,000, and insurance doesn't pay, unless you work for the city of San Francisco, where coverage...

(BEGIN VIDEO CLIP)

UNIDENTIFIED FEMALE: Nine "ayes," two "nos."

(CHEERING)

(END VIDEO CLIP)

BATTISTA: ... has just been approved.

(BEGIN VIDEO CLIP)

MICHAEL WEISS, SAN FRANCISCO CITY WORKER: I don't see why we should treat people who have gender identity disorder any differently than we would treat somebody who has something else that needs to be addressed medically.

(END VIDEO CLIP)

(BEGIN VIDEO CLIP)

ARANA: It's not as simple as, "Oh, I don't like my nose. It is too big, I think I will have a nose job."

(END VIDEO CLIP)

BATTISTA: The city itself will pay more for insurance and all city workers will be assessed a extra $1.70 a month.

(BEGIN VIDEO CLIP)

UNIDENTIFIED MALE: I've got enough stuff coming out of my check.

` (END VIDEO CLIP)

(BEGIN VIDEO CLIP)

TONY HALL, SAN FRANCISCO BOARD OF SUPERVISORS: I think it is political correctness. No one knows what the domestic partners aspect of this is going to cost, do we?

(END VIDEO CLIP)

BATTISTA: Should tax money be used to pay for sex change operations? And would you be willing to spend an extra $20 a year to cover your co-workers?

Good afternoon everyone and welcome to TALKBACK LIVE. What is it like believing you're a woman in a man's body, or a man trapped inside a woman's body? Most of us have a hard time understanding that and it's relevant to this issue. So let's talk first with Marcus Arana, a discrimination investigator with the San Francisco Human Rights Commission. He was once a woman named Mary. Marcus, thanks very much for joining us.

ARANA: You are quite welcome.

BATTISTA: Tell us first a little bit first about your personal story. When did you first realize or know that something was wrong?

ARANA: Well, when I was 5 years old living in Alaska, I saw the movie "PINOCCHIO," and in the end, the blue fairy came down and turned Pinocchio into a real boy, and I knew then that I needed a blue fairy. It's very common for transsexual people like me to be aware of their gender identity between about -- between the ages of 3 and 5 years old.

BATTISTA: And you felt more like a little boy, you're saying, at 3 to 5 years old.

ARANA: Absolutely. Everything inside of me said I was male. It wasn't about what my body looked like to me at that point, but more about how I felt when I closed my eyes and I thought about who I was.

BATTISTA: Did it affect your behavior?

ARANA: Well, certainly. I eschewed anything that had to do with little girls. I didn't play with dolls. I tried to play with the boys but they wouldn't play with me because they saw me as a little girl, so I spent a lot of time by myself in my bedroom drawing and reading and flying kites, a lot of solitary activity.

BATTISTA: So, you had to live with this for years. What was that like for you as you got older?

ARANA: It was very difficult. And I would say by the time that I finally went ahead with my transition, I couldn't wait any longer. I lived for 37 years in a body and a gender role that felt completely alien to me. And so it was with great joy that I was able to start living as Marcus.

BATTISTA: And when did that happen for you? When did you start the transition?

ARANA: I transitioned six and a half years ago, and I've been living full time as Marcus since then.

BATTISTA: And how has your family dealt with this?

ARANA: Well, that's been the difficult part of my story. I didn't lose my job, I didn't lose any friends, but I have two nieces I have never met because their parents keep them away from me, and my father disowned me for about five years. We've recently reconciled, but it's taken a lot of work, and it was very painful.

BATTISTA: From what I understand this condition can cause people to really sink into a very deep depression or become suicidal. Talk to us a little bit about that.

ARANA: It's very common, in fact the suicidality (sic) rate among transsexual people is about three times the national average. When you live in a role and in a body that is so completely alien to your experience and who you see yourself to be, and how you feel inside, it's tortuous.

Every time the paper boy called me ma'am, I wanted to scream. And eventually I sunk into about a four-year depression which finally ended -- no surprise to me -- with my transition.

BATTISTA: So is this more of a physiological disorder or psychological disorder?

ARANA: Well, it is classified in the DSM, the Diagnostic Statistical Manual, as gender identity disorder, and it has a prescribed medical standard of care for the treatment of this disorder.

BATTISTA: Part of the problem that you were facing with -- I'm sure -- with trying to get medical coverage for the sex change operation is that a lot of people view that surgery as elective.

