Though the psychiatric world recognizes and treats gender identity disorder — defined by the National Institutes of Health as a disconnect between a person's physical gender and the gender the person identifies with — that recognition hasn't translated into widespread insurance coverage for sex-change operations that some patients feel is the only solution to their turmoil. Most private insurance and Medicaid programs do not pay for the surgery, viewing it as elective; neither does Medicare.
Yet a Massachusetts judge has ordered the state to pay for sex-reassignment surgery for an imprisoned murderer.
There is little doubt that Michelle Kosilek — known as Robert in 1990, when he killed his wife after she discovered him dressing in her clothes — struggles with the disorder. After entering prison, Kosilek took hormone therapy, switched sexual identity and chose a new first name, though she is still in a men's prison serving a sentence of life without parole. According to doctors, she has attempted both self-castration and suicide because her image of her gender is so at odds with her body.
At first it might seem ridiculous for a person guilty of a heinous crime to receive taxpayer-funded surgery that is not necessary to save life or limb. But prisons do not deny psychiatric drugs to inmates who need them. Nor is it a simple matter of saving taxpayers money. Kosilek's surgery would cost only about $20,000; by contrast, if she doesn't undergo the surgery, the added cost for housing her in a men's penitentiary (she would be moved to a women's prison after surgery) would be significant over her lifetime; so would the expense of preventing further attempts at suicide or self-castration, or treating injuries sustained in those attempts.