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EDIT: Reassigning for a purpose

If a teenage girl wanted a nose job or a moderately overweight man sought liposuction, chances are their healthcare providers would tell them they’re on their own. However, a new proposal suggests that gender reassignment surgery, which like cosmetic surgery, is often regarded as a personal choice, is medically urgent enough to be covered by health insurance.

Boston City Councilors Michelle Wu and Ayanna Pressley, with support from Mayor Martin Walsh, filed a proposal Monday stipulating that transgender city employees should be provided access to gender reassignment surgery under their healthcare coverage. In order to ensure all city workers receive this form of care, the ordinance maintains that the city would be banned from contracting with healthcare companies who refused to provide such benefits.

In a Monday press release, Wu said this healthcare provision would ensure a more productive city.

“The City of Boston should set the standard as being an inclusive workplace to attract the most talented and committed employees,” she said. “The goal of this ordinance is to ensure comprehensive healthcare coverage for all municipal employees, regardless of gender identity or expression. It’s the best economic policy and the right thing to do.”

The plan would include the surgery itself, hormone therapy and mental health services throughout the reassignment process in order to provide aid to city workers suffering from Gender Dysphoria, a mental health disorder that classifies people whose physical gender conflicts with their mental one.

The cost of this addition to the city healthcare plan has not yet been disclosed, but evidence from other cities with these services, such as Portland, Ore., and San Francisco, suggests it would be minimal. However, the fact that the city is encouraging health coverage for what many people regard as an extreme form of plastic surgery calls into question the true medical necessity of these operations.

Although transgender individuals might not be in grave physical danger from the ailments of Gender Dysphoria, the mental implications of this disorder are no joke. The National Library of Medicine cites depression, anxiety and the threat of suicide as associated complications. Some people cannot leave their house if they feel fat that day, so one can imagine how difficult daily life must be if someone feels like a man in a woman’s body or vice versa.

Still, if this is something the city councilors want the community to be on board with, they need to be more open about where the money is coming from — and how much of it. Yes, Boston is a fairly liberal city with a resident majority that probably is not opposed to gender reassignment surgery, but it is plausible that some people may be opposed to funding an operation that seems more like a personal choice than a medical need. After all, the money might be coming from their taxes.

Private employers in and around Boston have already added gender reassignment provisions to their healthcare plans, including Emerson University, Tufts University and Boston University. When BU began offering gender reassignment surgery in its employee health insurance back in November, faculty in the Women’s Gender & Sexuality Studies program applauded the decision as a push to maximize the productivity and happiness of all employees.

“It is incredibly forward-thinking and smart for insurance to cover gender-affirmation surgery,” said Elizabeth Boskey, a lecturer in the WGS program, in a November interview with The Daily Free Press. “People who are able to affirm their gender as they choose, whether that’s medically or not, are happier and mentally healthier and are also more productive employees.”

Even with healthcare providing the cost, undergoing gender-reassignment surgery is a long and arduous process that can take years to be fully successful. And it’s not as if everyone who is transgender decides to undergo these operations. In five years of providing healthcare coverage to its city workers, San Francisco saw about 7 gender reassignment surgery requests from its city workers.

Someone willing to undergo the emotional and physical implications of this transition must really be willing to fight for it. With so few people taking advantage of the provision, it is likely only the most serious and affected transsexuals would apply for the operation.

There’s no denying that a city filled with satisfied workers results in a more productive community. All human beings deserve to be happy in their own skin, and if the small margin of city employees who could benefit from gender-reassignment surgery — and at a supposedly slim cost — would make a better Boston, then all residents would reap the rewards.

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