ARANA: You know, there are two points to talk about here, and the first is the misnomer that there's anything as sex change surgery. The procedures and treatments we are talking about having San Francisco cover are available for everybody else who are not transsexual. So they will pay for hormone replacement therapy in Mary but not in Marcus. They'll pay for a hysterectomy in Mary but not in Marcus.

And the second is this concept of elective. Now when people hear elective, they think cosmetic, like I'm running out and getting a nose job. It's not that easy. Its elective in the sense that I had elective back surgery in 1997. I had several options, one of which was having hormones injected into my spinal cord and I chose to have surgery.

Now I'm out of a wheelchair and I can walk. So, that elective surgery was very positive for my quality of life, and the same is true with transgender health care.

BATTISTA: But not -- am I correct in saying -- that not all transgenders go through the entire process, including the surgery? I mean, why wouldn't they?

ARANA: It depends upon the individual person and what they discuss with their psychologist and their own doctor. It is not up for me to dissect the transgender communities.

BATTISTA: Some questions for you from the audience.

ARANA: Sure.

BATTISTA: Josiah, go ahead.

JOSIAH: Yes, Marcus, I was wondering -- teenage years are always the hardest. How were your teenage years in high school?

ARANA: You know, it was pretty tortuous for me trying to live and be something that was so alien, and I really tried my best to be a good girl, but it never felt right. So, friendships were really hard for me to make. I ended up coming our as a lesbian when I was 15 because I was attracted to girls, and I was seen as a girl, so not only did I have to deal withholding my transsexuality inside, I had to be dealing with being seen as a lesbian youth.

BATTISTA: I have an e-mail from Janice in New Hampshire who says, "I was born a transsexual, I will die a transsexual. After living a lifetime with this birth defect I sought treatment for this medically. Once I had surgery three years ago, I lived for the first time. I think it is a disgrace that transgendered people are denied proper medical treatment."

Ruth is on the phone from California. Go ahead.

RUTH: Hi, thanks, Bobbie. You are great, this is the best show on TV. BATTISTA: Oh, thanks.

RUTH: Anyway, this is just one more instance of proof of what Mark Twain said, that the earth is the insane asylum of the universe. We are so concerned with what our bodies look like on the outside, between transgender operations and having our mammary memory glands stuffed. And people -- this is all an illusion; 90 percent of our problems are self-imposed in our minds and just be what you are and be happy with it and quit whining.

BATTISTA: Well, let me have Marcus address that.

ARANA: I am being what I am and that is the transsexual man you see before me. And what I'm asking for from the city of San Francisco, is that they remove the exclusion -- which they have voted to do -- that keeps me from having procedures available for people who aren't transsexual. And I have to go back to your concept of this being as simple as a nose job or tattoo or stuffing one's breast to make them bigger.

This is about me walking down the street as a man and living safely because I'm not walking down the street with 42-D bosoms, and that's a dangerous place to be when you're gender incongruent, and the world doesn't know what you are. People used to look at me before I had (UNINTELLIGIBLE) surgery and say, "What is it? Is it a girl or a boy?"

Two teenagers came up to me and said, "We've got a bet going. Are you a girl or a boy?" Everywhere I went I got stared at, looked at, talked about, spit on and called names. So this is far more than just making my nose look prettier or my cheek bones look higher, which, by the way, is not paid for by the insurance companies under this plan. But this is about me living a safe life as a man.

BATTISTA: I think what's confusing to people too, Marcus, is what exactly the term 'transgender' encompasses. Can you help us with that?

ARANA: Sure. In the context of this benefit plan, we're talking about people like me who are transsexual. These are people who actually physically transition from one gender role to another. It does not cover the larger group that 'transgender' covers, which could also include cross-dressers, transvestite, drag queens and kings, female and male impersonators -- that's a political term that covers a broader look at gender expression. But for the purposes of this health benefit, it's really only covering transsexual people.

BATTISTA: All right, Marcus, stay with us, if you will. We have to take a quick break here. When we come back we will talk to two members of the board of supervisors in San Francisco about their decision. We'll be back in a moment.

The question today: Should taxpayers be funding sex-change operations? Take the TALKBACK LIVE on-line viewer vote at cnn.com/talkback, AOL keyword, CNN. While there, check out my daily note and drop some e-mail. We'll be right back. (COMMERCIAL BREAK)

BATTISTA (voice-over): In March, the Berkeley, California Police Department apparently became the first in the country to require employees to take awareness classes on gay, lesbian, bisexual and transgender issues. Two-thirds of the six-hour covers issues specific to transgender men and women.

