November 20th marks the Transgender Day of Remembrance (TdoR). This is a day on which people come together to acknowledge the loss of people's lives to transphobic violence around the world.
There are differing views on this day.
For many trans-identified people and allies this is a day on which the reality of those murdered for being trans should be brought out into the spotlight. A day when we gather as a community to mourn the premature and violent ending of lives with which we feel some form of bond.
For some, this is a day on which privileged trans-identified people prey on the public image of more marginalised trans people in order to promote their own agenda. Many of the most famous murdered transwomen were not murdered for being trans, so they argue, but for being sex-trade workers, for being poor, and for being people of colour.
As I reflect on this TdoR, I am drawn to consider what my connection to these murdered people is, and what purpose this day serves for me and my community.
I am not a person of colour. I am not a sex-trade worker. I am not homeless.
I am a well educated, white, middle-class, able-bodied man. Yet, I feel a connection to the many people, predominantly poor women of colour, who have been murdered for attempting to live their lives in a world that was not accepting of them.
Could I suffer the same fate as them? Yes. Am I likely to? No. My places of privilege usually offer me a haven from many violent acts. Yet I feel a connection with them, and perhaps more importantly, a responsibility to them.
For me, the TdoR offers an opportunity to educate people. Not just for those who are outside of our community, but also for those within our community. Transphobic violence takes many forms, yet the one that we, as a community, seem to want to focus on - through attempts to create hate crimes legislation, specific human rights legislation, and most other current forms of legal action - are those obvious heinous acts perpetrated by individuals. The way that TdoR events are usually held is in keeping with this political action. We remember and count those that were brutally murdered in order to support our claims that we need more legislation.
Yet legislation does not make us safe. Legislation incarcerates trans individuals at rates disproportionate to nontrans individuals. Legislation makes trans individuals more likely to be victims of violence by erecting barriers to employment, education, and housing through an inability to access identity documentation. Legislation denies access to necessary medical care for many trans individuals. And legislation unequally financially burdens trans individuals with its fees, bureaucracy, and red-tape.
According to the International Transgender Day of Remembrance website, California, a state with hate crimes legislation that specifically includes gender identity, was the state with the most murders of transgender individuals this year - with almost twice as many as New York, where there is no hate crimes legislation that specifically includes gender identity. Even accounting for the difference in population, there were as many murders in the state with hate crimes legislation as without. Clearly, the legislation did not prevent the murders that occurred there this year. Why would we expect it to work next year, or in another jurisdiction?
What the TdoR statistics do not record are the ways in which trans-identified people face a myriad of government sponsored inequities that lead to pervasive premature death within our community. Moreover, theses inequities lead to various other marginalizations that often culminate in exposure to extreme acts of violence.
As long as there are institutionally sanctioned barriers for trans-identified people to access government issued identification, appropriate and inclusive medical care, employment, education, housing, and so on, trans individuals will die prematurely - and their deaths will be a result of government sponsored transphobic violence. For many of the people who have been and will be remembered at TdoR events around the world, this kind of government sanctioned violence is as responsible for their deaths as the men who so brutally murdered them.
For those trans people who have died premature deaths because of state-sanctioned or authorised violence, this ought to be their day of remembrance as well. when I use the term "premature deaths" I am referring to all of the ways in which our life span is affected by the distribution of life chances. Premature death includes: those who have died by their own hand, those who have died from drugs, those who have died through a lack of necessary nurturing, those who have died from diseases such as AIDS or Hep C, those who have given up and died of despair, and all others who have died early deaths because their life chances were unequal to others. All of these people should be remembered here as well, because they have all died premature deaths due to the unequal distribution of life chances brought about through legislation and policy.
When I consider my relationship to this year's TdoR, I feel that I have a responsibility to the many names that have been, and will be, read around the world, as well as to those that should be, but will not. As a very privileged trans individual, I have the opportunity to educate those people both outside our community, as well as those within our community, of the need to change our political projects and fight what we ought to consider the most heinous transphobic violence - that perpetrated by our governments and institutions. Hate crimes legislation and human rights codes will not prevent these violences from being enacted; they will not prevent premature death in our community; nor will they prevent the brutal murders of our community members in the future.
Saying no to violence enacted on our community requires us to strongly interrogate what we mean by violence. I define violence as the callous or unjust use of power or force, as in violating someone's rights or sensibilities, and the harm done by this. The most dangerous violence that our community faces is that perpetrated by laws and policies that prevent us from accessing needed services - such as identity documents, healthcare, housing, education, and employment - and that lead to an unequal distribution of life chances that results in premature death.
Saying no to violence enacted on our community requires solidarity and political action. Changing things for those of us who are already quite privileged does not help those who are not. For this reason any political action needs to take into account the members of our community that are most vulnerable. The unequal distribution of life chances does not mean that all trans people have the same disadvantages, or that all nontrans people are more privileged than all trans people. Changing things for those most at risk, strengthens our community, and benefits us all. Changes at this level require us to change policies and laws that place barriers to our accessing basic needs.
Saying no to violence enacted on our community requires our remembrance to extend beyond the mourning of death and crying for vengeance. It requires us to remember the ways that law and policy have not only allowed violence to occur within our community, but how law and policy function as the condition of possibility for such violence. It requires us to come together as a community and speak out against the unequal distribution of life chances. It requires us to focus on the ways that government legislation and policies lead to premature death.
Until political action is driven towards changing the distribution of life chances, there will be a need for days of remembrance. How many more people will we need to remember before we say no to violence enacted on our community by law and policy?
Saturday, November 21, 2009
Friday, October 23, 2009
TRANS:assemblages: Intersectionality and Beyond
Here is a preliminary draft of the paper I presented at the TRANS:assemblages discussion panel.
Psychiatry and Law: The Keys to TransCitizenship
One of the most contentious issues in trans activism is the medicalisation of being trans. Because psychiatric diagnoses are steeped in stigma, there is a desire by some activists to remove this stigma by removing trans’s relationship to psychiatry. It is this position that leads to attempts to remove Gender Identity Disorder from the DSM; a situation that has increased with the current discussions concerning DSM V.
This is an example of one of the ways in which trans activism has followed gay and lesbian activism; gay activists successfully lobbied to have homosexuality removed from the DSM in 1973, a move that was driven in large part by the position that homosexuality was not a mental illness, and, as such, was not deserving of the stigma that follows from such a diagnosis. Unfortunately, this kind of tactic tends to reinforce the stigma associated with mental illness (by using stigma as a reason to remove a diagnosis). In the case of the homosexual lobby, however, it removed a medicalized, diagnostic category from a group of people who are not in need of medical intervention or treatment because of their homosexuality.
This is, however, a point of rupture between the LGB and T communities. While people who identify as lesbian, gay, or bisexual do not require medical intervention, some trans identified people do. Not all trans identified people want or need medical intervention, but for those that do, diagnosis is the key. In order to access treatment, whether that treatment is funded by public or private insurance or paid for out of pocket, a medical diagnosis is required.
How would this diagnosis occur outside of the psychiatric model? The ‘signs’ and ‘symptoms’ of untreated Gender Identity Disorder, as well as the differential diagnoses, such as borderline personality disorder and schizophrenia, are mental not physical. The doctors best trained to make this differential diagnosis are psychiatrists, suggesting that the diagnosis of those trans-identified people requiring treatment appropriately belongs within the realm of psychiatry.
