Joseph Backholm is senior fellow for Biblical worldview and strategic engagement at the Family Research Council. This article appeared in WORLD Magazine on May 13, 2024.
Judges push to make states pay for transgender surgery
In an historic decision, the 4th U.S. Circuit Court of Appeals became the first appellate court to say states must pay for so-called transgender health care including sex “reassignment” surgeries and hormones. The case was a consolidation of two lawsuits, one from West Virginia and another from North Carolina. The 4th Circuit was once considered a more conservative court, but now has a majority eight justices appointed by Democratic presidents. Those eight justices joined to form the majority opinion in the case.
A central question involved the efficacy of cross-sex hormones and plastic surgery. North Carolina argued their decision not to fund these interventions was due, at least in part, to the fact they do not solve the mental distress patients cite as complaint. That argument is hardly on the fringe these days and is arguably becoming a consensus globally.
Just weeks ago, the National Health Service in the United Kingdom announced it would no longer prescribe puberty blockers as a way of treating gender dysphoria. It made the decision after commissioning a study that found “gaps in evidence” around the benefits of the drugs. Now puberty blockers in the United Kingdom can only be used in studies to find out if they are helpful, not under the assumption that they are. A year ago, Sweden, the first country to legalize gender reassignment surgery, also restricted so-called gender reassignment hormone treatments on minors, citing a lack of evidence the treatments benefit patients.
In light of these relatively recent developments, it is almost disorienting to see the majority in the 4th Circuit say: “Without evidence to show that gender-dysphoria treatments are ineffective, the North Carolina Appellants cannot show that the coverage exclusion is narrowly tailored to serve the state’s substantial interest in not covering medically ineffective treatment.” Without evidence? The whole world is talking about the lack of evidence to show these medical interventions are helpful, and much of the world is acting on it.
This case is part of a pattern that has developed over the past 20 years to involve everyone around you in your personal pursuit of happiness, whether they like it or not.
Having chosen ignorance, the court therefore concluded the state’s decision to provide mastectomies for women with breast cancer but not for women who want to look more like men is illegal, class-based discrimination. In a world where “I want it” is the only justification we require for anything, we see no difference between removing a body part infected with cancer and removing a healthy body part. Reason has been replaced by desire.
But there’s something else going on as well. This case is part of a pattern that has developed over the past 20 years to involve everyone around you in your personal pursuit of happiness, whether they like it or not. People don’t merely believe they have a right to an abortion, they believe they have a right to a taxpayer-funded abortion. And if you’re a doctor, they believe they have a right to make you perform the abortion. They don’t merely believe they have a right to a same-sex wedding, they believe they have a right to make you decorate it. They don’t merely believe they have the right to have children, they believe you should pay the costs of in vitro fertilization and surrogacy if they’re in a relationship incapable of producing children. Now, they don’t merely believe they have the right to cut off the genitals of children and put children on a lifetime supply of hormones, they intend you to pay for it. Their rights, your problem.
This case is certain to be appealed to the U.S. Supreme Court, and there’s reason to believe the outcome will change. Still, we need to understand the state of mind we’re being governed by. Much of the ruling class believes “the science” is settled about nearly everything. They are convinced there is nothing left to learn, so there is no need to think critically or deliberate, and they definitely do not want to know what you think. There’s no time for any of that because a revolution is on. All they want is your submission—and your money.