(on camera): OK. Beginning in July, city workers in San Francisco will be eligible to have transgender operations covered by medical insurance. How did that all come about? Meet Mark Leno, a San Francisco supervisor and founder of the transgender civil rights implementation task force.

Also, Tony Hall, a member of the San Francisco board of supervisors, is with us. Gentlemen, thank you for coming.

HALL: Thank you, Bobbie.

MARK LENO, SAN FRANCISCO SUPERVISOR: Hello, Bobbie. And let me thank you for the very respectful approach that you brought to this conversation. I know it is a difficult one for many people.

BATTISTA: Oh, no problem.

HALL: Thanks, Bobbie.

BATTISTA: Mark, let me start with you first, because you sponsored this legislation.

LENO: That's right.

BATTISTA: Why do you think that it is something that the taxpayer should pay for?

LENO: What we're really doing here, and I know that the media has really focused on the sex-change operations, but as Marcus pointed out, what we're really doing is ending an inequity that presently exists in access to our health system.

Non-transgender employees have the ability to have all sorts of medical treatments -- not necessarily uncommon medical treatments, you know, for heart disease or liver or kidney disease, need for psychotherapy, need for hormone treatments, for whatever reasons. But again, if there's a transgender employee with the very same medical needs, the city will not cover that, presently, and that's really what we're changing.

BATTISTA: Tony, I don't -- I get the feeling you don't look at it quite the same way.

HALL: Not quite the same way, Bobbie. Let me dispel the notion that first of all, anyone who does not agree with this legislation doesn't share the same compassion. That's not the truth. I think there's a lot of people out there that share the same compassion as my colleague when it comes to the transgendered or transsexual community. The reason I opposed it is for two reasons. First of all, I think it is discriminatory. It's discrimination in reverse, by providing a level of benefits to a certain group of society, in this case a small group, and unfortunately, the object here is the transgender community. It provides them a special group of benefits that other people are not able to get. Secondly, there's unknown costs associated with this program, and my question is: Where do we draw the line?

LENO: Bobbie, can I respond to that?

BATTISTA: Yes, go ahead.

LENO: OK. A health plan is, by its very nature, discriminatory, and is for special benefits for special people. Clearly, infertility treatments that we're going to provide is for a very specific group of employees. I won't be able to access it. It's for special needs for a special group.

The same could be said for Viagra or the same could be said for people who need hearing aids. They're are people with special needs, and we cover them. So this is no different from that. And if there are other groups out there that we have yet to cover, there's a process by which they can advocate for augmenting our benefits further. But right now we're just trying to make it equal.

BATTISTA: Well, it seems to me that what's sort of at the root of this problem is whether or not the transgender issue is a medically diagnosed condition, is it not? I mean, isn't that sort of the criterion for insurance coverage?

HALL: Bobbie, if I could just respond to Supervisor Leno. A health service system is not discriminatory by nature. The function of the health service system is to provide maintenance and preventive health care for those workers who cannot afford it on their own. With limited and finite resources, the only share of equity -- we have to look at equitable and fair distribution, so you cannot single out one group over another, as this legislation does.

For example, Marcus talked about the same availability that a nontransgendered woman would have. If she goes in for a hysterectomy, it's for a medical reason, medical necessity. In his case, he's asking for a hysterectomy to complete the gender identification transformation that he's asking for. I'm not passing judgment...

LENO: I'd like to respond to that.

HALL: I'm not passing judgment on that. What I'm saying is, with finite resources, a health service system has to be equitable. If it's not, it becomes discriminatory.

LENO: Supervisor Hall, you the should, by the same reasoning, not be supportive, though I've never heard you bring it up once, the infertility treatments, or the Viagra permission. That is not maintenance.

(CROSSTALK)

LENO: That's not maintenance, nor is that preventive.

HALL: Infertility and Viagra is a minor part of this legislation.

LENO: You did not comment on it once.

HALL: I am also -- I am concerned about...

(CROSSTALK)

BATTISTA: What I was getting to earlier is: Where do you draw the line? For example, obesity, in his book, that obesity is a medical problem for a lot of people.

LENO: Well, in his case you draw the line at transgender.