Moreover, attempts to divorce the transsexed body from discussions of madness and mental illness set the body outside of an important social context; a context that directly impacts many people’s everyday lives as well as their relationship to the state. While the pathologization of gender difference within psychiatry as madness can be traced to the mid 1800s, it is erroneous to then assume that this is the reason that today people often think of trans-identified people as crazy. The categorization of people as crazy, sick, or mad that occurs in common usage currently is, largely, a moralizing call to conform to acceptable norms, something that trans-identified people are seen as transgressing.
In May 2009, the Minister of Health in France, Roselyne Bachelot, called for the removal of transsexualism from the list of mental diseases, a call that was hailed as an historic step towards complete inclusion of transsexuals in citizenship. Many activists wrote and spoke of their hope to see similar declassifications occur around the world. The French move is instructive in that Bachelot called for the removal because transsexuals felt that being classified as having a recurring or persistent mental disorder was stigmatizing. However, the simple removal of the diagnostic category is unlikely to have a significant effect on the common perception that someone who is trans is crazy, delusional, or sick. Thus, the stigma of being trans remains, with or without the medico-legal label of recurring or persistent mental disorder.
What has been lost in the hailing of the French call as a victory is the accessibility of treatment. Insurance companies, particularly American insurance companies, which have an impact on both American insurers and Canadians with private insurance stemming from an American carrier or parent company, have been loath to provide monies for services they deem ‘elective’ treatments, and physical transition has often been caught up in this definition. Removing the diagnostic category will lead to an increase in such definitions, with a subsequent decrease in accessibility.
Funding by public healthcare has been contested and is not universally available across Canada, even though hormone treatment and gender reassignment surgery are internationally considered to be necessary and appropriate medical interventions. The medical necessity of the treatment suggests that it ought to be covered under the Canada Health Act, however without a diagnosis, questions of medical necessity will be rendered moot.
Most provincial healthcare programs across Canada deal with surgical access and funding on a case-by-case basis, with Ontario, Saskatchewan, and Newfoundland all requiring patients to be recommended for surgery by the Centre for Addictions and Mental Health in Toronto - formerly known as the Clarke Institute. Nova Scotia and Prince Edward Island do not fund surgeries of any kind for transsexed people. Manitoba and Alberta both delisted funding this year. British Columbia and Quebec cover some surgeries through their own medical networks, although the funding is extremely limited and difficult to obtain. As of 2009, no Canadian province provides funding for genital surgeries for female-to-male transsexed people. A series of surgeries that routinely cost between 40 and 150 thousand dollars; yet they all require the surgeries in order to change citizenship documentation, such as birth certificates.
Following in the footsteps of trans-identified people in Ontario 11 years earlier, there are human rights claims pending in response to the April 2009 Alberta delisting; however, the claims in Hogan v. Ontario were successful because people who had begun moving through the Clarke Institute’s very slow moving system were understood by the court to be entitled to complete the treatment they had, in good faith, entered into. When the Ontario Health Insurance Plan removed coverage for surgery, October 1st, 1998, Michelle Hogan, Martine Stonehouse, and the claimant identified as A. B. were all patients at the Clarke Institute in Toronto and had begun the process of physical transition. These three of the four claimants named in the case were successful; the fourth claimant, Andy McDonald, the sole female-to-male represented, was unsuccessful because the court ruled that as he was not a patient of the Clarke prior to the delisting of the surgery, he could not have an expectation of treatment, and therefore the delisting did not have a disproportionate adverse impact on him. McDonald’s desire for phalloplasty and the Clarke institute’s position on the surgery as “experimental” were noted in the court’s decision, and while this was not a deciding factor in his case being denied, it has been, and continues to be used as justification for the denial of genital surgeries for FTMs in a number of provinces across the country.
In Alberta, the government’s decision to delist the surgery was made with knowledge of the legal fight in Ontario, and Alberta’s claimants have a long, tough fight ahead of them. The Alberta government has attempted to derail claims by instituting a grandfather clause, thereby directly dealing with the reasoning behind the decision and remedy handed down in Hogan. The Alberta situation has also made the delisting itself much less transparent than in Ontario where the tariffs used to pay for the surgery were removed; in Alberta, it appears that the delisting has occurred through a change in the way that a policy requiring prior consent of the minister for funding is implemented, and not actually through any Orders in Council.
The similarities and differences between the two situations make it difficult to see the Alberta claims resulting in a similar remedy; as well, it is important to note that the legal remedy in Ontario resulted, not in widespread reinstatement of funding as is commonly believed, but only in the reinstatement of funding for the three successful claimants - eight years after their funding had been removed. A timeframe and remedy that can hardly be hailed as a success.
Two years after the 2006 Ontario Human Rights Tribunal result in Hogan, in May 2008, the Ontario government announced it would voluntarily relist gender reassignment surgery. This announcement was made with the proviso that there was not a framework in place, and that this would require consultation with stakeholders prior to its actual implementation. It is commonly believed that this announcement came about as a result of the successful outcome in Hogan and the possibility of further pending cases. Community groups, such as The Trans Health Lobby Group, have also claimed that the reinstatement of funding was a result of their direct lobbying. However, what precipitated the reinstatement was the possibility of the delisting being ruled discriminatory under the Charter of Rights and Freedoms; a possibility with far reaching consequences for all of Canada. A Charter challenge was scheduled to begin two days after Ontario’s announcement that it had voluntarily relisted. The Charter challenge was averted by the voluntary relisting, yet the implementation of funding has been a time and energy consuming process filled with discussion, debate, and lobbying, with little or no results at this time, 18 months after the announcement.
Because access to documents of citizenship for transsexed people are tied to genital surgeries, access to healthcare funding equates to access to citizenship. The recent government delistings, combined with the refusal of many private insurance companies to fund surgeries, means that Canadian transsexed people already face significant barriers to equal citizenship. The removal of Gender Identity Disorder from the DSM will likely only increase those barriers.
While some trans activists argue for its removal in order to remove the stigma of mental illness from trans-ness, access to physical transition requires a diagnosis; a diagnosis that can only be differentiated by a psychiatrist. Moreover, the stigma of drastically differing from sex/gender norms will not be removed with the removal of the psychiatric diagnosis. Perhaps a better strategy, then, would be for transsexed people to align themselves with groups that are fighting to remove stigma and change our understanding of mental health and illness or disorder, as well as with groups working toward changes in the way that citizenship and identity documentation is accessed.
Psychiatry and Law: The Keys to TransCitizenship
One of the most contentious issues in trans activism is the medicalisation of being trans. Because psychiatric diagnoses are steeped in stigma, there is a desire by some activists to remove this stigma by removing trans’s relationship to psychiatry. It is this position that leads to attempts to remove Gender Identity Disorder from the DSM; a situation that has increased with the current discussions concerning DSM V.
