Look, there's always going to be somebody deciding what procedures are provided to which people. This will involve politics to some extent. But, ya know', it'd be cool if doctors had some say.
Anyhow, exhibit A:
Folks over at Feministe were discussing birth certificates for transsexual people. In the comments, someone (lets call him piny) pointed out that the cost of transsexual-related medicine (I hate that way of putting it, because it relegates some medical procedures to queer world, while normalizing others) should be irrelevant to whether insurers actually pay for it. And he's right, of course. Insurers have made the same arguments with regard to mental health and autism, although recent legislation has gotten insured people closer to parity in coverage for mental illness.
Anyhow, lots of nastiness occurs when we suddenly decide that it's too expensive to care for some things. In the case of hormone replacement therapy for trans people, there's a nifty, unregulated black market (which isn't a completely bad thing, but could be better), and a handful of doctors that cater to affluent clients (who, surprisingly enough, will do what ever it takes to get healthcare, and actually have the means to do so). Certainly, there is a middle ground of affordable, competent providers, but they're thin on the ground. Without health insurance coverage, they likely always will be.
This brings me to my thoughts on abortion and charity. Between politics and insurance, reproductive medicine isn't as accessible as it should be-- not unlike medical care for trans people. Faced with medical bills myself, I've always wondered about holding a telethon. Unfortunately, charity does come close to being a zero-sum game. There's only so much money out there, and where does it go? Probably not to my hypothetical charity, Kunts4Kids* (which provides access to healthcare for young transwomen). Or to the equally alliterative and illusional Abortions4Adolescents. My guess is that the Nancy Reagan telethon for children with terminal cuteness would rake in a lot more money.
Sure, I want to cure terminal cuteness, and every other social acceptable disease. But this zero-sum crap puts me in the uncomfortable business of arguing that you should give money to my charities, as opposed to other ones. Salvation Army, anyone? It's not that I don't want to see a range of charities flourish... it's just that photo-opishness can actually hurt the least-privileged, because non-inclusive charities facilitate the illusion that everyone's being served.
Of course, a lot of the arguments about what health care we can afford are red herrings. As piny alludes to, if you really think something is necessary health care, you fund it. We wouldn't let insurers off the hook for cancer treatments (or boner pills, for that matter). So why would we for trans medicine, reproductive healthcare, autism or anything else? Ultimately, it depends on what the definition of "we" is.
Which brings me to exhibit B: Washington state's proposed delayed of domestic partner benefits due to budgetary restraints. Really? So are "we" citizens of Washington, or not?
* Of course, I'm making a joke here, lest you think I'm trying to promote the idea that gender transition is all about genitals.