Healthcare in the News

[jmj11]

I wanted to post two morning headliners regarding healthcare regarding unrelated topics, but each worthy of discussion.

The first is from CNN on the six fixes of healthcare and is worthy of consideration. You can access it here.

The second, a Fox News headline, is about a PA who was fired for not following her institution's guidance on using the pronoun that the patient prefers. This raises many questions worthy of a civil discussion. She states her decision is based on religious grounds. A place to start, but would quickly digress I'm afraid, is how does gender pronouns influence any religious tenant? Does an employer have the right to fire an employee over this issue? Is it also a Christian trait to be sensitive to other people? Some would say that it is woke going too far. The article is here.

[iconic]

Nothing like Christian love 

[CAAdmission]

Related to fixing healthcare, the solutions all sound great, but they are generally too simplistic for a very complex problem. Expand Medicaid? That will help, but how do you pay for it? We are trillions in debt - a number incomprehensible to the average person. Diversify medicine? That'd be great, but there is little hope of patching up deficits in a med school aged student. You'd need to promote the nuclear family as a fundamental societal good to decrease the number of broken families, and you would need to start fixing elementary and secondary education. Doing all this takes money, and you are drawing from the same pool from above that is trying to expand Medicaid. And now our defense spending is going through the roof. For healthcare cost savings, I'd have salary caps for all executives in the healthcare, pharmaceutical and insurance industries. 

Related to "pronouns," the main issue, simply, is truth. Is it kind and loving to acknowledge as real something that is a fantasy? If you had a psych patient that thought they were Napoleon, or a bear, or an airplane, how would you deal with it? If pronouns are going to cause someone discomfort, I just don't use them with that particular person. Everyone is happy, problem solved. 

[sas5814]

Expanded Medicaid just means more "free" healthcare for more people. I have seen in several socialized medicine type venues how "free" healthcare is treated. Something that has no cost has no value. Everyone except to poorest of the poor needs to have some small amount of skin in the game even if its $1 for a prescription co-pay.

The pronoun thing is making me tired. I am all about basic respect and courtesy for everyone but this has become a political football and can't be discussed in any rational way. It has become another "agree or die" issue. For someone to be fired over it just illustrates that fact. If anyone disagrees they will just be labeled some kind of "phobe".

[LKPAC]

1 hour ago, iconic said:

Nothing like Christian love 

Are you saying this sarcastically?  How does that forward the debate?

Christians are human, we are not perfect.  Before anyone starts bashing, and I'm not suggesting that anyone has yet, please remember that there are some of us Christians in this forum.

[Aunt Val]

Hi, jmj!  Thanks for bringing up some good discussion topics.

Concerning the second article, I think you're oversimplifying it a bit in your brief description of why the PA was fired.  You said that she "was fired for not following her institution's guidance on using the pronoun that the patient prefers."  But more precisely, the article says that she was fired due to asking for religious accommodation so that she would not be required to use preferred pronouns or to participate in transgender treatments; there was never any actual patient situation that happened.  It was all hypothetical.

I'm not convinced that suing an employer or former employer is the best way to go about addressing being wronged.  I'm not a fan of our sue-happy litigation system.  I guess with our current legal system sometimes there aren't a lot of other options.  But whether she should be suing or not, I think the PA does legally have a right to sue on religious grounds based on what I see in the article.

You ask, "How do gender pronouns influence any religious tenant?"  I'll take a stab at your question by saying that the seemingly superficial issue of pronouns actually touches at the heart of the existence of truth, how we determine if something is true or not, and how we apply our understanding of truth to everyday life.  Is there an absolute standard of truth outside of ourselves, or do we each determine inside ourselves what is true?  Since Christians believe that there is an absolute standard of truth that comes from God and is found written in the Bible, they (we) would say that when Bible talks about subjects like men and women it gives us true information that matters in our lives and in our interactions with others.  Since the Bible teaches that God creates people as male and female and that this is good (see the first few chapters of Genesis for starters), it means that people don't get to make up their own definitions of male or female or switch which they are.  Christians are also told not to lie or to harm other people.  Agreeing with a man that he is a woman or a woman that she is a man by using words (including pronouns) that affirm those false and unbiblical ideas would be lying.  Christians would argue that it would also be harmful.  You ask, "Is it also a Christian trait to be sensitive to other people?"  I would say that it is definitely a Christian trait to love other people, which often includes being sensitive to their feelings, but never at the expense of what is true and right and good.  So in sum, religious arguments could apply in the situation the article is talking about.