This is an example of one of the ways in which trans activism has followed gay and lesbian activism; gay activists successfully lobbied to have homosexuality removed from the DSM in 1973, a move that was driven in large part by the position that homosexuality was not a mental illness, and, as such, was not deserving of the stigma that follows from such a diagnosis. Unfortunately, this kind of tactic tends to reinforce the stigma associated with mental illness (by using stigma as a reason to remove a diagnosis). In the case of the homosexual lobby, however, it removed a medicalized, diagnostic category from a group of people who are not in need of medical intervention or treatment because of their homosexuality.
This is, however, a point of rupture between the LGB and T communities. While people who identify as lesbian, gay, or bisexual do not require medical intervention, some trans identified people do. Not all trans identified people want or need medical intervention, but for those that do, diagnosis is the key. In order to access treatment, whether that treatment is funded by public or private insurance or paid for out of pocket, a medical diagnosis is required.
How would this diagnosis occur outside of the psychiatric model? The ‘signs’ and ‘symptoms’ of untreated Gender Identity Disorder, as well as the differential diagnoses, such as borderline personality disorder and schizophrenia, are mental not physical. The doctors best trained to make this differential diagnosis are psychiatrists, suggesting that the diagnosis of those trans-identified people requiring treatment appropriately belongs within the realm of psychiatry.
Moreover, attempts to divorce the transsexed body from discussions of madness and mental illness set the body outside of an important social context; a context that directly impacts many people’s everyday lives as well as their relationship to the state. While the pathologization of gender difference within psychiatry as madness can be traced to the mid 1800s, it is erroneous to then assume that this is the reason that today people often think of trans-identified people as crazy. The categorization of people as crazy, sick, or mad that occurs in common usage currently is, largely, a moralizing call to conform to acceptable norms, something that trans-identified people are seen as transgressing.
In May 2009, the Minister of Health in France, Roselyne Bachelot, called for the removal of transsexualism from the list of mental diseases, a call that was hailed as an historic step towards complete inclusion of transsexuals in citizenship. Many activists wrote and spoke of their hope to see similar declassifications occur around the world. The French move is instructive in that Bachelot called for the removal because transsexuals felt that being classified as having a recurring or persistent mental disorder was stigmatizing. However, the simple removal of the diagnostic category is unlikely to have a significant effect on the common perception that someone who is trans is crazy, delusional, or sick. Thus, the stigma of being trans remains, with or without the medico-legal label of recurring or persistent mental disorder.
What has been lost in the hailing of the French call as a victory is the accessibility of treatment. Insurance companies, particularly American insurance companies, which have an impact on both American insurers and Canadians with private insurance stemming from an American carrier or parent company, have been loath to provide monies for services they deem ‘elective’ treatments, and physical transition has often been caught up in this definition. Removing the diagnostic category will lead to an increase in such definitions, with a subsequent decrease in accessibility.
Funding by public healthcare has been contested and is not universally available across Canada, even though hormone treatment and gender reassignment surgery are internationally considered to be necessary and appropriate medical interventions. The medical necessity of the treatment suggests that it ought to be covered under the Canada Health Act, however without a diagnosis, questions of medical necessity will be rendered moot.
Most provincial healthcare programs across Canada deal with surgical access and funding on a case-by-case basis, with Ontario, Saskatchewan, and Newfoundland all requiring patients to be recommended for surgery by the Centre for Addictions and Mental Health in Toronto - formerly known as the Clarke Institute. Nova Scotia and Prince Edward Island do not fund surgeries of any kind for transsexed people. Manitoba and Alberta both delisted funding this year. British Columbia and Quebec cover some surgeries through their own medical networks, although the funding is extremely limited and difficult to obtain. As of 2009, no Canadian province provides funding for genital surgeries for female-to-male transsexed people. A series of surgeries that routinely cost between 40 and 150 thousand dollars; yet they all require the surgeries in order to change citizenship documentation, such as birth certificates.
Following in the footsteps of trans-identified people in Ontario 11 years earlier, there are human rights claims pending in response to the April 2009 Alberta delisting; however, the claims in Hogan v. Ontario were successful because people who had begun moving through the Clarke Institute’s very slow moving system were understood by the court to be entitled to complete the treatment they had, in good faith, entered into. When the Ontario Health Insurance Plan removed coverage for surgery, October 1st, 1998, Michelle Hogan, Martine Stonehouse, and the claimant identified as A. B. were all patients at the Clarke Institute in Toronto and had begun the process of physical transition. These three of the four claimants named in the case were successful; the fourth claimant, Andy McDonald, the sole female-to-male represented, was unsuccessful because the court ruled that as he was not a patient of the Clarke prior to the delisting of the surgery, he could not have an expectation of treatment, and therefore the delisting did not have a disproportionate adverse impact on him. McDonald’s desire for phalloplasty and the Clarke institute’s position on the surgery as “experimental” were noted in the court’s decision, and while this was not a deciding factor in his case being denied, it has been, and continues to be used as justification for the denial of genital surgeries for FTMs in a number of provinces across the country.
In Alberta, the government’s decision to delist the surgery was made with knowledge of the legal fight in Ontario, and Alberta’s claimants have a long, tough fight ahead of them. The Alberta government has attempted to derail claims by instituting a grandfather clause, thereby directly dealing with the reasoning behind the decision and remedy handed down in Hogan. The Alberta situation has also made the delisting itself much less transparent than in Ontario where the tariffs used to pay for the surgery were removed; in Alberta, it appears that the delisting has occurred through a change in the way that a policy requiring prior consent of the minister for funding is implemented, and not actually through any Orders in Council.
The similarities and differences between the two situations make it difficult to see the Alberta claims resulting in a similar remedy; as well, it is important to note that the legal remedy in Ontario resulted, not in widespread reinstatement of funding as is commonly believed, but only in the reinstatement of funding for the three successful claimants - eight years after their funding had been removed. A timeframe and remedy that can hardly be hailed as a success.
Two years after the 2006 Ontario Human Rights Tribunal result in Hogan, in May 2008, the Ontario government announced it would voluntarily relist gender reassignment surgery. This announcement was made with the proviso that there was not a framework in place, and that this would require consultation with stakeholders prior to its actual implementation. It is commonly believed that this announcement came about as a result of the successful outcome in Hogan and the possibility of further pending cases. Community groups, such as The Trans Health Lobby Group, have also claimed that the reinstatement of funding was a result of their direct lobbying. However, what precipitated the reinstatement was the possibility of the delisting being ruled discriminatory under the Charter of Rights and Freedoms; a possibility with far reaching consequences for all of Canada. A Charter challenge was scheduled to begin two days after Ontario’s announcement that it had voluntarily relisted. The Charter challenge was averted by the voluntary relisting, yet the implementation of funding has been a time and energy consuming process filled with discussion, debate, and lobbying, with little or no results at this time, 18 months after the announcement.
Because access to documents of citizenship for transsexed people are tied to genital surgeries, access to healthcare funding equates to access to citizenship. The recent government delistings, combined with the refusal of many private insurance companies to fund surgeries, means that Canadian transsexed people already face significant barriers to equal citizenship. The removal of Gender Identity Disorder from the DSM will likely only increase those barriers.
