BFP wrote this post about a conversation between herself and Jay Sennett, in which she drew some connections between being a poor woman of color on welfare, and being a transperson:
So the two of us started comparing notes and really getting into the nitty gritty of what it is like to survive and negotiate the welfare and health care industrial complexes as a poor woman of color and a white trans man.
Jay talked about how much power those who are workers for the health care industrial complex have over patients. About how a trans person can be in a bed waiting to head into surgery, and everybody from nurses to doctors get their panties in a bunch–because why does this man need a hysterectomy? About how he has had to have female friends call and set up appointments with OBGYN’s because if he calls the receptionists think that he is pranking them. (Because even those who work in an OBGYN office haven’t figured out that trans people exist and need health care too). About how trans people are forced to constantly read situations and expectations–what does this little white lady expect me to be? What will the group of coworkers who pray together at lunch time tolerate? Who does the pizza delivery guy expect will answer the door? Will the nurse who is prepping me for surgery freak out?
At the same time, as a woman of color, I have had to deal with punk just out of college social workers and family memebers who don’t *get* why it isn’t ok to wait three months to get a starving family their food stamp rations. Why it is insane that every single social agency that works to “help” the poor wants copies copies and more copies of bills, rent contracts, pay stubs, income taxes, etc. How I had to walk over eight miles in one day (from one agency to the next) just to finally be told that the agency I started at couldn’t help me because the final agency I was supposed to go to was too far to walk and not on any bus route.
Medical care for transpeople is hugely dependent on class; the extent to which any given transperson is vulnerable is a matter of the amount of money they can spend. Sorting out issues of prejudice and danger means attempting to untie that knot. (Of course, the fact that transpeople must make this huge cash outlay is pretty good proof of prejudice in general.) The complication goes both ways, of course–a transwoman is more vulnerable to poverty if she cannot sleep in a homeless shelter.
I touched on class briefly in the post that listed all the reasons my surgery would not be difficult. Here are some examples of how class has made things easier:
I am more likely to have a job that offers health benefits. Instead of explaining my medical history to a random, unconnected assortment of medical professionals professionally obligated to provide me with the bare minimum of care, I get to select and stay with one primary care physician and a small set of colleagues of hers. Even if my carrier will not pay for surgery–and virtually none do–they are a resource I can use in related ways. For example, if I travel to Maryland to obtain chest surgery and subsequently develop a hematoma the size of my fist, I can take it to my doctor. Major complications from out-of-pocket surgery probably won’t result in tens of thousands of dollars of unmitigated debt. I am also more likely to be saved from a number of small costs associated with transition–for example, my doctor probably won’t charge me for the letter I’ll use to change my legal gender, or for the letter I might use to obtain surgery.
Of course, my financial status also means that I am more likely to be in good health in general, which means that I am less likely to face nightmarish emergency-room disclosures.
I am also more likely to have both the professional/educational credentials and the financial resources needed to relocate. This means that I can move to a big friendly city, instead of staying in an arid or hostile place. My options for transition–informed-consent clinics, nearby surgeons, sliding-scale therapy, relatively friendly and educated care providers–are directly affected by my location.
I am also more likely to have access to networking resources (my HMO qualifies). The internets, for example, have saved me hundreds if not thousands of dollars.
I can afford surgery. This is huge. For some of us, it can mean the difference between passing and not passing. For others, it can mean a body that can pass as non-transsexual. It can make us employable. It can give us the right to identification that we can produce. It can resolve health problems or relieve some of the need for healthcare. The transman described above, the one whose hysterectomy was a bureaucratic impossibility, has more options than a transman or a woman who simply cannot pay for any surgical procedure.
That having been said, there is prejudice against transpeople that permeates all levels of healthcare. That HMO won’t necessarily manage your care in any friendly way. An HMO will almost certainly discriminate against you in terms of transition-related surgeries, and may well discriminate against you in other ways. There’s no reason to believe that any given ftm will feel safe disclosing to his doctor–and many in fact don’t tell their doctors that they’re transsexual, because that gets them better care.
But so much of trans vulnerability is vulnerability to exposure. In other words, our chances of getting hurt are dependent on the number of strangers who have control over and access to our private lives. I would be far more vulnerable as a transperson if I were living on the street, or in transitional housing, or in a shelter, or in a prison. The privacy we gain through wealth is the privacy of the closet, but it provides protection all the same.