That being said, I think that someone could just as easily and logically make arguments against being forced to affirm transgender ideology and participate in transgender treatment on the basis of biology, medical science, and linguistics, even without referring to any specific religious teaching:

Biologically, there are two sexes, male and female, and it's hardwired into the DNA (genotype) and demonstrated in primary and secondary sex characteristics like genitalia (phenotype).  We all learn this in basic biology classes.  If a male person or a female person decides that he or she belongs to, or wants to belong to, the opposite sex category, that doesn't make it so biologically, even if the person attempts to alter his or her body in various ways.  It doesn't take any kind of religious argument to recognize this.  It's science.

Medically, transgender treatment is far from a settled science.  Even some pro-transgender-treatment medical providers are recognizing the risks and uncertainties in "gender-affirming care."  Requiring a medical provider to toe a political line on hot-button issues rather than ask questions and follow evidence-based medical science seems to fly in the face of "do no harm."  Isn't asking questions and seeking solid evidence how we do science?

Linguistically, the English language recognizes two sexes in its pronouns (plus the neuter "it" for inanimate objects).  Calling someone by an English pronoun that doesn't describe that person is just bad grammar.  Some other languages work differently in how they use pronouns, and that's fine.  A small group people are trying to change English by adding additional pronouns or altering long-established usage of the ones we already have, but seems like it's not catching on.

So those are my thoughts.

I would hope I wouldn't have to say this, but I'll add clarification just in case:  I don't hate transgender people.  Never have, never will.  Being a Christian, I care about them, just as I care about other people of various backgrounds and persuasions.  I saw a transgender patient today for a URI.  I confirmed the patient's current medication list (which included testosterone), evaluated the patient appropriately, recommended a course of treatment, and the patient left satisfied.  It wasn't a big deal.  If the patient had asked me for a refill testosterone rx in addition to getting help with a stuffy nose, I would have politely declined.  If the patient wanted to know why, I would have said "That's not a treatment that I provide, but I'm glad that I could help you with your congestion today."  Then if the patient wanted more details I would have respectfully explained further.

[LKPAC]

Aunt Val, thank you for a well-written and thoughtful post.  I hope you don't mind if I print this out and share it with colleagues.

 

[iconic]

3 hours ago, CAAdmission said:

 

Related to "pronouns," the main issue, simply, is truth. Is it kind and loving to acknowledge as real something that is a fantasy? If you had a psych patient that thought they were Napoleon, or a bear, or an airplane, how would you deal with it? If pronouns are going to cause someone discomfort, I just don't use them with that particular person. Everyone is happy, problem solved. 

This is in-fact transphobic. Not using pronouns that the patient prefers as well as comparing it to delusions of grandeur. Quite frankly, someone's gender identity is not for you to understand and is not the scope of this discussion 

[CAAdmission]

10 minutes ago, iconic said:

This is in-fact transphobic. Not using pronouns that the patient prefers as well as comparing it to delusions of grandeur. Quite frankly, someone's gender identity is not for you to understand and is not the scope of this discussion 

That's not quite true. There is no demand in the English language that requires the use of a pronoun unless a patient is trying to force an issue. A pronoun is always a substitute for another word which is perfectly valid to use.

I don't care if John thinks John is a he, a she, or a xim or xir. John's just John and no feeling are hurt. Happily when I am speaking directly with John, I can use "you" which also covers people that think they are somehow a "they."

What is the "scope of the discussion?" The degree to which a person gets to define their own identity?

[jmj11]

I will throw out some comments to contribute to the discussion, but my opinions are not wrapped in a hard core certainity, but more of a curiosity as to finding the best course and to hear what others think.

Regarding expanding Medicaid, one important question for a society is healthcare a basic human right? Should the rich in a society enjoy better healthcare and a longer life than those who, for a variety of reasons, do not have access to good healthcare? Much of the developed world seems to see healthcare as a basic human right, along with food and water. Regarding the cost, it is all about priorities. What are we willing to pay for go into debt for.

Regarding the second issue, I will start by saying I'm sorry if I oversimplified the introduction, but I was just giving a thumbnail introduction to the article. Yes, it was more complicated than that. I don't want to digress into a religious argument as within Christendom, there is not a monolithic opinion on the issue of gender identity and it is not simply a division between those of us who philosophically, believe in absolute truth and those who do not. Let me play devil's advocate and ask a further question. I will admit that I had very limited interaction with transgender patients and socially, I've had and have a few friends, and friends of my kids, who would be dealing with those issues, but that is limited and I have not done any type of exhaustive research.