While some trans activists argue for its removal in order to remove the stigma of mental illness from trans-ness, access to physical transition requires a diagnosis; a diagnosis that can only be differentiated by a psychiatrist. Moreover, the stigma of drastically differing from sex/gender norms will not be removed with the removal of the psychiatric diagnosis. Perhaps a better strategy, then, would be for transsexed people to align themselves with groups that are fighting to remove stigma and change our understanding of mental health and illness or disorder, as well as with groups working toward changes in the way that citizenship and identity documentation is accessed.
Thursday, October 22, 2009
Dean Spade visit to U of A
Trans Politics: Beyond Law & Order
Dean Spade, Assistant Professor, School of Law, Seattle University
When: Fri, 23 October, 12pm – 1pm
Where: University of Alberta Law Centre, Room 231-23
In the wake of Bill 44 legislation and the delisting of SRS, queer and trans issues in Alberta are becoming increasingly influenced by legal discourse. But, as Dean Spade's work shows, trans politics are also done "beyond law and order" in everyday and systemic styles of racism, classism, and the many disciplinary architectures through which we learn what our bodies mean. From prisons to poverty to psychiatry to post 9/11 surveillance, Dean Spade's version of 'trans' attends to the many ways in which gender is never a simply isolated identity or mode of discrimination. Dean is currently a professor at the Seattle University School of Law. He also founded the Sylvia Rivera Law Project in NYC, which provides free legal services to trans, intersex, and gender non-conforming people who are low-income and/or people of colour. He has also taught on the subjects of sexuality, gender, and law at Columbia and Harvard.
Discussion Panel: "TRANS.assemblages: Intersectionality and Beyond"with Dean Spade, Lucas Crawford, Carol D. Allan, Lane Mandlis, and Val Napoleon
When: Fri, 23 October, 3:30pm – 5:00pm
Where: University of Alberta Humanities Centre L-2
Professor Spade's visit is sponsored by APIRG, Faculty of Law’s Equality and Respect Committee, Women's Law Forum, OUTLaw, Peace by Piece, Institute for Sexual Minority Studies and Services, Department of English & Film Studies, Faculty of Arts, and Trudeau Foundation.
Dean Spade, Assistant Professor, School of Law, Seattle University
When: Fri, 23 October, 12pm – 1pm
Where: University of Alberta Law Centre, Room 231-23
In the wake of Bill 44 legislation and the delisting of SRS, queer and trans issues in Alberta are becoming increasingly influenced by legal discourse. But, as Dean Spade's work shows, trans politics are also done "beyond law and order" in everyday and systemic styles of racism, classism, and the many disciplinary architectures through which we learn what our bodies mean. From prisons to poverty to psychiatry to post 9/11 surveillance, Dean Spade's version of 'trans' attends to the many ways in which gender is never a simply isolated identity or mode of discrimination. Dean is currently a professor at the Seattle University School of Law. He also founded the Sylvia Rivera Law Project in NYC, which provides free legal services to trans, intersex, and gender non-conforming people who are low-income and/or people of colour. He has also taught on the subjects of sexuality, gender, and law at Columbia and Harvard.
Discussion Panel: "TRANS.assemblages: Intersectionality and Beyond"with Dean Spade, Lucas Crawford, Carol D. Allan, Lane Mandlis, and Val Napoleon
When: Fri, 23 October, 3:30pm – 5:00pm
Where: University of Alberta Humanities Centre L-2
Professor Spade's visit is sponsored by APIRG, Faculty of Law’s Equality and Respect Committee, Women's Law Forum, OUTLaw, Peace by Piece, Institute for Sexual Minority Studies and Services, Department of English & Film Studies, Faculty of Arts, and Trudeau Foundation.
Tuesday, October 20, 2009
Consciousness of Right Argument
Let us further consider how the consciousness of right argument that I mentioned in the previous post functions in relation to the delisting of gender reassignment surgery in Alberta.
While today we can see with hindsight that the delisting of GRS and chiropractic were simply initial shots over the bow to see how people would react to the slashing of social programs by the Alberta government, the way in which GRS was delisted, and the dramatic response to the announcement offer an interesting and instructive example of the ways that government - in this case the Alberta government – use the consciousness of right argument to their advantage.
What exactly is the consciousness of right argument? Consciousness of right is the belief that there is a universal human understanding of right and wrong, sin and morality. When we make recourse to such an argument, it is from the belief that others will hold our universal understanding as their universal understanding as well. If my truth is a marginalized position, it is unlikely to be universally accepted. For example, if I were to hold the belief that Albertans think blue-eyed people are smarter than brown-eyed people, and because of this truth, I wish to pass a law that allows only blue eyed people to attend university, I will likely run into significant resistance. I will not be able to make a consciousness of right argument, because a large number of people (probably the majority of people) will say that I am wrong, and that brown-eyed people are as smart as blue-eyed people, or that eye colour has nothing to do with intelligence, and therefore should have nothing to do with educational opportunities. This happens because the ‘truth’ that I am using to support my position is not a generally held belief.
If I use a ‘truth’ that is generally held, then my argument will likely hold, whether or not the truth I am espousing is true or not. For example, in the nineteenth century women were not granted the same rights as men in Canada. It was a generally held belief (by men anyway) that women were incapable of making decisions for themselves, and therefore they were not allowed to vote or enter into most contracts for themselves. While the argument that women were incapable of making these decisions was fairly universally held, it was not true.
Moreover, the generally held ‘truth’ used in the consciousness of right argument is not an objective position, but is actually morally loaded. By using a morally loaded ‘truth’, the argument turns on whether punishment or reward ‘ought’ to be meted out, rather than on whether the ‘universally’ held ‘truth’ is actually true (or universal - but that is really a separate issue).
The idea that some people are deserving of healthcare while others are not is anathema to the very concept of socially funded and available healthcare. Moreover, the Canada Health Act is designed to prevent this kind of systematic abuse by enshrining funding for necessary medical procedures within law. A legal position that is designed to prevent morally loaded discussions regarding who deserves care and who does not. However, the consciousness of right argument provides a useful distraction to these legalities. By opening the debate of who is deserving of care and, by extension, who is not deserving of care, the removal of funding from some necessary medical procedures appears justified within the public consciousness, after all, from an economic/ business standpoint there is only so much money. However the justification turns on an implicit acceptance that some are more deserving, while others are less deserving, rather than on the legal and medical determination of necessity.
It is also predicated on a business model in relation to healthcare - in that there is only so much money and we must mete it out as economically and responsibly as possible. This is where the use of corporate language to discuss services enhances the slippage between understanding the provision of healthcare as a service or as a business. Services offered by the government to its citizenry are not, should not, and cannot, be considered within a business model without destroying the intended program. Healthcare as a business needs to at the minimum break even, but ideally make a profit. This requires strict cuts to expenditures and increased avenues of revenue. Healthcare as a service requires that care be paramount in the equation, with financial concerns being of little or no significance. The idea of socialized healthcare means that everyone is deserving of care by virtue of needing care. The business model works against this by suggesting that some are not worthy of care because they create too large a financial burden on the rest. Within the business model of healthcare we are so busy arguing over who is more or less deserving, that the notion of universal healthcare gets lost completely. Moreover, social service programs are designed specifically to assist those in our society who are most in need of the service; ruling some out of healthcare because we don't like them or sympathise with them works against this, serving only to further marginalise those most in need.
