nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
See here for more discussion.

Thursday, February 4, 2010

Don't Forget to Take Your Tax Deduction for Sex-Change Surgery

A US Tax Court has ruled that costs incurred in "sex-change operations and procedures" are tax-deductible.  The decision is an interesting one from a policy perspective, and was the product of a divided court (8-5-3).  Whatever your beliefs about sex-change procedures, the decision floats to the surface of a complex sea of rulings and regulations on sexual identity-related medical treatment.  I mention only a couple.

Critics of healthcare reform have pointed out that the disparity in costs between states comes about in part by what each state requires its insurers to cover:  to wit, in New York, a high-premium state, the insurance board requires coverage of sex-change operations.  This cost is then shared by all participants.  If you don't want to pay this cost, tough luck:  you can't get a policy from out-of-state.

By contrast with this court decision, reported here (Bloomberg, Feb 3), breast augmentation is not tax-deductible.  The distinction the court and others have made is that augmentation is an appearance issue, and having surgically created sex characteristics is not.  On the other side of this argument, I offer my personal clinical experience that for many women breast appearance is an important aspect of their identity, and potentially a serious mental health issue--the seriousness of which was a major factor in the search for surgical treatment of breast cancer that did not involve radical mastectomy.  Also, I have had gay and lesbian patients, not seeking sex-change, who don't consider themselves to be strictly attracted to the same sex, but more that they are a different-sex person in a same-sex body.  On the other hand, possibly they did not accurately apprehend their feelings and were searching for an alternative explanation.  Does this decision incentivize those individuals to re-consider their identity?

I'm treading on some very sensitive issues, and it's important to point out that I have no firm opinion one way or the other.  My clinical experience may be slanted, I'm not female, and can't hope to experience these situations.  As a policy issue, however, it's fascinating to consider the shifting boundaries and trends involved as we search for social justice in a cultural and political melange.

So, in an effort to get us to step back and not become too grim and polarized, I offer the following tax scorecard in jest:

Gonads 1, Boobs 0.

Doc D

Opinions are entirely my own

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