OLYMPIA -- At a time when lawmakers struggled to find money for health care for the state's most vulnerable people, Washington taxpayers footed the bill for a sex-change operation, penile implants, breast augmentation and ear piercings.
In his most recent review of state Medicaid expenses, Auditor Brian Sonntag found thousands of questionable expenditures in the 2004 fiscal year. One in particular jumped off the page.
Medicaid paid $9,549.92 to surgically transform a woman into a man.
"You pick up the paper or watch the evening news and you see senior citizens who can't get medications of diabetes and things," Sonntag said. "And here you see tax dollars being used for things like this, it makes you ask, 'Why?' "
Previously unreleased details from last year's audit question the necessity of several other procedures the state subsidized.
The documents show the state spent at least $3,500 to insert and repair penile implants, $40,000 on plastic and cosmetic surgery and more than $100,000 on unauthorized breast implants and augmentation.
Two people had their ears pierced at a total cost of $210, according to the report.
According to the state's medical director it is all about how you define the term "medically necessary:"
State Medicaid Director Doug Porter said the department takes issue with Sonntag's conclusion that the procedures were unallowable expenses.
"The debate would be whether or not they were medically necessary," Porter said. "And medical necessity is a term that is, as we speak, is undergoing revision. ... There are many things that we have traditionally paid for that were deemed medically necessary that we are calling into question on a more frequent basis."
But a sex-change operation still could be covered by Medicaid.
"Gender dysphoria is the diagnosis, the treatment for which is gender reassignment," Porter said. "Some physician has determined that it's a man who really should be a woman and they are suffering psychological effects of this condition, and the only correction to restore them to a higher function is a sexual reassignment."
Sounds like a stretch to me.
Big-government types will say that the program simply needs better oversight, but I don't think that's true. There's always going to be this debate between what sorts of health procedures and care are necessary and which aren't. That's why government needs to get out of the health care business altogether, not plunge itself further in. Taking government out of the equation means that decisions about what is and is not necessary care are left between the parient and the doctor.
And that's the way it should be.