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Should Convicted Murderers Get Free Sex Changes?

March 28, 2014: Photo provided by the California Department of Corrections and Rehabilitation shows Michelle-Lael Norsworthy. (AP Photo/California Department of Corrections and Rehabilitation.)

A federal judge has ordered the people of California to foot the $100,000 bill for sexual reassignment surgery for someone serving a life sentence for murder.

AP (“Judge orders California to pay for inmate’s sex change“):

A federal judge on Thursday ordered California’s corrections department to provide a transgender inmate with sex change surgery, the first time such an operation has been ordered in the state.

U.S. District Court Judge Jon Tigar in San Francisco ruled that denying sex reassignment surgery to 51-year-old Michelle-Lael Norsworthy violates her constitutional rights. Her birth name is Jeffrey Bryan Norsworthy.

The ruling marks just the second time nationwide that a judge has issued an injunction directing a state prison system to provide the surgery, said Ilona Turner, legal director at the Transgender Law Center in Oakland, which helped represent Norsworthy.

The previous order in a Massachusetts case was overturned last year and is being appealed to the U.S. Supreme Court.

[…]

Norsworthy, who was convicted of murder, has lived as a woman since the 1990s and has what Tigar termed severe gender dysphoria — a condition that occurs when people’s gender at birth is contrary to the way they identify themselves.

“The weight of the evidence demonstrates that for Norsworthy, the only adequate medical treatment for her gender dysphoria is SRS,” Tigar wrote, referring to sex reassignment surgery.

California Department of Corrections and Rehabilitation officials said they are considering whether to appeal the ruling.

“This decision confirms that it is unlawful to deny essential treatment to transgender people” in or out of prison, said Kris Hayashi, executive director of the Transgender Law Center. “The bottom line is no one should be denied the medical care they need.”

Not much has changed in either my thinking or legal precedent since my August 2013 posting on “Chelsea Manning and the Law.”  In Manning’s case, the US taxpayer is paying for hormone treatment. On balance, that strikes me as reasonable. Gender dysphoria is a serious medical condition and, as a general rule, prisoners are entitled to proper medical care.

This case takes it quite a bit further. Sexual reassignment surgery is much more drastic a measure than hormone therapy and much more expensive. The AP story estimates that it “could run as high as $100,000 depending on the circumstances.”

This raises at least two issues. First, given that this is a state action, how do we assess the moral tradeoffs in authorizing the surgery? Second, presuming that this surgery is the ethical course of treatment, should the public pay for it?

Answering the first question is well outside my expertise and comfort zone. Under normal circumstances, I’m reasonably comfortable in allowing the conflicted individual to make decisions with mental health professionals. The Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People established by the World Professional Association for Transgender Health have been evolving for decades and strike me as rigorous. Indeed, some argue that it places too onerous a burden on those seeking reassignment surgery.

But, surely, a convicted murderer who presents with gender dysphoria has more complicated mental health issues? Aside from whatever wiring issues made them commit the violent act to begin with, the additional stresses of prison life make it much more challenging to untangle the gender issues. And that’s especially true in a case, like this one, where the individual is imprisoned with others of their apparent sex while presenting as someone of the opposite sex. Again, it’s just beyond my present knowledge levels to untangle.

Presuming, however, that we’ve successfully navigated those complexities and become comfortable with the decision that, yes, gender reassignment surgery is in the best interests of the patient, is it reasonable that the taxpayers of California should pay for it? The default answer would be Yes. Given that prisoners are wards of the state, they’re generally entitled to essential medical care free of charge.

Yet sexual reassignment surgery may be different. It’s quite expensive—$100,000 actually strikes me as an absurdly low estimate, given how much almost any surgical treatment requiring hospitalization costs—and generally considered elective surgery in the United States. Most insurance plans won’t cover it. (Hell, most won’t pay for LASIK surgery, which is cheap and life-changing.) As noted in the above-cited piece on the Manning case, the Veterans Administration will pay for hormone treatment but not sexual reassignment surgery. So, Tigar has basically ruled that convicted murderers have more rights than honorably discharged veterans.

I haven’t the foggiest idea how this case will fare on appeal, presuming California petitions. But, as weird as it seems now, it likely won’t be long before this treatment becomes “routine” and the very question being addressed here will seem silly. Medicare began covering the treatment last year and there’s growing momentum to include coverage in insurance plans. The European Court of Human Rights declared that the treatment was a basic right way back in 2002.

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About James Joyner
James Joyner is the publisher of Outside the Beltway, an associate professor of security studies at the Marine Corps Command and Staff College, and a nonresident senior fellow at the Atlantic Council. He's a former Army officer and Desert Storm vet. He earned a PhD in political science from The University of Alabama. Views expressed here are his own. Follow James on Twitter.

Comments

  1. Neil Hudelson says:

    Yet sexual reassignment surgery may be different. It’s quite expensive—$100,000 actually strikes me as an absurdly low estimate, given how much almost any surgical treatment requiring hospitalization costs—and generally considered elective surgery in the United States. Most insurance plans won’t cover it. (Hell, most won’t pay for LASIK surgery, which is cheap and life-changing.) As noted in the above-cited piece on the Manning case, the Veterans Administration will pay for hormone treatment but not sexual reassignment surgery. So, Tigar has basically ruled that convicted murderers have more rights than honorably discharged veterans.