Consciousness of right arguments attempt to shift the justification for a lack of care to a ‘universal truth’ that those who are not deserving are not deserving because it is not ‘medically necessary’, although this is not actually a medical or legal truth. Medically, the necessity of GRS as a treatment for severe GID is well documented and supported throughout the world by medical professionals, yet some Albertans and Albertan politicians would like us to believe that they know better. It is this group that is using the consciousness of right argument; an argument that is charged with the moral attitude that transsexuality is merely a bad choice made by immoral people who do not deserve access to care. And with the business model of healthcare taking a firmer grip in the province, the consciousness of right arguments are likely to continue and be directed at many other groups as well.
Is this how you want access to healthcare to be determined?
While today we can see with hindsight that the delisting of GRS and chiropractic were simply initial shots over the bow to see how people would react to the slashing of social programs by the Alberta government, the way in which GRS was delisted, and the dramatic response to the announcement offer an interesting and instructive example of the ways that government - in this case the Alberta government – use the consciousness of right argument to their advantage.
What exactly is the consciousness of right argument? Consciousness of right is the belief that there is a universal human understanding of right and wrong, sin and morality. When we make recourse to such an argument, it is from the belief that others will hold our universal understanding as their universal understanding as well. If my truth is a marginalized position, it is unlikely to be universally accepted. For example, if I were to hold the belief that Albertans think blue-eyed people are smarter than brown-eyed people, and because of this truth, I wish to pass a law that allows only blue eyed people to attend university, I will likely run into significant resistance. I will not be able to make a consciousness of right argument, because a large number of people (probably the majority of people) will say that I am wrong, and that brown-eyed people are as smart as blue-eyed people, or that eye colour has nothing to do with intelligence, and therefore should have nothing to do with educational opportunities. This happens because the ‘truth’ that I am using to support my position is not a generally held belief.
If I use a ‘truth’ that is generally held, then my argument will likely hold, whether or not the truth I am espousing is true or not. For example, in the nineteenth century women were not granted the same rights as men in Canada. It was a generally held belief (by men anyway) that women were incapable of making decisions for themselves, and therefore they were not allowed to vote or enter into most contracts for themselves. While the argument that women were incapable of making these decisions was fairly universally held, it was not true.
Moreover, the generally held ‘truth’ used in the consciousness of right argument is not an objective position, but is actually morally loaded. By using a morally loaded ‘truth’, the argument turns on whether punishment or reward ‘ought’ to be meted out, rather than on whether the ‘universally’ held ‘truth’ is actually true (or universal - but that is really a separate issue).
The idea that some people are deserving of healthcare while others are not is anathema to the very concept of socially funded and available healthcare. Moreover, the Canada Health Act is designed to prevent this kind of systematic abuse by enshrining funding for necessary medical procedures within law. A legal position that is designed to prevent morally loaded discussions regarding who deserves care and who does not. However, the consciousness of right argument provides a useful distraction to these legalities. By opening the debate of who is deserving of care and, by extension, who is not deserving of care, the removal of funding from some necessary medical procedures appears justified within the public consciousness, after all, from an economic/ business standpoint there is only so much money. However the justification turns on an implicit acceptance that some are more deserving, while others are less deserving, rather than on the legal and medical determination of necessity.
It is also predicated on a business model in relation to healthcare - in that there is only so much money and we must mete it out as economically and responsibly as possible. This is where the use of corporate language to discuss services enhances the slippage between understanding the provision of healthcare as a service or as a business. Services offered by the government to its citizenry are not, should not, and cannot, be considered within a business model without destroying the intended program. Healthcare as a business needs to at the minimum break even, but ideally make a profit. This requires strict cuts to expenditures and increased avenues of revenue. Healthcare as a service requires that care be paramount in the equation, with financial concerns being of little or no significance. The idea of socialized healthcare means that everyone is deserving of care by virtue of needing care. The business model works against this by suggesting that some are not worthy of care because they create too large a financial burden on the rest. Within the business model of healthcare we are so busy arguing over who is more or less deserving, that the notion of universal healthcare gets lost completely. Moreover, social service programs are designed specifically to assist those in our society who are most in need of the service; ruling some out of healthcare because we don't like them or sympathise with them works against this, serving only to further marginalise those most in need.
Consciousness of right arguments attempt to shift the justification for a lack of care to a ‘universal truth’ that those who are not deserving are not deserving because it is not ‘medically necessary’, although this is not actually a medical or legal truth. Medically, the necessity of GRS as a treatment for severe GID is well documented and supported throughout the world by medical professionals, yet some Albertans and Albertan politicians would like us to believe that they know better. It is this group that is using the consciousness of right argument; an argument that is charged with the moral attitude that transsexuality is merely a bad choice made by immoral people who do not deserve access to care. And with the business model of healthcare taking a firmer grip in the province, the consciousness of right arguments are likely to continue and be directed at many other groups as well.
Is this how you want access to healthcare to be determined?
Friday, May 22, 2009
Thoughts on Sexology, Psychiatry, and Alberta
So, as I sit and read sexology and psychiatry texts from the late 1800s, I am brought to consider some of the building blocks that led to the Nazi extermination of "degenerate" individuals (the mentally incompetent, homosexuals) and “races” (Jews, Gypsies), and their striking similarity to some of the arguments used by the Alberta Tories in relation to their buget cuts. These are merely initial rambling thoughts, and I have not completed them. As I am fairly historically inept, I welcome any suggestions for revising any historical inaccuracies or nuances that might be beneficial.
When Benedict Augustin Morel (1809-1873), a french psychiatrist, publishes his theory of degeneration in 1857, he provides an explanation for the causes of insanity and social deviance. This is taken up by Richard Krafft-Ebing. According to Hubert Kennedy (1988, p. 195):
When Wilhelm I, king of Prussia was proclaimed German emperor in January 1871, the new North German penal code was implemented across the empire; a penal code that criminalized sexual behaviours between men.
When we consider that degeneration theory, as it was developed and popularized by Krafft-Ebing towards the end of the nineteenth century, produced an excellent justification for the ever-increasing anti-Semitism in Germany, and was clearly the theory on which the Nazis based their decision to murder “degenerate” individuals (the mentally incompetent, homosexuals) and “races” (Jews, Gypsies) (Kennedy, 1988), and we combine it with the justification of "consciousness of right" that was used to continue to punish behaviour the courts were willing to accept as medically pathological (problematic, but a different problem) not criminal, we see some of the major foundations from which the Nazis were able to act. We can also see the justifications that the Alberta government used to legitimate its eugenics project (as well as residential schools) as coming from similar logics: particularly that of degeneracy, but also that of the consciousness of right, in that the uninformed population has often sided with the arguments of degeneracy and its subsequent responsibilization and blaming.