HALL: How about people suffering -- the hundreds of city workers that suffer from heart problems. Cardiac reconstruction is only covered to $2,500 and 36 visits over the course of a person's lifetime. People suffering from learning disability, children, they're not eligible for these benefits. People who have hearing problems, people born with birth defects.

LENO: Hearing is actually in this legislation.

(CROSSTALK)

HALL: I met with the transgendered and transsexual community to find out if it was elective or birth defects. I was told it was birth defects, great. What about the person who's born with one limb or one lung? A person who needs prosthetic device?

(CROSSTALK)

Bobbie, do we get to respond at some point?

BATTISTA: Yes, and then the audience wants to get -- has questions and comments for you as well.

LENO: Sure. Again, there's some misinformation out here. We are covering for hearing aids. And again, there are...

(CROSSTALK)

HALL: Up to $1,000.

LENO: If I could just finish up.

HALL: Go ahead, Supervisor.

LENO: There are any number of ailments and treatments that we do not yet cover, and if the supervisor wants to continue to expand the benefits that are due city workers, there is a process, as I mentioned, to advocate those needs and concerns at the Health Service System Board, and we can have that debate. But it's important to recognize that we are just challenging the transgender issue here, and that is because this is a very unpopular, unknown, disliked and -- a group that we don't identify with.

HALL: Not true.

(CROSSTALK)

LENO: We don't advocate them.

HALL: Not true.

BATTISTA: You may be opening a Pandora's box, I think, is what a lot of people think, by setting a precedent. But for this group...

LENO: My point is, all those other benefits that are in this program also open the Pandora's box, but we are challenging those.

HALL: That's not true.

BATTISTA: Let me go to the audience. Mary has a question.

MARY: I was just wondering, how do you decide who a sex change is medically necessary for and who it's not necessary for?

LENO: That is the doctor's decision.

HALL: Right, but...

LENO: Let Marcus address that. I think that's...

HALL: I would like to address that.

ARANA: I can answer that...

HALL: OK.

ARANA: Since I'm the person who is going through this process. It's a very difficult process to determine who is eligible for gender reassignment. It takes years of psychotherapy. It takes years of living full-time in a gender role that you're moving towards. So it's not anything that anybody can just walk in the door and demand, like a nose job or breast augmentation.

Secondly, to the point that Supervisor Hall made about my hysterectomy -- he's making assumptions about the health of my body. The reality is, I do have pathology and have so far been denied a hysterectomy, solely because I'm transgender.

HALL: Marcus, that's not the truth. You were denied a hysterectomy because the health services board said it was not medically necessary.

ARANA: You -- Mr. Hall, you have no idea what's going on with my body since you're not talking to my doctor...

(CROSSTALK)

HALL: I'm going on what you told me the other day. Marcus...

ARANA: What I'm telling you today, sir, is I'm being denied a hysterectomy solely because I'm transsexual, despite the fact that there is evident pathology.

(CROSSTALK)

ARANA: And until July 1st, that's going to be the case. After July 1st, I have an opportunity of having my pathology addressed, and that is true, Mr. Hall. You can take it for that.

BATTISTA: I've got to take a quick break. I'm sorry, gentlemen. We'll come back to this, though, in just a minute. As we do, Kristin in Hackettstown e-mails us: "Gender identity disorder is a disorder, not a lifestyle choice. People need to understand this."

And Bonnie in Gainesville says: "I used to be ridiculed for being flat-chested. Why not have San Francisco pay for my breast implants?"

We'll be back in just a second.

(COMMERCIAL BREAK)

BATTISTA: The Nebraska Supreme Court ordered a lower court to redetermine damages awarded to Teena Brandon's mother. JoAnn Brandon sued the county and the sheriff who failed to protect her daughter. The chief justice said the award of a little more than $17,000 is so low it quote -- "shocks the conscience." The story of Brandon's murder was told in the 1999 movie "Boys Don't Cry."

All right. We're back, and Barbara has been patiently waiting on the phone. Barbara, go ahead.

CALLER: Hi. I just want to respond to the woman who said that they should get over it. This is a medical problem. These people aren't choosing to do what they're doing. They're not choosing to run away from their families and uproot their lives. I know somebody personally who did this, and it's extremely sad that they are not recognized as being a patient. They are a patient. They need help. They need people to have awareness. They're not choosing this.

BATTISTA: All right, Barbara, thank you.

And, Gene, you had a question for the supervisors.