It is one thing for someone to say, "I am a man. I have a penis." when in reality they have a vagina. That would be the delusional aspect that some have suggested. It is another thing for someone to say, "I was born with a female body, but I have felt like a male since I was a kid and that feeling is intense. So much so, that my life would be devoid of meaning if I had to continue identifying as a female. No, I don't have a penis, but I wish I did." The transgender people I've met, were in the latter category. They would deny it was simply a personal choice, such as waking up one day and saying, "Hmm. I think I want to be male today."

I really want to avoid a religious argument as those tend to digress, like political arguments, very rapidly. Again, I hope you don't take what I'm about to say in an offensive way as it is not meant that way, but I just wanted to further the logic.

Personally, I spent almost thirty years in the evangelical world, I am a Christian, but no longer relate to that subculture. When I was an evangelical (more than 30 years ago) we viewed homosexuality the same way, a simple choice of sin, rebellion against God. But then something happened to me. I began having homosexual friends. Many of them. I heard their stories of how hard they struggled to be hetrosexual becuse their lives would have been so much easier if they were, but something intense was going on that was far beyond a simple choice. I am now hearing the same type of stories from the few transgender folks I know. I would use the pronoun that they prefer out of respect for them as human beings and my love of them. If they came into my clinic and said, I have a lesion on my penis, and they pulled down their pants and they had a vagina, I would not confirm that delusion. But this is about people who say their souls are one gender but their bodies is another. That is different than delusion. The absolute truth in this situation is that something real is going on with them. I don't know the research and one could do the nature vs nurture discussion, but it appears to be nature as they describe siblings with "correct" gender identification, raised in the same households, and the fact this problem with gender identity started so early.

The Genesis story of creation was a simple statement of history, and I don't see it as a book of law. If it were, it would add, "God created you either male or female and if you try to change that, you are evil."

So in summary, when I saw patients who prefered to be addressed in a pronoun that was different than their X-Y chromosomes, of course I would do as they wanted. Because I cared about them and the absolute truth of the matter, wasn't me confirming a delusion, but confirming a reality of something they were dealing with in their personal lives. But the bottom line I want to make to the Christian argument or the absolute truth argument, is that there is not one size fits all in the opinions. I respect yours having held the same view years ago.

 

[CAAdmission]

There's a discussion similar to this over in the political thread area. I'll pose the same question here that I posed over there. 

What's the difference between someone who wishes to undergo surgery to conform to the gender they identify with, and someone who wishes to undergo surgery to conform to a handicap they identify with?

https://www.tandfonline.com/doi/full/10.1080/15265160802588194

There are healthy people out these looking for a surgeon to transect their spinal cord. Is this ok? Why or why not?

[sas5814]

1 hour ago, iconic said:

This is in-fact transphobic

and this is exactly what I was referencing. You may disagree with her belief and her premise but there was nothing phobic about it. There was nothing malicious about it. Trying to stamp it with a politically charged word that implies hate or fear does exactly what I was talking about.....agree or die.

Edited October 19, 2022 by sas5814
added words for clarity.

[rev ronin]

22 minutes ago, jmj11 said:

But this is about people who say their souls are one gender but their bodies is another.

This is a religious perspective, not a scientific perspective.

First, gender as a novel linguistic concept has no objective reality. It's particularly problematic in that gender expression varies from culture to culture, so that what might appear to be behavior consistent with one gender in one context is attributed to the other gender (assuming a gender binary, of course) in other contexts.

From a scientific standpoint, sex chromosomes are XX or XY, and those with other sex chromosome patterns have a number of problems including almost universally being unable to reproduce. XX or XY work. XXY, XYY, etc. do not optimally function for human thriving and reproduction, and are properly characterized as genetic disorders because of that.  Doesn't mean the people who have them are any less worthwhile as human beings in whatever non-utilitarian belief system you hold, but it does mean they cannot easily do what XX or XY folks can.

Now, using that chromosomal reality, a human being is constructed, with parental genetic material, gestational influences, and postpartum influences. From a scientific standpoint, a person's sense of self is a biochemical program (software) running on a brain that's built from cells, and their subsequent phenotypical expressions, that are affected by all those factors but built on an XX or XY sex chromosome pattern. Again, from a purely scientific standpoint, there is no such thing as 'mind' divorced from the underlying 'brain'--to think otherwise is to assert a supernatural view of selfhood.