While with hind-sight we can link the acceptance and proliferation of anti-Semitism (and other directed hatreds) in Germany to these theoretical turns, we must then be aware of how the theoretical foundations can be laid for the future. So when the health minister uses simplistic divide and conquer techniques, such as setting the health needs of seniors against the health needs of a smaller, more marginalized group such as transsexuals, what he is doing is appealing to the masses through a consciousness of right argument. And, when you consider much of the feedback news stories about the need for GRS received, you can see that this tactic worked. When people, like this uniformed person who posted on a facebook group, are busy arguing that:
We can see both the logic of degeneration and the logic of consciousness of right at work. He believes that transsexuals are mutilating their bodies through an inability to accept being gay; this argument is flawed on many levels, but the point of it is to argue that physical transition is degenerate behaviour. Because the behaviour is degenerate, it then makes sense to argue that the government should not pay for transition; however this is based, not on medical knowledge of transsexuality, but in the false belief that transsexuality is merely a degenerate behaviour, and as such should be morally excluded as it is "unworthy". This becomes the consciousness of right argument, as many more uniformed people jump to the same conclusion based on their lack of knowledge and moral judgement.
What should frighten us is that this is a pattern of behaviour that we have seen before. While we may believe that there was no way of foretelling the outcome of the constellation of events that led to the Nazi holocaust prior to its happening, we can now see them quite clearly. What is frightening is that we can see them happening again, possibly in smaller ways, and possibly in smaller numbers, but, hey, isn't that exactly how it all started the first time?
When Benedict Augustin Morel (1809-1873), a french psychiatrist, publishes his theory of degeneration in 1857, he provides an explanation for the causes of insanity and social deviance. This is taken up by Richard Krafft-Ebing. According to Hubert Kennedy (1988, p. 195):
The power of Morel’s degeneration theory was underscored by Annemarie Wettley, who wrote in reference to Krafft-Ebing: What essentially appears here is the coercive force that degeneration theory exercised. This is clearly distinguished precisely in Krafft-Ebing, since he possessed neither the religious-anthropological background of Morel nor the ideological-speculative one of Magnan. He quite simply took over the dogma of degeneration that had become purely formalistic and he so essentially dominated the psychiatry of his time with it, that Bumke later designated this era as the reign of the degeneracy theoretician von Krafft-Ebing. The principal significance of Krafft-Ebing, however, lies not so much in psychiatry as in sexual pathology, whose modern founder he was. (Wettley:203-204)
When Wilhelm I, king of Prussia was proclaimed German emperor in January 1871, the new North German penal code was implemented across the empire; a penal code that criminalized sexual behaviours between men.
§152 upholds the punishment set for sodomy and paederasty in the Prussian penal code (§143). For even if the omission of the penal clause can be justified from the stand point of medicine, as through many grounds taken from theories of penal law, the people’s consciousness of right judges these acts not only as vices, but rather as crimes, and the lawmakers must, in the face of this perception of right, justly hesitate to declare such actions free of punishment, which in the public opinion happily are taken as worthy of punishment.(Hirschfeld, 1914, p.963)
When we consider that degeneration theory, as it was developed and popularized by Krafft-Ebing towards the end of the nineteenth century, produced an excellent justification for the ever-increasing anti-Semitism in Germany, and was clearly the theory on which the Nazis based their decision to murder “degenerate” individuals (the mentally incompetent, homosexuals) and “races” (Jews, Gypsies) (Kennedy, 1988), and we combine it with the justification of "consciousness of right" that was used to continue to punish behaviour the courts were willing to accept as medically pathological (problematic, but a different problem) not criminal, we see some of the major foundations from which the Nazis were able to act. We can also see the justifications that the Alberta government used to legitimate its eugenics project (as well as residential schools) as coming from similar logics: particularly that of degeneracy, but also that of the consciousness of right, in that the uninformed population has often sided with the arguments of degeneracy and its subsequent responsibilization and blaming.
While with hind-sight we can link the acceptance and proliferation of anti-Semitism (and other directed hatreds) in Germany to these theoretical turns, we must then be aware of how the theoretical foundations can be laid for the future. So when the health minister uses simplistic divide and conquer techniques, such as setting the health needs of seniors against the health needs of a smaller, more marginalized group such as transsexuals, what he is doing is appealing to the masses through a consciousness of right argument. And, when you consider much of the feedback news stories about the need for GRS received, you can see that this tactic worked. When people, like this uniformed person who posted on a facebook group, are busy arguing that:
Millions of years of human evolution and now some have the ability mutilate oneself and take pills for the rest of one's life for the purpose of vanity, they will never be less than the natural way they were born, there is nothing wrong with being gay, unless you are religious, the bible frowns on such things, I find it disgusting that even a penny of tax dollars would go to medically unworthy pursuits, you are who you are, be proud in being gay, there is nothing wrong with it. Love yourselfs as you are, please do not mutilate yourselfs.(Richard Molnar, Calgary)
We can see both the logic of degeneration and the logic of consciousness of right at work. He believes that transsexuals are mutilating their bodies through an inability to accept being gay; this argument is flawed on many levels, but the point of it is to argue that physical transition is degenerate behaviour. Because the behaviour is degenerate, it then makes sense to argue that the government should not pay for transition; however this is based, not on medical knowledge of transsexuality, but in the false belief that transsexuality is merely a degenerate behaviour, and as such should be morally excluded as it is "unworthy". This becomes the consciousness of right argument, as many more uniformed people jump to the same conclusion based on their lack of knowledge and moral judgement.
What should frighten us is that this is a pattern of behaviour that we have seen before. While we may believe that there was no way of foretelling the outcome of the constellation of events that led to the Nazi holocaust prior to its happening, we can now see them quite clearly. What is frightening is that we can see them happening again, possibly in smaller ways, and possibly in smaller numbers, but, hey, isn't that exactly how it all started the first time?
In Germany, they came first for the communists. And I didn't speak up because I wasn't a communist.
And then they came for the trade unionists. And I didn't speak up because I wasn't a trade unionist.
And then they came for the Jews. And I didn't speak up because I wasn't a Jew.
And then they came for me. And by that time there was no one left to speak up.
Monday, April 13, 2009
Alberta Budget and Other Costs
In previous posts I have discussed the minimal amount of money that the projected savings of $700,000 is in relation to the larger budget. But now let's consider the economic argument that the government has made over needing to save $700,000 by delisting GRS, by considering whether this projection can be considered accurate and whether it actually is a cost-saving move.
The costs associated with untreated mental health issues, such as GID, have been documented in a number of different areas. People with untreated GID often have difficulty finding legal and gainful employment, suffer from discrimination in many forms, access other social services at a rate higher that either populations without GID or populations with treated GID, and can be victims of violent transphobic attacks. The results of these kinds of difficulties can often crop up as expenses in other lines of the provincial budget, such as: costs for judicial inquiry and incarceration due to criminal activities; costs associated with suicide deaths; costs associated with mental health services and other social service agencies and supports (such as for AISH or welfare); and the costs of investigating and following up on violent and hate-motivated attacks. These costs are representative of the possible expenses due to untreated GID and are not to be considered an exhaustive list.
The inability to find legal and gainful employment can lead people to criminal activity. Add to this the need to pay out of pocket for medical treatments ranging from $20,000 - $100,000, and the likelihood of criminal activity increases. According to the CBC in 2006 the cost of incarcerating one person in an Ontario provincial jail was $52,000. The cost to incarcerate someone in a federal corrections facility was substantially more: $110,223 to hold one male prisoner in a maximum security institution for a year, and $150,867 to house a female prisoner in a maximum security facility for a year. These costs reflect only the direct incarceration cost and do not consider the costs of police investigations, public defenders, prosecutors, and other associated policing and court costs.