    If a procedure is deemed medically necessary (and LASIK, while life-changing, generally isn’t)), should the cost really matter? Yes, I know insurance companies don’t consider it medically necessary. Insurance companies aren’t doctors. Ask a psychiatrist, psychologist, or a transgendered person yourself, and see what their thoughts are on the necessity of reassignment surgery. As you argued re: hormone treatment, they are wards of the state and we have a duty, as one who has placed them there, to cover necessary medical treatments. Are you saying medically necessary surgeries are OK unless we decide we don’t like the bill? If so, where is the cut off? Heart transplants costs much more–do we tell all prisoners that if they have a bad organ, their whatever-year sentence was just turned into (effectively) a life sentence?

    Or is it that this person’s conviction is for a life sentence? I don’t know how that strengthens your argument, but you cited it repeatedly throughout. I think if a person is a lifer, a medical doctor and psychologist-approved surgery would then become even more necessary–there’s no chance we can just wait for this lady to get out of jail and have her own insurance/Obamacare cover it. And if having a life-sentence does somehow preclude you from necessary-but-too-expensive surgeries, I would hasten to point out that our justice system doesn’t exactly have a stellar record at placing only the guilty in jail.

    Not to mention that if you are worried about extraneous costs to taxpayers via the DOC, looking at medical expenditures is not the first place one should start.

    Finally, on what planet can you state that Tigar, by ruling in favor of of an inmate, he is ruling against veterans? You are right that this surgery–when needed–should be covered by the VA. Denying it to inmates is not the solution to achieve equity.

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  2. Lars the Great says:

    I say cut of his willie and don’t give him anything at all. This is all the in the bible already in Ezekiel 23:20:

    She lusted after her lovers, whose genitals were like those of donkeys and whose emission was like that of horses.

    So what if this he/she wanted a donkey penis like the bible says then do we have to pay for that too?

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  3. Tyrell says:

    This is a convicted murderer. Under no circumstances should one cent of taxpayer money be used for any such treatment. If anyone wants this type of procedure, they should have to pay for it themselves. But someone serving life for murder? Bizarre, weird ! If this judge thinks this should be done, let him pay for it instead of socking the taxpayers. Certainly justification for having this judge removed.

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  4. James Joyner says:

    @Neil Hudelson:

    Yes, I’m not sure this is “medically necessary,” since the vast majority of transgendered individuals don’t receive it. Yes, I think it’s reasonable to take cost into consideration, as well as the fact that they’re sentenced to life in prison. Given that organ transplants are extraordinary measures and there’s a scarcity, I don’t think I’d give them to prisoners.

    Hormonal treatments are easier, if not a slam dunk. They’re typically provided to indigent people on Medicaid. But I’m not persuaded that convicted murderers are entitled to Cadillac-level treatment on our dime, let alone for treatments that most Americans with good jobs can’t afford.

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  5. Guarneri says:

    I hear that “she” is suffering considerable mental distress about a sagging jaw line, hair loss and those pesky wrinkles around her mouth. Add that stress to being an inmate. Wow. Call in the plastic immediately. She might commit another murder.

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  6. Ron Beasley says:

    Even an evil “liberal do gooder” like me thinks this is absurd!!!!!!

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  7. al-Ameda says:

    This procedure is not necessary for the physical health of the inmate, so … nope, I would NOT authorize this surgery.

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  8. HarvardLaw92 says:

    James, just an aside, but can you please do something about this troll problem?

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  9. HarvardLaw92 says:

    I don’t pretend to even remotely understand the basis of this condition, but it seems to me that the determination is best left to those qualified to make it – the doctors. If they affirm that it’s medically necessary, then the state should pay for it, otherwise no.

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  10. JohnMcC says:

    I am as liberal as I guess anyone you’re likely to meet in a day or week or whatever. But I don’t understand transgender. Probably an artifact of my age but my empathy is just not that elastic.

    http://www.commonhealth.wbur.org/2015/03/genderfluid-identity

    @HarvardLaw92: What?! You aren’t panting to find what else Ezekiel has to teach us about living in the 21st century?

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  11. Loviatar says:

    @HarvardLaw92:

    I don’t pretend to even remotely understand the basis of this condition, but it seems to me that the determination is best left to those qualified to make it – the doctors. If they affirm that it’s medically necessary, then the state should pay for it, otherwise no.

    DING, DING, DING we have a winner.

    But James won’t leave it to the doctors, he is a Republican, he believes his opinion should carry more weight than the professionals trained to make those determinations (i.e. Abortion Rights).

    —–

    James, just an aside, but can you please do something about this troll problem?

    I saw your question and had to chuckle, because I grew up in NYC it reminded me of the vermin problem you could have in an apartment building. I substituted Landlord for James and Roaches for Troll. I learned the only way you’ll ever get rid of roaches is if the owners wants to get rid of the roaches. By his inaction we can theorize that James has no problems with trolls infesting his blog.

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  12. HarvardLaw92 says:

    @JohnMcC:

    Tempting, but – no … :The best response to an infestation of cockroaches is to call the exterminator. -D

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  13. HarvardLaw92 says:

    @Loviatar: Get out of my head! 😀

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  14. steve says:

    The answer is no. Same with cosmetic surgery.

