mapping the medical necessity minefield

First, some definitions, noting that there are widely divergent definitions for all these terms and none are perfect or uncontaminated by the biases of the medical establishment. I picked those I most agreed with:

• Sex: either of the two major forms of individuals that occur in many species and that are distinguished respectively as female or male especially on the basis of their reproductive organs and structures.(Merriam-Webster)
• Gender: the behavioral, cultural, or psychological traits typically associated with one sex. (Merriam-Webster)
• Gender Role: A set of behavior patterns, attitudes, and personality characteristics stereotypically perceived as masculine or feminine within a culture. (Dictionary of Psychology, Oxford)
• Gender Identity:A sense of awareness, usually beginning in infancy, continuing throughout childhood, and reaching maturity in adolescence, of being male or female or somewhere between.
• Gender Identity Disorder: A mental disorder characterized by a strong and persistent identification with the opposite sex, coupled with persistent discomfort with one's own sex or gender role, causing significant distress or impairment in social, occupational, or other important areas of functioning. (Dictionary of Psychology, Oxford)
• Medical Necessity: Services/procedures which are approved in accordance with recognized medical standards as effective and appropriate and are essential to retard, reduce or eliminate an impairment. (Dictionary of Psychology, Oxford)

Imagine for a moment the image of a little boy, deformed from birth, burdened by twisted limbs and looking forward only to a lifetime of social rejection and revulsion. Or consider a boy whose face is ravaged by burns, subjected to the full force of society's skin-deep judgements. Fortunately, modern medical science can often offer these children a remedy against that dour future through complicated and often expensive surgery. Would you think that surgery "medically necessary?" What insurance company would turn down covering the costs of the procedure for such an innocent child? What kind of monster would deny that child the right to live peacefully and happily for the sake of saving a little money? The answer is not many at all (but the fact that I can't say "none" speaks to the fatal flaws in our health care system).

Now imagine that you woke up tomorrow morning and your physical body had been switched to the opposite sex you had all your life, but your mind was still of that original sex. A man suddenly forced to live with a female body against his will, indeed, against his very core idea of self. What if there were a surgery, expensive but available, that could fix this dissonance between mind and body and restore the proper bodily sex organs to that man? Most likely, insurance companies would consider this surgery "medically necessary" as well and cover it's cost to the unsuspecting victim, right? What insurance company would deny a man the right to get his proper body back? The answer is again not many at all.

Finally, imagine a little girl, deformed from birth, cursed with a "boy's" physical body - one totally at odds with her self-image. Forced to live life in a gender completely incongruous with her desires and personality because we as a society do not check in any way for this type of disorder in our children. So that girl is forced to live out society's strict "male" gender role and scared to death of the consequences of revealing her true self despite the internal pain, shame and turmoil it causes. Fortunately, it is possible for this girl to overcome these massive cultural obstacles and come to embrace her true gender. And there is a (fairly expensive) treatment for this disconnect between mind and body as well. What insurance company would deny such a girl the right to correct this debilitating physical defect? The answer, history shows us, is almost always the same: complete coverage denial...