According to a Canadian study published in 2000, the estimated total cost, on average, per suicide death in New Brunswick in 1996 was $849,878. Another study published in 1995 (Miller) estimated the cost of suicide by gunshot deaths per death to be over $1 million. Both of these studies used direct and indirect costs in estimating these numbers. Direct costs included: hospital services, physician services, autopsy services, police investigations, ambulance services, and funeral/cremation services. Both ambulance and funeral services are expenses that are usually passed on to the individual in Alberta, however in the case of completed suicides where there is no estate or next of kin, these expenses do become the government's responsibility. Also included are indirect costs. These include: potential years of life lost and discounted future earnings. In keeping with the government's argument that this is solely an economic decision, these figures do not take into account the human toll of loss of life, such as the value of loss of friendship or family connection, as these are not readily quantifiable based on productivity markers. Also not taken into account are the direct costs associated with mental health services for friends and family members or the loss of their productivity due to grieving the death. A further consideration that is not reflected in the numbers is the expense of child protection services in cases where the death involves the custodial parent of dependant children. Considering these costs would raise the cost of each suicide death significantly.
The costs of treatment facilities in mental health wards, as well as the cost of seeing mental health patients in emergency rooms and other facilities is a significant expense, and while it is virtually impossible to pull out the costs associated only with untreated GID, it certainly forms a portion of the overall cost of mental health treatment. According to the Alberta Mental Health Board December 2007 report, "Mental health visits to ERs take considerably longer than other health conditions" (p. 59). This means that some of the expense (in both economic terms and costs to delivery of service, such as time to treatment) of seeing patients in hospital emergency rooms can be reduced by providing more appropriate treatment methods - such as surgery for GID.
Mental health treatment costs also need to consider the costs of addictions. Addictions tend to be higher in people with untreated GD than in the overall population; a frightening consideration in relation to the Canadian Addictions Survey
(CAS) 2004 results which indicate that, compared to national averages, Alberta had higher rates of per capita alcohol consumption, high-risk drinking, and reported harms associated with drinking. So Albertans are already in need of more addictions treatment, and persons with untreated GID add to this expense.
The expense of medical care and police investigations into assaults and other forms of violent attacks and hate crimes against trans-identified people should also be considered, but there appears to be a lack of reports targeting this area.
As stated, previously, these are only a few of the costs associated with untreated GID. From an economic perspective: if one of the sixteen people who would have had surgery under the previous funding took their own life by some means other than gunshot ($849,878); and three people were incarcerated due to criminal activities placing one of them in a Corrections Canada female institution ($150,867), one in a Corrections Canada male institution ($110,223), and the third in a provincial jail ($52,000); then the expense of saving $700,000 would be $1,162,968, without taking into consideration the remaining 12 people. This without adding in the expense of increased access to mental health facilities and services, policing and judicial expenses, AISH, social assistance programs, child protection services, and inflation, to list but a few.
The number of people effected is not the issue. Whether the general population believes it is necessary or not is not the issue. What is at issue is whether the government's argument that this will save them money is in fact true. Clearly, it is not. Clearly, it will cost the provincial government (as well the federal government, municipalities, and individuals) significantly more than the 'savings'. Economically this is not a sound investment. Economically the cost overrides the 'benefit' of 'saving' this money. Let's hope that the Minister realises his mistake and corrects it before he costs the government a substantial amount more money in litigation costs and human rights complaints.
References:
Alberta Mental Health Board. (December 2007). Mental Health Needs of Alberta: Select Factors and Findings.
Miller T. (1995). Costs associated with gunshot wounds in Canada in 1991. Can Med Assoc J;153:1261S8.
The costs associated with untreated mental health issues, such as GID, have been documented in a number of different areas. People with untreated GID often have difficulty finding legal and gainful employment, suffer from discrimination in many forms, access other social services at a rate higher that either populations without GID or populations with treated GID, and can be victims of violent transphobic attacks. The results of these kinds of difficulties can often crop up as expenses in other lines of the provincial budget, such as: costs for judicial inquiry and incarceration due to criminal activities; costs associated with suicide deaths; costs associated with mental health services and other social service agencies and supports (such as for AISH or welfare); and the costs of investigating and following up on violent and hate-motivated attacks. These costs are representative of the possible expenses due to untreated GID and are not to be considered an exhaustive list.
The inability to find legal and gainful employment can lead people to criminal activity. Add to this the need to pay out of pocket for medical treatments ranging from $20,000 - $100,000, and the likelihood of criminal activity increases. According to the CBC in 2006 the cost of incarcerating one person in an Ontario provincial jail was $52,000. The cost to incarcerate someone in a federal corrections facility was substantially more: $110,223 to hold one male prisoner in a maximum security institution for a year, and $150,867 to house a female prisoner in a maximum security facility for a year. These costs reflect only the direct incarceration cost and do not consider the costs of police investigations, public defenders, prosecutors, and other associated policing and court costs.
According to a Canadian study published in 2000, the estimated total cost, on average, per suicide death in New Brunswick in 1996 was $849,878. Another study published in 1995 (Miller) estimated the cost of suicide by gunshot deaths per death to be over $1 million. Both of these studies used direct and indirect costs in estimating these numbers. Direct costs included: hospital services, physician services, autopsy services, police investigations, ambulance services, and funeral/cremation services. Both ambulance and funeral services are expenses that are usually passed on to the individual in Alberta, however in the case of completed suicides where there is no estate or next of kin, these expenses do become the government's responsibility. Also included are indirect costs. These include: potential years of life lost and discounted future earnings. In keeping with the government's argument that this is solely an economic decision, these figures do not take into account the human toll of loss of life, such as the value of loss of friendship or family connection, as these are not readily quantifiable based on productivity markers. Also not taken into account are the direct costs associated with mental health services for friends and family members or the loss of their productivity due to grieving the death. A further consideration that is not reflected in the numbers is the expense of child protection services in cases where the death involves the custodial parent of dependant children. Considering these costs would raise the cost of each suicide death significantly.
The costs of treatment facilities in mental health wards, as well as the cost of seeing mental health patients in emergency rooms and other facilities is a significant expense, and while it is virtually impossible to pull out the costs associated only with untreated GID, it certainly forms a portion of the overall cost of mental health treatment. According to the Alberta Mental Health Board December 2007 report, "Mental health visits to ERs take considerably longer than other health conditions" (p. 59). This means that some of the expense (in both economic terms and costs to delivery of service, such as time to treatment) of seeing patients in hospital emergency rooms can be reduced by providing more appropriate treatment methods - such as surgery for GID.
Mental health treatment costs also need to consider the costs of addictions. Addictions tend to be higher in people with untreated GD than in the overall population; a frightening consideration in relation to the Canadian Addictions Survey
(CAS) 2004 results which indicate that, compared to national averages, Alberta had higher rates of per capita alcohol consumption, high-risk drinking, and reported harms associated with drinking. So Albertans are already in need of more addictions treatment, and persons with untreated GID add to this expense.
The expense of medical care and police investigations into assaults and other forms of violent attacks and hate crimes against trans-identified people should also be considered, but there appears to be a lack of reports targeting this area.