GENE: Certainly. I would like to ask how much is this program going to cost the taxpayers of San Francisco?

HALL: I'd like to respond to that, if I can.

LENO: And then I'd like to follow up.

BATTISTA: Sure. HALL: That's the second half of my argument. The costs are really unknown. They allow a $50,000 cap on surgical procedures. That's quite a bit more than hundreds of other people out there that are city workers that are not allowed that privilege.

Secondly, there's unknown costs to the city because hormone treatments, postoperative psychotherapy and other medical treatments are provided for -- quite in excess of the benefits package that other groups in our society are now receiving, other groups that are city workers. I cited them:: hearing, cardiac rehabilitation, obesity, cosmetic and reconstruction -- surgical reconstruction of anything. There's limits, there's caps, and we're dealing with finite amount of money here.

LENO: Bobbie, can I respond to that?

BATTISTA: Yes, Mark, go ahead.

LENO: The supervisor is a little confused, in that we know specifically how much it's going to cost, and we checked with our budget analyst. All you have to do, multiply two numbers. $1.70 per month, per employee in the health plan times the number of people who are in the health plan.

What it might cost our insurers, Supervisor Hall is correct...

HALL: Taxpayers.

LENO: No, that is the insurers' cost. Our cost is the number of employees in the plan by the number -- the dollar per head. But it comes to about $680,000.

BATTISTA: Right now, we're...

(CROSSTALK)

HALL: What's not mentioned here, is in San Francisco, Bobbie, domestic partners are allowed the same health benefits.

BATTISTA: OK.

(CROSSTALK)

BATTISTA: If we get into numbers, what we're talking about so far is about 14 city employees, correct, that are...

LENO: That is about correct. Fourteen at present.

HALL: They made the calculation on 35, but at this time we don't know how many domestic partners are going to be available.

BATTISTA: Do you think it's likely...

(CROSSTALK)

LENO: What isn't being clarified here is that the unknowns will affect our insurers' costs. Our costs re fixed, the number of people in the system times the $1,70 per month.

HALL: Somebody's paying for this. Where do we draw the line? That's the bottom line. Somebody's paying for it other than the people that are benefiting from it.

LENO: Our rates will either go up or down, depending upon how much our insurance...

HALL: Rates will never go down.

BATTISTA: A couple of more questions here. Ralph, go ahead.

RALPH: A board made this decision. I'm just wondering why the employees weren't given a chance to vote on it.

HALL: Great question.

LENO: Great question.

HALL: I proposed that early on. They were never given the right to vote or say in this matter. And they're the people that are paying the bill.

BATTISTA: Well, was there much opposition to it?

LENO: Bobbie, again, we're -- we're elected to -- we're elected to lead, and that's why we're here.

HALL: We're also elected...

LENO: Our voters (UNINTELLIGIBLE). But also let me point out...

HALL: We're elected to represent the people, and that's why I'm here.

LENO: The other -- let me please speak. The other components in this package are not being proposed that the voters should vote on them, and that's why this is discriminatory. No one is asking about the infertility treatments or the acupuncture or the $50 deductible from the health for the pharmaceutical expenses. Just this one is being singled out, and we must admit our own bias if we're going to get beyond it. And that's what Supervisor Hall is struggling with.

HALL: Our own -- the reason we're here is because people in San Francisco are very "tolerable," they're not discriminatory, and that's why this is happening in San Francisco. And God bless them, and I'm here to represent them, all their concerns, not just one select group.

BATTISTA: Let me go to Lee in Virginia on the phone -- Lee.

LEE: Hello?

BATTISTA: Go ahead.

LEE: Yes. I think perhaps one of the solutions could be that maybe some of the physicians or doctors should make this more affordable to those people that are in need of this. I think that -- I also had a question to the panelist. I wanted to know what percentage of people who are transgender change their mind.

BATTISTA: Marcus, perhaps you can help us with that.

ARANA: I sure can. The incidents of surgical regret is almost nonexistent. In 98 percent of the time, people express extreme satisfaction with the surgical results. In about 2 percent of the time, people express some kind of dissatisfaction with the look of things, but not with having changed gender roles. So you're looking at a phenomenally high success rate with this intervention.

And I want to say again this is not about offering sex-change surgery. There's no such thing. This is about removing an exclusion that specifies that trans-sexual people cannot have the same procedures like hormone replacement therapy that other people who aren't trans-sexual do get paid for.

