It's more than a feeling, it's a thorough psychiatric assessment. If they did pay for it on their own everyone will pay for post-operative care anyway. And If you're going to deny them treatment then why even bother offering them a diagnosis? Our system will fund an evaluation of just about any medical issue but stop short of actually treating some people.
First off, I don't want it to be interpreted that i am marginalizing transgendered folks, that is not my intent. However, the very same psychiatrist that analyses the GSR candidate can see an overweight woman who claims that there is a beautiful thin woman screaming to get out. The fact is, the existing system is for medically necessary procedures. GSR surgery is not considered medically necessary.. You can't point to a broken knee, a cancerous tumour or a ruptured spleen. Regardless of the psychiatrist's diagnosis, it is still an ailment that exists in the mind of the patient.
You have mentioned that GSR surgeries are being denied to those that want it... Nothing is farther from the truth. The procedure is available to anyone that wants it.. All they have to do is pony-up the cash... For someone (ie GSR recipient) that sees this as life-or-death situation, I am absolutely floored by the notion that they don't see it as important enough to pay their own way.
In terms of the overlap between public and private servives, i fully agree and would suggest that as the healthcare system experiences further economic stresses, you may see those services vanish entirely. Regardless, the example of GSR also exemplifies the current circumstance and would likely do so even if the patient had to foot the bill themselves.
As for GRS candidates, they apparently are at high risk of suicide attempts. Is it a better use of taxpayer money to have them in and out ER's?
To start, there is no certainity that the GSR surgery will 'solve' the patients problem. In reading various articles about this (it's been in the news lately), there have been frequent reference to the notion that there is a reasonably high chance that the GSR recipient won't necessarily believe (after tthe fact) that the surgery successfully addressed their psycological issues.
The suicde issue is obviously a heart-wrenching circumstance, however, transgender persons do not have a lock on suicidal tendencies. To employ your logic in that realm, you have made the case that anyone with an individual and subjective psycological issue should receive surgery...
If those that absolutely believe that they need GSR surgery believe it, the issue of gvt paying would be far down on the list on importance and they would either work for a period of time to get the $$ together (the lobby suggests that the surgery is about 35K - that is not 100's of thousands) or seek the help from friends or family.
Sorry, but it is a hard pill to swallow in believing that it is extremely important to them, but not pressing enough to come up with the money.