As stated, previously, these are only a few of the costs associated with untreated GID. From an economic perspective: if one of the sixteen people who would have had surgery under the previous funding took their own life by some means other than gunshot ($849,878); and three people were incarcerated due to criminal activities placing one of them in a Corrections Canada female institution ($150,867), one in a Corrections Canada male institution ($110,223), and the third in a provincial jail ($52,000); then the expense of saving $700,000 would be $1,162,968, without taking into consideration the remaining 12 people. This without adding in the expense of increased access to mental health facilities and services, policing and judicial expenses, AISH, social assistance programs, child protection services, and inflation, to list but a few.
The number of people effected is not the issue. Whether the general population believes it is necessary or not is not the issue. What is at issue is whether the government's argument that this will save them money is in fact true. Clearly, it is not. Clearly, it will cost the provincial government (as well the federal government, municipalities, and individuals) significantly more than the 'savings'. Economically this is not a sound investment. Economically the cost overrides the 'benefit' of 'saving' this money. Let's hope that the Minister realises his mistake and corrects it before he costs the government a substantial amount more money in litigation costs and human rights complaints.
References:
Alberta Mental Health Board. (December 2007). Mental Health Needs of Alberta: Select Factors and Findings.
Miller T. (1995). Costs associated with gunshot wounds in Canada in 1991. Can Med Assoc J;153:1261S8.
Saturday, April 11, 2009
Alberta Budget Cuts
The Minister of Health would have Albertans believe that services need to be cut from the $12.6 billion provincial health budget in order to come up with the money to add an additional $42 million to seniors home care. To that end, the budget delisted two of the apparently 30 services that Alberta Health currently covers that the provinces are not explicitly required to fund by the Canada Health Act: chiropractic at an estimated savings of $53 million dollars and GRS at a reported savings of $700,000. Clearly, there is something wrong with either the argument or the math involved in this position.
This is a classic divide and conquer argument. It works like this, if you are in support of seniors homecare, and you are aware that we are in a recession and that the government is projecting a deficit, then you recognise that in order to increase funding for seniors something else has to be cut. Cutting funding from a small relatively obscure group of people who many people are drastically misinformed about seem like a likely target. Why? Because the way that the argument works is this: should we fund seniors who need home care, or should we fund something that many people do not understand and are afraid of? To argue for the funding of GRS can then be seen as arguing against the funding of some other group - in this case seniors - who are seen as larger and more deserving of funding.
However, this decision isn't as simple as taking the money from Peter to pay Paul. One would think that if this is entirely a financially driven decision, then of the 30 services that are not required to be funded the best choice would be to choose the ones that would save the most money. If, for some reason, the Minister wanted specifically to cut two of the 30 services, perhaps because of a longer range vision in which the plan is to cut two services a year for the next 15 years, or to cut 3 next year and four the following and so on until all 30 services are gone, then it still would make sense to cut the largest expenses first; thus saving the largest amount of money in both the short and long terms and more significantly reducing the provincial deficit. Logically then, if this is an economic decision and not an ideological one, chiropractic and GRS must be the two most expensive of the 30 services. At $700,000 projected for GRS, I find it hard to believe that this is the case. Moreover, if it is the second most expensive of the 30 services, then the cost of public outcry over the delisting of the next 28 services will definitely outweigh the economic savings of cutting them.
This, of course, is without taking into account the government's earlier move to eliminate health premiums; a move that according to the 2009 budget website will "save" Albertans and Alberta businesses $1 billion dollars. So if we cut the income to Alberta Health $1 billion, and increase Alberta Health's spending $558 million, then it makes sense to cut these two services in order to generate $53 million and $700,000? Clearly, this math does not make sense. It doesn't take an economics degree to realise that cutting $700,000 dollars has no impact on funding for seniors or anyone else outside of the group directly effected by the delisting of GRS. If the Minister's concern is solely to try to balance the budget and have spending increase by $558 million, then reinstating health premiums - garnering $1 billion - certainly is the better financial move.
All Albertans ought to be concerned by these kind of tactics. Either the Minister believes that average Albertans are not smart enough to see that his math does not add up, or else the Minister's grasp on mathematics is shockingly lacking. In either case, it seems that Albertans ought to be concerned about the decisions made by a government that is either incredibly inept or thinks of their constituents as such. As Albertans, perhaps it is time that we stopped allowing ourselves to be drawn into debates around who deserves access to care - and by extension who doesn't. All Albertans deserve access to care. We also deserve an accountable, responsible government; one that doesn't denigrate its citizens or hide ideological positions behind ridiculous, unsupportable economic decisions.
This is a classic divide and conquer argument. It works like this, if you are in support of seniors homecare, and you are aware that we are in a recession and that the government is projecting a deficit, then you recognise that in order to increase funding for seniors something else has to be cut. Cutting funding from a small relatively obscure group of people who many people are drastically misinformed about seem like a likely target. Why? Because the way that the argument works is this: should we fund seniors who need home care, or should we fund something that many people do not understand and are afraid of? To argue for the funding of GRS can then be seen as arguing against the funding of some other group - in this case seniors - who are seen as larger and more deserving of funding.
However, this decision isn't as simple as taking the money from Peter to pay Paul. One would think that if this is entirely a financially driven decision, then of the 30 services that are not required to be funded the best choice would be to choose the ones that would save the most money. If, for some reason, the Minister wanted specifically to cut two of the 30 services, perhaps because of a longer range vision in which the plan is to cut two services a year for the next 15 years, or to cut 3 next year and four the following and so on until all 30 services are gone, then it still would make sense to cut the largest expenses first; thus saving the largest amount of money in both the short and long terms and more significantly reducing the provincial deficit. Logically then, if this is an economic decision and not an ideological one, chiropractic and GRS must be the two most expensive of the 30 services. At $700,000 projected for GRS, I find it hard to believe that this is the case. Moreover, if it is the second most expensive of the 30 services, then the cost of public outcry over the delisting of the next 28 services will definitely outweigh the economic savings of cutting them.
This, of course, is without taking into account the government's earlier move to eliminate health premiums; a move that according to the 2009 budget website will "save" Albertans and Alberta businesses $1 billion dollars. So if we cut the income to Alberta Health $1 billion, and increase Alberta Health's spending $558 million, then it makes sense to cut these two services in order to generate $53 million and $700,000? Clearly, this math does not make sense. It doesn't take an economics degree to realise that cutting $700,000 dollars has no impact on funding for seniors or anyone else outside of the group directly effected by the delisting of GRS. If the Minister's concern is solely to try to balance the budget and have spending increase by $558 million, then reinstating health premiums - garnering $1 billion - certainly is the better financial move.
All Albertans ought to be concerned by these kind of tactics. Either the Minister believes that average Albertans are not smart enough to see that his math does not add up, or else the Minister's grasp on mathematics is shockingly lacking. In either case, it seems that Albertans ought to be concerned about the decisions made by a government that is either incredibly inept or thinks of their constituents as such. As Albertans, perhaps it is time that we stopped allowing ourselves to be drawn into debates around who deserves access to care - and by extension who doesn't. All Albertans deserve access to care. We also deserve an accountable, responsible government; one that doesn't denigrate its citizens or hide ideological positions behind ridiculous, unsupportable economic decisions.
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