    Steve

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  15. Loviatar says:

    @HarvardLaw92:

    I’m a New Yawker, of course I’m going to be in your head, thats what we do. 😀

    Speaking for myself I’m thrilled that you’ve started commenting here. A lot of the postings from Doug tends to be on legal issues and with his biases I’ve always felt that the issues were framed in an ideological way. Its good to have someone here with the legal expertise to challenge him and his biases.

    P.S.

    good work on James P

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  16. Gustopher says:

    I don’t understand the transgender, but I am willing to believe that gender reassignment is necessary if the doctors say it is medically necessary.

    Do Medicare and Medicaid cover gender reassignment surgery? Do silver level plans in the convict’s state cover it?

    If the answer here is yes, than I think it is obvious that the state has to foot the bill. But, the answer isn’t yes, so we then have to decide if the state needs to provide a higher level of care to prisoners than most people in the state who are not prisoners. And I think the answer there is no — although the state should allow the prisoner to get the treatment if the prisoner can pay for it.

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  17. Tyrell says:

    @Loviatar: “proper medical care” And what kind of care did this murderer’s victim get from her ? And Judge Tigar – what about the constitutional rights of the victim ?
    It would be hoped that the governor of California will step in and stop this nonsense, maybe even replace this misguided judge. But I understand he has his hands full with a huge drought.

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  18. HarvardLaw92 says:

    @Loviatar:

    As a fellow New Yorker, yes we do. I’ve been here for years now though :-)

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  19. michael reynolds says:

    I’m more concerned for what follows. This individual, following gender re-assignment, will necessarily be transferred to a women’s facility. She’ll be physically female but with a man’s musculature and strength, and perhaps a man’s aggressiveness. I’d worry about the female inmates. This is a murderer, after all.

    That said, I agree that this is a medical call.

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  20. Loviatar says:

    @Tyrell:

    One of the reasons I have a strong distaste and dislike for Republicans is that they’ve changed me as a person. In response to their depredations and actions I’ve changed in a lot of ways to become more like them. I’ve become less tolerant of dissent, I’ve become angrier in my responses, I’m a more suspicious person. All of these are not got things.

    One of the ways I’m proud to say that I haven’t changed is that I’m not vengeful or mean spirited to those weaker than me or whom I have the power to harm. I don’t do it for some holistic reason, I do it for the simple reason of “there for the grace of god go I”.

    That empathy thing again.

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  21. Scott says:

    @Tyrell:

    And what kind of care did this murderer’s victim get from her ? And Judge Tigar – what about the constitutional rights of the victim ?

    We have a system of criminal trials and punishment. Michelle-Lael Norsworthy was tried and sentenced to life imprisonment. She was not sentenced to life imprisonment and mandatory sicklness. She was not sentenced to life imprisonment and some other punishment.

    Your concern about the victim is valid but not part of the question here. If you want to advocate for life imprisonment as well as a lifetime of systematic retributions on the convict go right ahead. But that is a separate argument.

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  22. James Joyner says:

    @HarvardLaw92: What is it that you’d have me do about the “troll problem”? There are hundreds of comments a day on the site and I can’t possibly read all of them. There are ways of banning specific commenters who consistently violate our comments policies and I have done so, as recently as two days ago. But, short of requiring that commenters have registered accounts—which would drive away a lot of legitimate commenters–there’s only so much I can do.

    @Loviatar: I haven’t the slightest idea why you think this is a partisan issue, much less how I’m somehow advocating a “Republican” position here. I’m acknowledging that criminals, traitors, and transsexuals have rights but also that there are trade-offs. The fact that some people in the medical community would argue that this treatment is “necessary”—and I’m inclined to be sympathetic to that argument—isn’t dispositive. Especially since we don’t provide it to non-criminals on a standard basis.

    Additionally, a big part of the reason that I post on topics like this—wherein I repeatedly acknowledge that I’m at the edges of my expertise—is to spark discussion and gain additional perspectives.

    @HarvardLaw92 and @Loviatar: “James P,” who only recently started commenting on my posts, should be gone now.
    @michael reynolds: My limited understanding is that the hormonal treatment that precedes gender assignment surgery largely nullifies that concern. That is, most of what gives men an inherent physical advantage in terms of strength and musculature comes from testosterone.

    @Scott: Actually, Jeffrey Bryan Norsworthy was the one sentenced and convicted. That the gender dysphoria was made known only afterwards complicates the problem.

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  23. HarvardLaw92 says:

    @James Joyner:

    It seems pretty evident that one person is using a multitude of personas to create tension and disrupt the conversation. That involves nothing more than identifying IP addresses being used by multiple personas and blocking them.

    Heck, even a post which says “this identity and that one and that one are all the same person”, coming from someone in the position of being able to state it with authority would go a long way.

    I’m not saying you need to establish a police state, but it is getting to the point where something needs to be done.

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  24. Loviatar says:

    @James Joyner:

    Amusingly, shortly after you write this,

    I haven’t the slightest idea why you think this is a partisan issue, much less how I’m somehow advocating a “Republican” position here.

    you write this,

    The fact that some people in the medical community would argue that this treatment is “necessary”—and I’m inclined to be sympathetic to that argument—isn’t dispositive.

    That has become the Republican position, your layman’s opinion is worth more than the medical community.

    The non ideological position would be as said by HarvardLaw92 up thread:

    I don’t pretend to even remotely understand the basis of this condition, but it seems to me that the determination is best left to those qualified to make it – the doctors. If they affirm that it’s medically necessary, then the state should pay for it, otherwise no.