So if an XX brain thinks it would be better off with XY secondary sex characteristics, that's a problem. We're all agreed that it is. We're not agreed on what causes it--I'm sure most people who think they know for certain what does are at least partially wrong--or how to remedy it.

And, since we're not agreed on what to do about it, there can be disagreements about whether the secondary sex characteristics should be modified to match the sense of self, or whether the sense of self should be conformed to the exiting sex characteristics. Various people react with horror to one or the other of these options, and much talking past each other ensues.

Scientific inquiry supports setting up an RCT. Can't be placebo controlled or blinded, obviously, but we don't even have this level of prospective inquiry on the books yet. Some object to the entire idea, saying we don't RCT parachutes. This is true, but there is no reasonable quality evidence that shows long-term improvement in mental health distress or suicidality of the affected individuals for transition-affirming interventions.  The evidence from the prior gold standard in pediatric gender dysphoria, watchful waiting, yielded 85+% desistence with puberty, and many of the formerly gender dysphoric youth ended up as same-sex attracted teens and adults.

[rev ronin]

56 minutes ago, jmj11 said:

Regarding expanding Medicaid, one important question for a society is healthcare a basic human right? Should the rich in a society enjoy better healthcare and a longer life than those who, for a variety of reasons, do not have access to good healthcare? Much of the developed world seems to see healthcare as a basic human right, along with food and water. Regarding the cost, it is all about priorities. What are we willing to pay for go into debt for.

Medicaid should not be equated to a human right to healthcare. If healthcare were believed to be a human right, Medicaid would be outlawed. Medicaid is terrible, and I have yet to have anyone seriously disagree with me when I label it "coverage without care." Most specialists do not take medicaid--heck, most everyone who runs the numbers won't take medicaid, because for most practices, it's barely more profitable to have a medicaid patient than to simply close the business for that period of time. I have heard that an X-ray for a medicaid patient gets the radiology practice $5 in reimbursement. After check in, tech time, processing, reading, and billing, does anyone seriously believe the radiology practice makes even a dime on that?  Certainly not any practice that doesn't have brutally impersonal economy of scale.

Yes, people should have the ability to access good healthcare. Medicaid isn't good healthcare.

 

[iconic]

23 minutes ago, sas5814 said:

and this is exactly what I was referencing. You may disagree with her belief and her premise but there was nothing phobic about it. There was nothing malicious about it. Trying to stamp it with a politically charged word that implies hate or fear does exactly what I was talking about.....agree or die.

calling someone's identification with a different gender from their biological sex DELUSIONAL is transphobic as well as refusing to honor someones pronouns or preferred name. This is very black and white. You can think whatever you want about it. As I said someone's gender identity is not for you or for me to understand, but it is transphobic to misgender those patients and imply that they are delusional. If you want to get technical someone may in fact suffer a delusional disorder which may-include a psychotic belief about one's gender, this does not at all apply to the vast majority of transgender patients 

Edited October 19, 2022 by iconic

[rev ronin]

Regarding the other portions, I have some briefer thoughts:

1) Nurses. Nurses rock. The fact that the NP profession is siphoning away all the best and brightest nurses, along with a number of "direct entry" NPs is terrible for the profession. The fact that new NPs make less money than experienced floor RNs in in-demand specialties suggests we have our nursing workforce upside-down. We need a better-conforming pyramid (CNA/LPN/RN/NP) of nursing labor accessible throughout inpatient and outpatient healthcare settings.

2) Diversity. Heck yes we need practitioners who relate to their patients' experiences! Unfortunately, we can't really fix diversity in healthcare without fixing the underlying social settings and issues, as has been alluded to above.  The fact is, there are few "diverse" candidates, they can pick where they want to go, and healthcare isn't an ideal place, what with burnout, etc. You're seeing a lot of children of immigrant families who instill a belief in healthcare as valuable choose healthcare careers. That's great for color diversity sometimes, but a first generation Senegalese immigrant doesn't necessarily share that much with a Black child who grew up in inner city Atlanta, Detroit, etc.

As many of you know, I worked as a manager in a Fortune 100 tech company for about half a decade. During that time, I watched diversity issues have waaaaay more than a thumb on a scale. To this day, I respect all the people involved, and I still deal with what I now know to be moral injury over how I was, as a people manager, forced to treat people differently on the basis of protected class characteristics, and never once to benefit a white or Asian employee.

3) Trust in science.  Again, heck yes! Mask mandates and vaccine mandates for children and adults were akin to the old saw about the drunk looking for his car keys under the lamp post down the street from where he had dropped them because the light was better.  Most public health employees should be fired, because working in public health attracts people who are OK with controlling other people's lives for the greater good, without recognizing that self determination is itself a good.