So there are women in the health service system who are having hormone replacement therapy. There are men who are having testosterone injections who are not trans-sexual. And is paid for.

HALL: And it's called medically necessary, and the transgender community has the same standards. What you're asking for here is an exception to those standards.

LENO: Just like infertility is a medical necessity, Viagra is a medical necessity.

BATTISTA: That'll have to be the last word.

LENO: Thank you.

BATTISTA: That'll have to be the last word here.

(CROSSTALK)

HALL: That's a new one on me.

BATTISTA: Lisa in the audience, hang on just a second. Tony Hall, Mark Leno and Marcus Arana, thank you all very much for joining us today. We appreciate it.

HALL: Bobbie, thank you very much. Appreciate it. Thank you.

LENO: Thank you, Bobbie.

ARANA: Pleasure.

BATTISTA: Coming up in a moment, find out what taxpayers are saying about this new city benefit. We'll be back.

(COMMERCIAL BREAK)

BATTISTA: Welcome back. A couple of more e-mails. Eva in Nashville says: "We had a sermon in church about transgender persons. Before that service, I had no idea what torture those folks go through. If I were a city worker in San Francisco, I'd be willing to assist my fellow employees, change their gender if that would be the appropriate thing for them."

Ronald says: "As a longtime resident of San Francisco and gay man, I am never amazed at what the board of supervisors proposes and passes. If one wants a sex change, fine. Just don't make me pay for it."

BATTISTA: Welcome back. We are now joined by Alan Amberg, who is the founder of LesBiGay Radio Broadcast out of Chicago.

ALAN AMBERG, FOUNDER, LESBIGAY RADIO: Hey, Bobbie.

BATTISTA: Hey, good to see you. And Melanie Morgan, a radio talk-show host on KSFO 560 AM in San Francisco. Melanie, good to see you.

MELANIE MORGAN, RADIO TALK-SHOT HOST: Thank you, Bobbie.

BATTISTA: Alan, first, we should, I think, preface this by saying that, you know, being gay and being transgender are not the same thing. We just thought that you might have a unique perspective on this since, you know, the radio station that you founded appeals to these various groups.

AMBERG: Well, and of course, transgender listeners were an important part of what we did. But what I think the reason that gays and lesbians very often fall into the same corner as transgender folk is because people tend to dislike us or be afraid us for the same reason, and that is that we break the rules of gender.

As Supervisor Lena said, the reason nobody is questioning infertility treatments or Viagra is because that assists men (UNINTELLIGIBLE) like men and women (UNINTELLIGIBLE) like women. But when people cross those borders, it just makes other folks crazy, is what's going on.

BATTISTA: Well, as we learned today, the city policy, the way it is, doesn't cover birth defects, and a lot of people would look at this as a birth defect, this gender disorder. So...

AMBERG: You know, I...

BATTISTA: ... why -- I don't -- why just that one thing?

AMBERG: Well, you know, I think that's really a red herring. Let's begin with the fact that access to health care in general in this country is a very screwed-up, limited thing, that a lot of people who need health care can't get at it.

If you look at this issue in many countries of Europe, it's a nonissue. In Germany, where everybody gets health care, this is considered a medical condition, and if a doctor says a that transgender person needs it, they get it. So I mean, let's begin with the fact that we're arguing about something really tiny here. I'm wondering what Supervisor Hall has to say about the fact that lots of people get involved in things that shouldn't be medically necessary but cost a fortune: i.e., smokers who incur emphysema, motorcyclists who ride without helmets. These things are incredibly expensive on the health-care budget. But we've all been convinced we're supposed to pay for those things.

BATTISTA: Well, Melanie, in the research I had, it did seem it is labeled officially a medical condition, so why shouldn't it be covered?

MORGAN: Well, I think it is a medical condition, but it's not a medical condition that all the taxpayers of the city and county of San Francisco should have to pay for. We are talking at most 35 people here.

What we have work at work, Bobbie, is pressure politics on part of the gay and trans-sexual community. All right, so they are very good at politicking, but that doesn't mean that everybody needs to be paying for their wishes, their wants, and their medical needs.

AMBERG: And Melanie, gay and lesbian, bisexual and transgender people have been paying for your wishes and wants and needs for decades, to the tune of thousands and thousands of dollars a piece.