    Notice the difference; in your statement, your opinion takes precedence over medical recommendations, a circumstances which has become standard operating procedure for the Republican party (e.g. Climate Change, Abortion Rights).

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  25. James Joyner says:

    @HarvardLaw92:

    It seems pretty evident that one person is using a multitude of personas to create tension and disrupt the conversation. That involves nothing more than identifying IP addresses being used by multiple personas and blocking them.

    Heck, even a post which says “this identity and that one and that one are all the same person”, coming from someone in the position of being able to state it with authority would go a long way.

    There’s been a lot of speculation along these lines over the last couple years but I’ve actually been unable to verify it. For example, despite similarities in writing styles, there’s zero evidence that Jenos is Jay Tea. They not only have different IP addresses but the associated IPs are in different parts of the country.

    I’ve IP-banned “James P,” who apparently followed Doug over from Facebook and initially did so on his posts. But, again, there’s no evidence that he was previously someone else: He used a fixed IP on all posts under the “James P” handle and no other commenter ever used that IP.

    As best I can tell, “Lars The Great” is the sockpuppet of one of our longtime regular left-of-center commenters trying to spoof a right-of-center troll. Only two people have used that IP.

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  26. HarvardLaw92 says:

    Removing James P was a good idea, although it looks like he may have reinvented himself as Lars The Great. Any action is appreciated though, so thank you.

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  27. James Joyner says:

    @HarvardLaw92: No, “Lars The Great” is one of our smarter liberal commenters doing a shtick. I’ll let it go for a bit to see where it goes.

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  28. HarvardLaw92 says:

    @James Joyner:

    Point accepted and I’ll respect that you’ve looked into it & taken action as best you can. I assure you, and I think I can probably speak for the others in this regard as well, that it is appreciated.

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  29. James Joyner says:

    @Loviatar: This is a very complex issue. So, no, even if there were a medical consensus that this treatment is necessary it doesn’t follow that convicted murderers have a right to get it for free when prison guards, war veterans, and the working poor don’t.

    I’ve moved well to the left on the transgender issue. My longstanding view on health care—perhaps owing to my growing up with socialized medicine as an Army dependant—is that it ought be provided by the state for everyone. My evolved view is essentially “Medicare for all” with those who are able to afford it to be able to buy “Cadillac” coverage either out of pocket or via supplemental insurance. Regardless, I don’t think prisoners should go to the head of the line.

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  30. Loviatar says:

    @James Joyner:

    So, no, even if there were a medical consensus that this treatment is necessary it doesn’t follow that convicted murderers have a right to get it for free when prison guards, war veterans, and the working poor don’t.

    Again, you’re substituting your opinion for medical recommendations. You can’t help yourself, its now SOP for Republicans.

    Additionally, who said anything about moving prisoners to the head of the line, whats been said is, let the medical professionals decide. If the professionals decide it is a medically necessary procedure, then as a ward of the state and with the state being responsible for the prisoners health and welfare then yes the prisoner should get a state paid for medical procedure.

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  31. HarvardLaw92 says:

    @Tyrell:

    Governors have no jurisdiction over federal judges, who serve for life / until they decide to retire unless removed from office. You’d have to impeach him in the House and convict him in the Senate in order to remove him – which I can tell you won’t be happening.

    Reading is fundamental …

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  32. HarvardLaw92 says:

    @James Joyner:

    it doesn’t follow that convicted murderers have a right to get it for free when prison guards, war veterans, and the working poor don’t.

    I’ll have to split with you on that point. Prisoners become wards of the state, no differently than if they were foster children, and the state becomes responsible for protecting their well-being until they are released from custody.

    I completely agree re: not getting the whole transgender thing. I’ve tried and I can’t wrap my mind around it, primarily because I have no frame of reference in which to even begin to understand it, but I’m prepared to respect the judgment of medical professionals that it exists. If they’re prepared to professionally go on record as determining that the surgery is a necessary medical treatment, that’s enough for me. Absent such a determination, though, no dice.

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  33. James Joyner says:

    @Loviatar: You’re making an appeal to authority when none exists. Liberals like to point to “scientists say” and conservatives to “the generals say” as if that somehow settles it. Unless we’re talking about a discrete factual point, it doesn’t. They provide expert input but public policy decisions are made, at least ostensibly, based on the will of the people.

    That will might be that prisoners get the same treatment as, say, Medicare recipients. It might be that they’re entitled to the very best care available, period. But it’s a public policy argument, not a purely medical one.

    @HarvardLaw92: We may simply be operating on different senses of what “medically necessary” means. It’s a no brainer, both in terms of simple humanity and the 8th Amendment, that prisoners are entitled to standard medical care like an appendectomy or gall bladder removal. I don’t know that they’re entitled to extraordinary interventions like heart transplants, which are necessarily rationed.

    The transgender issue is not only relatively novel in and of itself but it’s part of the larger mental health care issue, which itself is far from settled. I’m prepared to take the word of the best practitioners that the best way to treat gender dysphoria is to make the body conform to the mind rather than vice versa, even though the latter would seem more logical from a lay standpoint. But sexual reassignment surgery is still an extraordinary treatment that the overwhelming number of transgendered individuals don’t get for one reason or another–whether it’s cost, access, or whatever. (I really don’t know.) So, it’s hard to seee a definition of “medically necessary” that both comports with that reality and necessitates providing it free of charge to those in the pokey for life on a murder rap.

