You can now change your sex and charge the American taxpayer, according to new rules just issued by the Department of Health and Human Services.

Up until now, the government denied Medicare payments for such surgeries, which were considered not medically necessary. Changes in genitalia and other secondary sexual characteristics are now considered medically necessary and therefore available for taxpayer funding.

The ruling came at the request of a 74-year-old man who wants genital excavation in order to have the semblance of a vagina.

The cost of such surgery can be astronomical. For a man seeking a vagina, the cost can run upwards of $20,000. For a woman who wants a penis constructed, the costs can range much higher, closer to $50,000.

Those huge amounts are far more than Medicare beneficiaries pay in premiums in a year, let alone what the average worker pays in the Medicare tax each year, which is only 1.45% of annual income.

Assuming that an individual makes $100,000 per year, he would pay at most $1,045 in Medicare taxes. So, if one worker who makes $100,000 a year pays roughly over $1,000 to Medicare each year, it would take one worker twenty years to pay for another person’s sex-change, or twenty people one year to do the same.

Dr. Paul McHugh, who for many years headed the department of psychiatry at Johns Hopkins University and who closed the pioneering sex-change unit at Johns Hopkins, said, “I concluded that Hopkins was fundamentally cooperating with a mental illness. We psychiatrists, I thought, would do better to concentrate on trying to fix their minds and not their genitalia.” 

He added, “As for the adults who came to us claiming to have discovered their ‘true’ sexual identity and to have heard about sex-change operations, we psychiatrists have been distracted from studying the causes and natures of their mental misdirections by preparing them for surgery and for a life in the other sex. We have wasted scientific and technical resources and damaged our professional credibility by collaborating with madness rather than trying to study, cure, and ultimately prevent it.”

Dr. Rick Fitzgibbons, with Phillip Dutton and Dale O’Leary, published a paper in the National Bioethics Quarterly on the psychology of “sex reassignment surgery.”

The authors say the belief one is “trapped in the body of the wrong sex” is “generated by a disordered perception of self… such a fixed, irrational belief is appropriately described as a delusion.” They call sex reassignment surgery “a category mistake” that offers “a surgical solution for psychological problems.” They add that it is related to “addiction to masturbation and fantasy, poor body image, excessive anger, and severe psychopathology in a parent.”

According to the literature there are two types who seek sex reassignment surgery: homosexual transsexuals and autogynephilic transsexuals. Autogynephilic transsexuals “are men in love with the image of themselves as women.” They find sexual excitement in dressing up as women and often have fantasies of being penetrated. If they have partners, the partners are mostly props in the fantasy. The paper says most autogynephilic transexual males consider themselves to be heterosexual. Many marry and have children, and some eventually decide they want to live full time as women and then seek sex reassignment surgery.

Homosexual transsexuals are “men whose appearance, gestures, and speech are perceived as feminine.” They believe they can pass for women and attract masculine heterosexual men.

Dr. Paul McHugh says these men are “conflicted and guilt-ridden homosexuals who see a sex-change as a way to resolve their conflicts over homosexuality by allowing them to behave sexually as females with men.”

Typically private insurance does not cover such surgeries, but that could also change with the new ruling, as private companies often take their lead from the federal government.

The Williams Institute, an LGBT research institute at UCLA, estimates there are 700,000 transgender people in the United States, or roughly .0029 percent of the adult population.