MORGAN: Hey, we're all in this together, Sam. There's no question about that. But we are talking about 35 people here; and were also discussing a lot of people who have birth defects who aren't being covered at all.

AMBERG: Cover them.

MORGAN: I have no problem at all with this operation. In fact, I think, after having talked to many people in this community -- and one just this morning -- I think that it's important that they have the operation if they want it, and if it is deemed medically necessary. But why don't we create a pool of private money? Why does it have to be government money?

AMBERG: Because government is the employer in this particular case. We don't have a government insurance system. In this particular case, the employees work for the city government. And what we've already established in San Francisco is that the city is not only a city, it's a corporation. They have the right to extend whatever fringes and benefits they deem necessary.

MORGAN: We have established in San Francisco is, we have a kooky board of supervisors, a very nutty, weird board of supervisors that the rest of country looks at and goes, where did those people come from?

(LAUGHTER)

AMBERG: Well, Melanie, let me tell you something: that wacky, kooky board of supervisors decided to take on the domestic partners issue by passing an ordinance, saying that the corporation would do business with companies that did not discriminate against gays and lesbians. And that wacky, kooky board stood their ground. And the result is: thousands of companies, including some of the largest corporations across America, now treat their gay employees fairly.

MORGAN: And it has also resulted in Catholic charities not being able to service some of the very poorest people in San Francisco, because of that policy.

AMBERG: Because Catholic charities chooses to discriminate and accept government money for it. If they want to discriminate, then they -- if they want to take government money, then they don't discriminate. If they don't want your money, then fine, they can do anything they want.

MORGAN: The last time I checked, the last time I looked in San Francisco, the trains still don't run on time, there's rampant homelessness...

AMBERG: And 35 trans-gendered people didn't cause that.

MORGAN: ...and the board of supervisors are worrying about 35 transsexuals. I think we really need to be more cost efficient.

AMBERG: But those transgenders didn't cause your potholes.

BATTISTA: We got to take a quick break here; I'm going to the audience when we come back.

(COMMERCIAL BREAK)

BATTISTA: We're back; we will go to the audience. And Natalie just posed a good question. What was it?

NATALIE: The question is: it's just like they decided that the city would not do business with any corporation that so-called discriminated against gays and lesbians. Are they now going to make the same precedent that is, if the corporations failed to agree and provide the same type of health benefits, will they turn cold on them again?

AMBERG: Well, who knows the answer to that question, but Natalie, the bottom line is, there's no question that cities across America -- and San Francisco is only one of them.

I can tell you in Chicago, if you pick up a city of Chicago contract, there's a list of things you have to agree to. And one of them is that you don't discriminate on a whole series of points.

Another is, you have to treat your employees fairly. And you have to have workers compensation insurance. I mean, there's a wide variety of things that cities in general do make their contractors do; that's just good business practice. And as a corporation, they have the right to do so of they wish.

MORGAN: The short answer to your question is yes. That's exactly what's going to happen. Corporations will be pressured into providing the exact same benefits that the city and county of San Francisco is planning on delivering. So, you are a very perceptive question there.

And it will cost corporations and business, and ultimately you and I, a lot more money on the behalf of 35 people at most, in this particular instance.

AMBERG: Melanie, let me ask you a question: this kind of surgery cost about at most $100,000 a person. So, we're talking about 35 times 100 -- let's say there's $3 million involved there. Do you know what the cost of a heart attack, a stroke, of an aneurysm? Things that people get from a car crash, because they are not wearing a helmet or smoking? Do you know what the cost is in millions and millions?

What is your policy going to be to stop the millions of smokers and the billions of dollars they cost us? And by the way, I should say my other half is a smoker, so it's not like I'm not familiar with this issue.

MORGAN: OK. Let me ask you this question: Who will come up the approximately $5 million in overtime for the fire department that we don't now currently fund? I mean, are we going to let everybody's houses burn down, because we could be using the $3 million to...

AMBERG: But Melanie, don't blame 35 transgender people for the fact that you don't have enough funds for your fire department.

MORGAN: I am not blaming them.

AMBERG: OK, so let's focus on the fire department.

MORGAN: I am talking about a pattern of overspending by the board of supervisors, because they want to respond every pressure politic group in San Francisco.

AMBERG: Well, that's why you have a ballot box, Melanie. That's why you have a ballot box.

MORGAN: I would like to know if we are going to draw a line here. Why can't I come up and say, I think I have got a few more facial wrinkles today than I had yesterday, wouldn't it be nice if I could have some plastic surgery?