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  34. Tyrell says:

    I think about people I know who are retired, some are veterans, decent, law abiding citizens who struggle to pay bills, who have to forgo doctor visits and medicine because they don’t have the money; medicare doesn’t cover it all. To many of them, event basic dental treatment is out of the question. Yet this judge is giving a $100,000+ unnecessary medical procedure to a convicted murderer!! On top of that, he is using money that is not his: it is the taxpayers’ dough ! Shameful.

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  35. wr says:

    @James Joyner: ” No, “Lars The Great” is one of our smarter liberal commenters doing a shtick”

    Go figure.

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  36. HarvardLaw92 says:

    @James Joyner:

    Correct, which is why I doubt that there will be a panel of doctors willing to assert that this gender reassignment surgery is medically necessary – but that professional judgment needs to remain one left to the doctors. None of the rest of us – including you or I – are qualified to make that determination.

    SCOTUS has been pretty clear, in Estelle v. Gamble, 429 U.S. 97 (1976), that a deliberate indifference by prison officials to the medical needs of the prisoners under their control violates the 8th Amendment.

    It’s certainly a moral issue, no doubt, but legally, it’s pretty clear cut. If a prisoner needs a heart transplant, the state pays for a heart transplant.

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  37. Loviatar says:

    @James Joyner:

    You’re making an appeal to authority when no exists. Liberals like to point to “scientists say” and conservatives to “the generals say” as if that somehow settles it. Unless we’re talking about a discrete factual point, it doesn’t. They provide expert input but public policy decisions are made, at least ostensibly, based on the will of the people.

    @Tyrell:

    Yet this judge is giving a $100,000+ unnecessary medical procedure to a convicted murderer!! On top of that, he is using money that is not his: it is the taxpayers’ dough ! Shameful.

    Same message; one is all pretty and nice and the other one is direct from the base. But at the end of the day no difference between the two.

    The Republican id: I in all my greatness and intelligence as a white man gets to decide who should receive the states largesse. Not the law, not the rules that we’re governed by, not the experts that guide our elected officials, but me as white male.

    As I’ve said before, when it comes down to it, James is no different from Tyrell. If you give money to, provide intellectual/ethical and moral cover to and ultimately vote for political Tyrells, then you are them. James is Tyrell.

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  38. James Joyner says:

    @HarvardLaw92:

    It’s certainly a moral issue, no doubt, but legally, it’s pretty clear cut. If a prisoner needs a heart transplant, the state pays for a heart transplant.

    Gamble injured his back doing prison labor, complained of pain, and was not only left untreated but punished for refusing to continue working. In Helling v. McKinney, the court found that prisoners had a right not to be subjected to a steady stream of second hand smoke. That strikes me as very elemental care. Have there been rulings establishing more extraordinary care, such as heart transplants?

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  39. Loviatar says:

    I’m done arguing with James on this subject. How do you argue with someone who says things like this:

    You’re making an appeal to authority when none exists.

    I guess doctors are no longer considered medical authorties.

    Liberals like to point to “scientists say” and conservatives to “the generals say” as if that somehow settles it.

    Its good to know that scientist and generals opinions carry the same weight as a layman. None.

    Unless we’re talking about a discrete factual point, it doesn’t.

    A Republican referencing discrete factual points, to bad he’s using the term to refute facts.

    They provide expert input but public policy decisions are made, at least ostensibly, based on the will of the people.

    The public policy decision has been made at the will of the people; inmates are entitled to medical care while they are wards of the state. A judge has confirmed that policy decision.

    That will might be that prisoners get the same treatment as, say, Medicare recipients. It might be that they’re entitled to the very best care available, period. But it’s a public policy argument, not a purely medical one.

    This one you should have just went with Tyrell’s argument: ugh, its a icky bad person. Damm the law I shouldn’t have to pay for medical care for icky bad people.

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  40. JWH says:

    I wouldn’t support forcing the prison system to pick up the cost of his gender-reassignment surgery unless the prison system has resources left after it has provided necessary medical (and dental) care for other inmates.

    While I am sure this plaintiff considers gender-reassignment surgery to be important, I think it needs to take a back seat to other medical issues.

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  41. JWH says:

    I didn’t express the above well. I think that if it comes to a choice between paying for this prisoner’s gender-reassignment surgery, vs. paying for another inmate’s life-saving organ transplant or chemotherapy, I would choose the life-saving surgery every time.

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  42. Tillman says:

    No, “Lars The Great” is one of our smarter liberal commenters doing a shtick.

    Huh.

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  43. HarvardLaw92 says:

    @James Joyner:

    Gamble’s problem was that he received care which was inappropriate, not that his medical needs were deliberately ignored. That renders Gamble’s case one of misfeasance, specifically medical malpractice. That’s pretty distinct from nonfeasance. Having a duty to act, but acting irresponsibly, is quite different from having a duty to act, but refusing to act.

    In short, the ruling in Estelle v. Gamble held that the state has a responsibility to provide for the medical needs of prisoners, but that the medical staff employed by Texas had simply committed medical malpractice via unintended error (which didn’t abrogate its 8th Amendment obligations) instead of willful neglect (which would have constituted a violation).

