Medical Examiner

Transgender Service Members’ Medical Costs Are Not a “Burden”

They’re valid, and they’d be cheaper than what the military currently pays for Viagra.

U.S. President Donald Trump delivers remarks to U.S. military
President Donald Trump delivers remarks to U.S. military personnel at Naval Air Station Sigonella in Sigonella, Italy, on May 27.

Darrin Zammit Lupi/Reuters

On Wednesday morning, President Donald Trump used his favorite policy forum to announce that he was reversing the Obama administration policy of opening military service to transgender individuals. “Our military,” he tweeted, “must be focused on decisive and overwhelming victory and cannot be burdened with the tremendous medical costs and disruption that transgender [sic] in the military would entail.”

The word to focus on in this statement is burdened. Not only does the president think transgender service members would be a distraction, but he also believes their health care would be so exorbitantly expensive that their service to our country would not be worth it.

A 2016 paper by the Rand Corporation titled “Assessing the Implications of Allowing Transgender Personnel to Serve Openly” estimated that about 2,450 transgender people are on active duty (out of 1.3 million active-duty service members altogether), and of that number, around 29 to 129 service members would seek care related to a gender transition in any given year. The total cost of their health care would increase overall expenditures on health care by between $2.4 million and $8.4 million annually, which amounts to a 0.04 to 0.13 percent increase in total active component health care expenditures. The true cost may even be lower; when the University of California system began to cover gender transition surgery in 2005, it only ended up covering 28 surgeries over a period of five years. By way of comparison, in 2014 the Department of Defense spent more than $84 million on Viagra and other medications to treat erectile dysfunction.

Are there costs associated with gender reassignment surgery? Of course, and like almost everything else in American health care, they can appear overwhelming at first glance. But the treatments are medically sound and warranted—paying for a gender transition is just as worthy a means of creating a strong military as paying for another service member’s mental health care or cancer treatment. The 2011 National Transgender Discrimination Survey found that 41 percent of transgender respondents had attempted suicide (as compared with 1.6 percent for the general population), in many cases due to lack of access to the transition services that successfully treat gender dysphoria. Recognizing transgender medical concerns as real and treatable (in the military and beyond) could give transgender individuals a greater chance of thriving.

The aforementioned survey also found that 20 percent of transgender individuals had served in the military; during the same period, 10 percent of the adult population of the United States had served. This survey was conducted before the military began to move to officially accept transgender service members, meaning that every one of those respondents had to serve while in the closet. Transgender people have assuredly been in the military for many years, and many more will continue to serve our country regardless of whatever edict regarding their status is issued via tweet.

What is at stake, then, is not whether transgender people will be allowed to serve but what sorts of lives they will be allowed to live while serving. Will they be pushed back into the closet, forced to hide their own identities at risk of losing their jobs and the ability to serve their country, or will they be acknowledged as fully human and extended the same basic health care rights that are extended to every cisgender service member? By shelling out millions for Viagra and other erectile dysfunction medications, we already recognize the importance of quality of life for those who would defend our country. To refuse to extend the same decency to transgender individuals has nothing to do with money and everything to do with our own lingering prejudices.