AMBERG: And Melanie, wouldn't it be nice if I could say, I'm going to get married today and get the 1,049 rights and privileges that translate into money that you can get as a heterosexual?

BATTISTA: Let me break in on all these rhetorical questions. And let me take Jean on the phone from Texas.

CALLER: Yes. If this happened to one of my children, I would stop at nothing; I would pay anything to make him or her whole and these poor people are born the victims of a very unfortunate throw of genetic dice, and if we can help them in any way, we should. MORGAN: You just said something very important there. You said you personally would go and do anything to help that child. It is your responsibility to help your child if you feel that way. It is not the responsibility of all of society. I think...

CALLER: I disagree.

MORGAN: I think I came up with a pretty darn good idea. I think, because this is an important issue for many of these transgender people, and I sympathize and understand that they are going through hell, why don't we come up with a private pool of money?

AMBERG: Well, tell me; are we going to come up with a private pool of money, as the earlier guest suggested, to cover women who get hormone replacement therapy and men who get testosterone therapy? Why do they get it and not other people?

MORGAN: Medical necessity.

AMBERG: Oh, I see. Because you have decided what is medically necessary.

BATTISTA: How much of this argument has to do with money and how much of it has to do with morality or our perceptions...

AMBERG: Bobbie, that's the point. In other countries where there is universal health care, this is not an issue. In our country, we are only arguing about this small amount of people and this tiny amount of money, because in our country, we grudgingly hold out health care to only people who are middle class and have good enough jobs.

We have 40 million people in this country who don't have health care. Melanie, how much time do you spend on your radio show, trying to get the uninsured and underinsured of your city covered? How much time do you spend working on people who are on Medicaid, instead...

MORGAN: If you want to have an argument about universal health care, we can have that argument, but that's not what this issue is about today.

AMBERG: So, you are wasting a lot of energy on 35 people.

MORGAN: This issue is about, where do we draw the line?

All of the people of San Francisco deserve to have better health care. There's no question about that. But that's not to say that these 35 people should get the very best health care available.

AMBERG: And let me tell you that a lot of transgender people do not get the very best health care, that many transgender people are the victims of doctors...

MORGAN: They will in San Francisco.

AMBERG: Thank God. Why not?

BATTISTA: This is a good debate, you guys. We've got to take another break. And John, I will get you when we come back.

(COMMERCIAL BREAK)

BATTISTA: OK, John in the audience, go ahead, question, comment?

JOHN: Yes, the question is, there is a delicate balance here that's -- it's a community issue and it's been approved by the community board, so it will take place.

My question is: is this an inroad for a separate class distinction under the constitutional guidelines, which is race, religion, gender or sex or age? Is this where we are going to do in that direction? Or is it just kind of a test on that level on constitutional issues?

I know, being empathic with those people from San Francisco, I understand where they are coming from, but I live in the middle of country now. But -- is this going to spread like wildfire or just isolated and into the community?

AMBERG: Well, the point is is that every community should always have the right to expand the civil rights it offers its citizens. And personally, any time people want to expand the rights they offer citizens, it's a good thing. Any time people want to expand health care, that's a good thing. It's not a zero sum game, where, if we give to some, it takes it away from others.

MORGAN: It is a zero sum game. We have finite resources in San Francisco and California, my heavens! We can't even keep the lights on in this state, let alone take...

AMBERG: That's not the fault of the 35 transgendered people.

MORGAN: And this civil right, I predict, will not spread to any place other than New York and few other cities in the country, because the rest of the country looks at this use of government money as completely nuts.

AMBERG: And Melanie, I would like to say it's a sad statement when civil rights becomes an issue of what we can afford. We can't afford not to have them. That's what this country is based on. Got it?

MORGAN: This country is based on the United States Constitution.

AMBERG: Which is about giving... That's about giving a level playing field to everybody who's here. That's the vision of this country. Not that some people get more than others and right now, that's the case.

BATTISTA: I have to jump in.

MORGAN: Some people are getting more than others.

BATTISTA: I have a feeling this topic may come up a time or two again. Melanie Morgan and Alan Amberg, thank you both so much for joining us.

AMBERG: Thank you, Bobbie.

MORGAN: Thank you, Bobbie.

BATTISTA: Thank you to the audience as well. And we'll see you again tomorrow for more TALKBACK LIVE.

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