    There have been several transplants conducted at state expense post-Estelle. No additional rulings have been needed or, to my knowledge have even been pursued – because the holding in Estelle is clear – the state may not deliberately withhold medically necessary treatment from prisoners in their care. In the case of transplants, they can be rejected by the reviewing medical team on the same bases that they would reject other prospective recipients, but the state can’t just summarily say “prisoners are not entitled to transplants” as a policy statement.

    Whether we like them or not, prisoners are entitled to medically necessary care at state expense.

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  44. JohnMcC says:

    @James Joyner: Thank you, sir. Truly enjoy your site.

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  45. JohnMcC says:

    @Tillman: When Lars quoted Ezekiel, I should have sniffed that out. Whoever did that has a great sense of humor and I’d love to spend an evening around the barbeque with them but in this case they didn’t reckon with the depth of ignorance of folks like our social disease. Mr/Ms Poe (of Poe’s law) must have had a similar visitation from whatever outer space our social disease emerged from.

    And our social disease found his way here via facebook? Another reason I have no social media footprint. Good grief! Does Mr Mataconis have family references and connections on FB?

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  46. James Joyner says:

    @HarvardLaw92: Ah. Gotcha. I’m hung up on the “medically necessary” verbiage, in that we clearly don’t provide transplants to whomever has a need for them without regard to ability to pay. Therefore, I’ve always presumed that was at some extraordinary tier. It’s interesting that we’ve decided that we have a duty to provide them to prisoners but not to ordinary citizens.

    Which, not to hijack my own thread, brings forth all sorts of other questions such as: why is organ donation voluntary?

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  47. James Joyner says:

    @Loviatar: You’re either simply trolling at this point or being deliberately obtuse. There’s simply no way to intelligently get there from a post that begins by referencing an older post arguing for providing hormone therapy for Chelsea Manning, whom I otherwise despise as a traitor, and that asserts the premise that, “Gender dysphoria is a serious medical condition and, as a general rule, prisoners are entitled to proper medical care.”

    The posting and the discussion that follows is about the complexities of making the decision to authorize gender reassignment surgery in the case of a mentally disturbed individual locked up in the hellhole that is the American prison system, the fact that we as a society don’t provide anything close to this level of care to our indigent citizens or our veterans, and concluding with a prediction that the whole discussion will likely seem silly in the not too distant future.

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  48. Loviatar says:

    Whenever I hear the term PC I always think, what does that person have against being Personally Courteous?

    I’ve come to the realization though there is a another form of PC, the inability to point out that a persons political words or actions are harming another. Doing so is considered rude and inappropriate. Its why you can see pundits get on television and flat out lie or in some cases advocate horrible things without any other person on stage going wait thats wrong, you’re a liar and and a horrible person. Unfortunately, it seems we’ve gotten to the point where only comedians can speak truth to power.

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  49. HarvardLaw92 says:

    @James Joyner:

    It’s an odd thing for some to wrap their mind around, but essentially, from a legal perspective prisoners are pretty much the equivalent of dependent children.

    Now, that hasn’t stopped states from trying every trick in the book to get around it. Tennessee, for example, will provide a transplant, but only after the prisoner-patient funds his/her own post-operative care (which is pretty ludicrous on face, IMO, but they got away with it in the case of James Earl Ray). I don’t know many prisoners who are in a position to pay for that, so it’s a clear case of deliberately arranging the situation to avoid paying, but somehow they got away with it anyway.

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  50. Tillman says:

    @JohnMcC: I had been thinking as I upvoted the donkey genitals passage, “No fundie ever quotes the donkey genitals passage.”

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  51. Tyrell says:

    @James Joyner: I would have the view that any medical care for a prisoner should in cases of emergency, life threatening, injuries, or medication for diabetes, high blood pressure, etc.
    There are two issues that are mixed here. One is that a person has taken the life of another, so just what sort of treatment and general conditions are they entitled to above food, water, and a roof ? I would say that this sort of procedure is low on the priority list: down there with lasik eye surgery and breast implants.
    The other issue is the use of tax money for the procedure, when so many can’t afford basic medical care. I have no issue if someone wants to pay for this themselves, just as I would have to pay for dental work and lasik eye surgery; things that I would have done if I had the money.
    Thanks for the comments and different views on this.

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  52. anjin-san says:

    @James Joyner:

    I seem to recall you giving Jenos a pointed and specific warning about sock puppetry not long ago. And this is diminishing the quality of the OTB.

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  53. James Joyner says:

    @anjin-san:I tend to read all the comments on my own posts, although sometimes stop when the thread gets long and taken over by sidebar conversations. The one posting in this thread was the first I’d seen of “Lars” and just thought it a silly comment until HL92’s comment above. At that point, I researched and figured out what I thought the gig was—a pointed trolling of a specific troll.

    I often don’t get a chance to see comments on postings written by the other front pagers. There are a handful of commenters that mostly follow one writer’s threads, so I don’t see the most egregious stuff. Banning trolls is harder than it looks, especially if they have multiple IP addresses or change names constantly.

    It’s a major undertaking to police threads and most of us don’t have the time or energy. It’s why so many sites either shut off comments entirely or just let them become a total free-for-all.

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  54. HarvardLaw92 says:

    @James Joyner:

    Allow me to propose that my slave summer associate, once he gets here anyway, volunteer himself as a poleeceman for this forum.

    😀 muahahahahaha 😀

    (I’m kidding …)

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  55. David M says:

    I tend to think most if not all of the conservative commenters here are not sock puppets, and most are too quick to jump to that conclusion. There are a lot of people on the internet, and the posts here are consistently linked on memeorandum, so the default assumption should be that new commenters are not sock puppets, absent extraordinary evidence.

