Last week the Boston City Council voted to require that city health plans cover “gender dysphoria” — the condition of either not knowing what gender you are or knowing with great certainty that you are different from how you grew up. It seems like a minor thing. The new rule covers only those who actually work for the city, and a handful of folks, perhaps, really stand to benefit.
But when it comes to certain issues, it’s the principle that counts. And the councilors’ vote stands as a sharp rebuke to other state politicians who should have known better but, when it came to a tough case affecting transgender people, took the politically easy way out.
The subject of transgender identity is evolving, complicated and, for many, probably uncomfortable as well. Most of us have no recollection of becoming male or female; we were pronounced one or the other at birth, and that’s simply the way we are. But for some small portion of the population — perhaps 1 percent or less — things aren’t that easy, and their torment is intense. Rejected as oddities or freaks, they are often outcast and despairing, suffering high rates of unemployment and poverty, and far more likely to attempt suicide (41 percent versus just 1.6 percent for everyone else).
There are solutions. One is tolerance; it’s amazing what a bit of open-mindedness can accomplish. Others include psychological counseling, hormone therapy, and sex reassignment surgery. Some argue that such procedures are elective, as if they were little different from cosmetic surgery. Eventually, I think, they’ll be recognized as a basic human right. Why? It’s a simple matter of justice.
In his influential 1971 book, “A Theory of Justice,” American philosopher John Rawls proposed a thought experiment. Suppose a group of people could get to design the kind of society they want and are then to be born into that world. However, as they work on their plans, they operate under a “veil of ignorance,” not knowing how they’ll end up: white or black, male or female, rich or poor. The logic of this approach has appeal across the political spectrum. Liberals embrace the notion that such a hypothetical society would prize equality under the law. For conservatives, it would be a society that would also maximize individual freedoms, giving people the opportunity to succeed or fail on their own merits.
And if there was a chance that you could be born into what seemed to you the wrong body, what kind of world would you want? Presumably one where you wouldn’t be mocked, where you would be accepted for who you are, and where personal wealth did not dictate access to the treatment needed to become the person you thought you should be.
Which brings us to the controversial case of Michelle Kosilek. Kosilek was born as Robert in 1949 and for years — beginning as a child, according to her telling — was seeking transition to a woman. Denied that, she went underground, trying to live as a man, getting married, fathering a son, and then — in 1990 — killing her wife.
There’s no doubt about the crime and no doubt Kosilek should be imprisoned. But since her incarceration, she’s been fighting to get sex reassignment surgery. Courts have been sympathetic to her arguments. To their shame, however, the prison system and the Commonwealth of Massachusetts have been going all out to stop her. And left-leaning politicians — including Governor Deval Patrick and Senator Elizabeth Warren — have opposed Kosilek’s quest as well.
Granted, it’s hard politics. Kosilek’s in prison, after all, and doesn’t make for a sympathetic character. Voters seem outraged at the idea. Still, the state would pay for other medically necessary treatments.
Boston’s city councilors took a different course. Their legislation, proposed by newcomer Michelle Wu and veteran Ayanna Pressley, passed unanimously. Mayor Martin Walsh says he intends to sign what Wu terms “a matter of equity and of fairness.” My guess is that someday the liberals who were quick to deny Kosilek her rights will be stumbling over themselves to make amends, much as Hillary Clinton is now trying to explain away her past opposition to same-sex marriage. Boston’s politicians won’t have to make such apologies. They did the right thing.
Tom Keane can be reached at email@example.com.
Correction: An earlier version of this story misstated the first name of philosopher John Rawls.