Let me be clear: Vaccines are a GREAT THING. mRNA vaccines are a GREAT THING, an incredible success over a blazing fast timeline. Vaccine mandates are terrible, and in the long run will prove to have killed several orders of magnitude more people than were saved from Covid. Public health dweebs don't get America's endemic oppositional defiant disorder. It's part of our libertarian streak on both left and right, and it goes "If it were actually good, you wouldn't have to try to force me to get it."

Cloth masks never did anything in the one real-world cluster trial in Bangladesh. So why did we ever request, let alone demand, them? Public health theater. Three words that, in my mind, get to the heart of the drop in trust of science.

[rev ronin]

22 minutes ago, iconic said:

calling someone's identification with a different gender from their biological sex DELUSIONAL is transphobic as well as refusing to honor someones pronouns or preferred name. This is very black and white. You can think whatever you want about it. As I said someone's gender identity is not for you or for me to understand, but it is transphobic to misgender those patients and imply that they are delusional.

Delusional... you keep using that word. I do not think it means what you think it means.

In all seriousness, how does calling a transgender-identifying individual by biologically appropriate pronouns cause harm? Sure, using a non-preferred pronoun might be disrespectful, but is it harmful? As good volunteer firefighters are prone to do, we teased one of our number incessantly after he'd wished a Merry Christmas to an obviously Jewish patient (well, or someone who decorated their house with Stars of David for some other reason...) on the way out the door. The guy was his own biggest critic, because he realized his cultural default had been disrespectful to the person he to whom had been trying to wish peace and seasonal joy.

If you're suggesting that, a la Somewhere in Time, that if a transgender-identifying  individual could just thoroughly convince themselves that they are their desired sex rather than their underlying biological sex that it would solve all their problems, and that the rest of society's failure to conform to their desired reality is preventing that... I'd like to see a demonstration that that's actually possible and beneficial, before we discuss whether impairing others' expression to support it is even feasible.

Of course, the entire presupposition that pronoun usage should reflect gender identity rather than biological sex is a non-inclusive approach to language: Everyone believes in sex (well, almost everyone), but not everyone believes in gender identities. Why are we preferring language usage that necessarily excludes many cultures' beliefs?

[Emdecc]

50 minutes ago, iconic said:

calling someone's identification with a different gender from their biological sex DELUSIONAL is transphobic as well as refusing to honor someones pronouns or preferred name. 

Boosting this! The distinction between sex (objective, biological) and gender (a personal identifier, subjective to the individual) is clear and generally agreed upon. It is quite easy to refer to someone by their preferred pronouns while still accounting for their biological sex in your treatment plan. Better yet, if you can't seem to manage respecting someone's gender identity you can always just use their name. Linguistically, pronouns can always be replaced with someone's name. I recommend trying this next time you feel inclined to misgender someone.

Edited October 19, 2022 by Emdecc

[iconic]

8 minutes ago, rev ronin said:

Delusional... you keep using that word. I do not think it means what you think it means.

In all seriousness, how does calling a transgender-identifying individual by biologically appropriate pronouns cause harm? Sure, using a non-preferred pronoun might be disrespectful, but is it harmful? As good volunteer firefighters are prone to do, we teased one of our number incessantly after he'd wished a Merry Christmas to an obviously Jewish patient (well, or someone who decorated their house with Stars of David for some other reason...) on the way out the door. The guy was his own biggest critic, because he realized his cultural default had been disrespectful to the person he to whom had been trying to wish peace and seasonal joy.

If you're suggesting that, a la Somewhere in Time, that if a transgender-identifying  individual could just thoroughly convince themselves that they are their desired sex rather than their underlying biological sex that it would solve all their problems, and that the rest of society's failure to conform to their desired reality is preventing that... I'd like to see a demonstration that that's actually possible and beneficial, before we discuss whether impairing others' expression to support it is even feasible.

Of course, the entire presupposition that pronoun usage should reflect gender identity rather than biological sex is a non-inclusive approach to language: Everyone believes in sex (well, almost everyone), but not everyone believes in gender identities. Why are we preferring language usage that necessarily excludes many cultures' beliefs?