    Anyone thinking it’s odd that the conservative commenters sometimes sound alike just needs to go over to Redstate, HotAir, FreeRepublic, etc and they’ll see just how many people hold those same opinions.

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  56. Rob Prather says:

    I actually find myself to the right of James on this, which is unusual these days. I’m not a lawyer, but I really don’t see the point of a sex change for a person who will spend life in prison. Also, Michael Reynolds’ comments about her being transferred to a female prison seem relevant.

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  57. Loviatar says:

    It used to be that Republicans along with Democrats could be counted on to do the hard work on keeping our country safe.

    Food On Floor, Catnaps As Diplomats Sealed Iran Nuclear Deal

    U.S. Energy Secretary Ernest Moniz and Iranian atomic energy chief Ali Akbar Salehi, who studied at M.I.T. at the same time, would meet one on one and then report back on what they discussed.

    When Kerry needed calculations or tweaks, officials described him putting his team to work and sometimes popping in to let them know they needed to move more quickly.

    Kerry also got involved in details as granular as travel plans for the other foreign ministers and helping with scheduling conflicts. After Russian Foreign Minister Sergey Lavrov left, Kerry persuaded him to come back.

    The critical meeting with the Iranians lasted nine hours between Wednesday night and Thursday morning. Emotions at times ran high as sleep deprivation kicked in.

    Now all we have from the Republican side are bomb throwers and nihilist and those that support them.

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  58. Gustopher says:

    I’m surprised no one on the right has brought up the moral hazard of providing gender reassignment surgery for prisoners — it encourages the transgender community to commit crimes for the free surgery.

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  59. Gustopher says:

    @James Joyner:

    My limited understanding is that the hormonal treatment that precedes gender assignment surgery largely nullifies that concern. That is, most of what gives men an inherent physical advantage in terms of strength and musculature comes from testosterone.

    My limited understanding is that you are wrong — the strength and musculature has been developed under years of testosterone and does not completely atrophy.

    But the underlying question of whether she would pose a greater threat to the other female inmates may be moot — she is likely receiving special protection in male prison, and would receive similar scrutiny in female prison.

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  60. wr says:

    @JWH: ” I think that if it comes to a choice between paying for this prisoner’s gender-reassignment surgery, vs. paying for another inmate’s life-saving organ transplant or chemotherapy, I would choose the life-saving surgery every time.”

    Or, you know, we could just adequately fund the medical care in these prisons we’re so hot to build everywhere.

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  61. wr says:

    @Tyrell: “Yet this judge is giving a $100,000+ unnecessary medical procedure to a convicted murderer!! On top of that, he is using money that is not his: it is the taxpayers’ dough !”

    Ssshhh. No one tell Tyrell that when the judge sentenced the murderer to be incarcerated, he didn’t get sent to the judge’s house but to another building that was not his but is owned by taxpayers.

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  62. DrDaveT says:

    @wr:

    Or, you know, we could just adequately fund the medical care in these prisons we’re so hot to build everywhere.

    I’m mildly boggled that James’s takeaway from “Convicted murderers get better health benefits than veterans or ordinary citizens” is that convicted murderers need worse healthcare.

    Pro tip: other first-world nations do not have this problem, because other first-world nations recognize that health care for everyone is important, and they provide it. Even to non-felons.

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  63. Loviatar says:

    Change transgender murderer to blond, blue eyed foster child and change sex change operation to heart transplant and we wouldn’t be having this discussion. But what the conservatives and others on this site don’t realize, in the eyes of the law both are wards of the state and are entitled to medical care.

    What scares me is how many supposed liberals are willing to walk away from the rule of law because the law is being applied to someone they consider not worthy. That is one way bigotry is advanced; this time its a transgender murderer, next time its a black gang member, the time after that its a hispanic illegal immigrant. Each time it gets a little easier to justify the denial of medical care, each time it just gets a little easier to ignore the rule of law because some think the recipient is not worthy.

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  64. jd says:

    Just a gentle correction: there is no such word as ‘transgendered’. ‘Transgender’ is an adjective. One is not ‘transgendered’ any more than one would be ‘heterosexualed’. One is also not ‘a transgender’.
    Many here have admitted an ignorance of things transgender. I invite you to read an easy, informative booklet on the subject published by PFLAG:
    Guide to Being a Trans Ally.

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  65. HarvardLaw92 says:

    Sidenote to James: evidently the troll found a way around your IP ban. Thanks for trying anyway. You’d think the guy would get the hint.

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  66. James Joyner says:

    @DrDaveT: As noted @upthread, I’ve supported baseline care for all for as long as I can remember. But I’m arguing in the context of the existing system, not the ideal system, and think it odd that we prioritize prisoners over prison guards. Further, even if we had “Medicare for all,” or some such baseline, we wouldn’t necessarily fund every procedure. While the “death panels” trope during the Obamacare debate was largely nonsense, there was a grain of truth: we’d have professionals deciding how to best allocate scarce resources. We do that—and I presume even the most generous European systems do that—in the case of organ transplants, for example.

    @Gustopher:The first real thought I’d had about the issue was when I wrote a posting a couple years back titled “Transgender Woman Plays College Basketball to Little Controversy.” It referenced an AP story and I did a little outside research which pointed to a radically diminished advantage post-hormone therapy.