I use delusional in a clinical sense. Delusional is a clinical term that can be part of presentation in psychosis. If you are interested in caring for the gender-nonconforming individuals, I suggest you familiarize yourself with WPATH guidelines 

[sas5814]

2 hours ago, iconic said:

This is in-fact transphobic. Not using pronouns that the patient prefers as well as comparing it to delusions of grandeur. Quite frankly, someone's gender identity is not for you to understand and is not the scope of this discussion 

trans·pho·bi·a

 

NOUN

1. dislike of or prejudice against transgender or transsexual people:

    

    

   You can disagree with her premise. You can think she is wrong headed or even just stupid if you choose. Nothing in what she said indicated hatred, dislike or prejudice. Her words indicated just the opposite. It just angers you that she doesn't share your truth so you attack with a hot button weaponized word. It doesn't fortify your argument.

    

   Make you arguments thoughtfully. Deconstruct hers. Have an actual discussion instead of a shouting match across a picket line. Nobody's mind was ever changed by anger and name calling.

[rev ronin]

17 minutes ago, iconic said:

I use delusional in a clinical sense. Delusional is a clinical term that can be part of presentation in psychosis. If you are interested in caring for the gender-nonconforming individuals, I suggest you familiarize yourself with WPATH guidelines 

Sorry, but WPATH guidelines are based on a "very low certainty" level of evidence at best. If I'm interested in caring for individuals with gender dysphoria, why on earth would I want to consult guidelines based on low quality evidence? My concern is doubled when we're talking about children, doubled again when we're talking about irrevocable hormonal or surgical interventions.

(https://www.tandfonline.com/doi/full/10.1080/0092623X.2022.2046221)

(and I treat individuals with gender dysphoria on a regular, currently weekly, basis, and have been doing so for years. Many of them have eating disorders.)

[jmj11]

2 hours ago, CAAdmission said:

There's a discussion similar to this over in the political thread area. I'll pose the same question here that I posed over there. 

What's the difference between someone who wishes to undergo surgery to conform to the gender they identify with, and someone who wishes to undergo surgery to conform to a handicap they identify with?

https://www.tandfonline.com/doi/full/10.1080/15265160802588194

There are healthy people out these looking for a surgeon to transect their spinal cord. Is this ok? Why or why not?

Exactly. I have a friend born with a form of spina bifida who has spent her entire life working to be a "normal" bipedal person. This meant a lot of surgery, orthotics, bracing, a ton of PT and hard work. She can now walk with a crutch. Did God create her to be a wheelchair bound woman for her entire life and now she has disobeyed her intent? I don't think anyone would argue that.

[jmj11]

1 hour ago, rev ronin said:

Medicaid should not be equated to a human right to healthcare. If healthcare were believed to be a human right, Medicaid would be outlawed. Medicaid is terrible, and I have yet to have anyone seriously disagree with me when I label it "coverage without care." Most specialists do not take medicaid--heck, most everyone who runs the numbers won't take medicaid, because for most practices, it's barely more profitable to have a medicaid patient than to simply close the business for that period of time. I have heard that an X-ray for a medicaid patient gets the radiology practice $5 in reimbursement. After check in, tech time, processing, reading, and billing, does anyone seriously believe the radiology practice makes even a dime on that?  Certainly not any practice that doesn't have brutally impersonal economy of scale.

Yes, people should have the ability to access good healthcare. Medicaid isn't good healthcare.

 

I accept your argument. Medicaid is not ideal, only better than nothing. I think we could do better as a society. My European friends love their national care.

[CAAdmission]

3 hours ago, jmj11 said:

Should the rich in a society enjoy better healthcare and a longer life than those who, for a variety of reasons, do not have access to good healthcare?

They always will, in every society. Democratic, commie, dictatorship, you name it. They will also driver nicer cars and live in nicer houses. This is why most people aspire to make more money. It's just the way the world works. 

 

1 hour ago, jmj11 said:

Exactly. I have a friend born with a form of spina bifida who has spent her entire life working to be a "normal" bipedal person. This meant a lot of surgery, orthotics, bracing, a ton of PT and hard work. She can now walk with a crutch. Did God create her to be a wheelchair bound woman for her entire life and now she has disobeyed her intent? I don't think anyone would argue that.

That article argues the opposite case. As an example, what would you say to a healthy, able bodied person who identifies as having spina bifida and wants a surgical procedure to induce paraplegia?

[CAAdmission]

2 hours ago, Emdecc said:

Better yet, if you can't seem to manage respecting someone's gender identity you can always just use their name. Linguistically, pronouns can always be replaced with someone's name. I recommend trying this next time you feel inclined to misgender someone.

This is precisely what I suggested above, but it was labeled as being "transphobic."