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  67. Tyrell says:

    @Loviatar: I think there is a huge difference in basic medical care for convicts and some sort of elective surgical procedure such as the one that this judge has misguidedly ruled must be done (a procedure that has been questioned over the years as unnecessary by a lot of medical doctors). One would think that when a person takes the life of another that they have then forfeited a lot of services and advantages that law abiding citizens have. It seems reasonable to expect our judges to feel the same way (I noticed that he did not volunteer to pay for it, yet leaves the taxpayers holding the bag). What the judge should have done was give that money to the victim’s family. I would hate to think that a convicted felon would be placed ahead of a family member on an organ transplant waiting list.
    What we have today are prisons that are more like country clubs, and judges who care more about the criminals than their poor victims !!

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  68. Loviatar says:

    @Tyrell:

    I think there is a huge difference in basic medical care for convicts and some sort of elective surgical procedure such as the one that this judge has misguidedly ruled must be done (a procedure that has been questioned over the years as unnecessary by a lot of medical doctors).

    I’ll repeat my response from up thread when James Joyner made the same argument.

    You’re substituting your opinion for medical recommendations. You can’t help yourself, its now SOP for Republicans. Also, your argument would be more convincing if you used simpler words such as; ewww, its an icky bad person. F@#$ the law I shouldn’t have to pay for medical care for icky bad people.

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  69. steve says:

    Just so you know, what really happens now is that inmates are released if at possible if they need medical care. That way the state/county need not pay. Also, you can always find some docs who will say something like this is “necessary”, especially if their paychecks depend upon it. The literature supporting it as necessary that i have read seems weak, but it is not my area of expertise.

    That said, I think prisoners do forfeit some rights. They lose their right to liberty and many of their rights of communication. The loss of the ability to have truly elective surgery also seems like a reasonable loss to me. If you made it to 51 without the surgery, you can continue to go without.

    Steve

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  70. wcgirlstar says:

    First off, the procedure, namley, Gender Reassignment Surgery, is way under the $100,000 Cost estimate. The actual cost assuming the procedure is done in California is between $23,000 to around $30,000. Even if you factor in the cost of the officers needed to watch over her in the hospital and during surgery etc…the cost is still under $35,000 dollars.

    Second, the state of California requires insurance companies who insure individuals in California, to provide coverage for transgender related services, including Gender Reassignment Surgery, so long as the individual seeking treatment is under the care of a doctor who deems the procedure to be medically necessary.

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  71. James Joyner says:

    @wcgirlstar: Thanks. That’s useful contextual information.

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  72. HarvardLaw92 says:

    @James Joyner:

    The troll James P doesn’t believe that you IP banned him. He’s still commenting here

    Might be helpful if he hears it from you, since he’s clearly intent on remaining here.

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  73. Tyrell says:

    @wcgirlstar: If insurance companies have to cover that kind of procedure, no wonder premiums are so high. To me, that is no more important than lasik eye surgery, breast implants, and a lot of dental procedures.

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  74. michael reynolds says:

    Wait, James P has been banned?

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  75. Lars the Great says:

    I only existed to screw with James P. My life has no meaning.

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  76. HarvardLaw92 says:

    @michael reynolds:

    James referenced IP banning him above. Evidently he has changed his IP address and keeps posting. The guy just has no shame.

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  77. wr says:

    @Tyrell: ” To me, that is no more important than lasik eye surgery, breast implants, and a lot of dental procedures.”

    Hey, if your house burns down it’s no big deal to me. So I don’t think insurance should cover your loss.

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  78. James Joyner says:

    @michael reynolds: @HarvardLaw92: I’ve tried a couple other steps.

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  79. HarvardLaw92 says:

    @James Joyner:

    Muchos danke 😀

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  80. Surreal American says:

    @HarvardLaw92:

    Chag Sameach, HL92!

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  81. Surreal American says:

    @James Joyner:

    Happy Easter to you and all our hosts at OTB!

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  82. HarvardLaw92 says:

    @Surreal American:

    Thank you, and Happy Easter to you 😀

    (I’m already sick of matzah … LOL)

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  83. michael reynolds says:

    Easter?

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  84. Davebo says:

    @HarvardLaw92:

    Governors have no jurisdiction over federal judges, who serve for life / until they decide to retire unless removed from office. You’d have to impeach him in the House and convict him in the Senate in order to remove him – which I can tell you won’t be happening.

    That’s not exactly correct. Trust me, Federal Judges are “removed” without the procedure you mention every year.

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  85. DrDaveT says:

    @michael reynolds:

    Easter?

    That most important of Christian feast days that confuses the heck out of kids who can’t quite make out the connection between rabbits and eggs.
    Easter (n.)
    Old English Easterdæg, from Eastre (Northumbrian Eostre), from Proto-Germanic *austron-, “dawn,” also the name of a goddess of fertility and spring, perhaps originally of sunrise, whose feast was celebrated at the spring equinox, from *aust– “east, toward the sunrise”, from PIE *aus– (1) “to shine” (especially of the dawn); see aurora.

    Bede says Anglo-Saxon Christians adopted her name and many of the celebratory practices for their Mass of Christ’s resurrection. Almost all neighboring languages use a variant of Latin Pascha to name this holiday (see paschal). Easter egg attested by 1825, earlier pace egg (1610s). Easter bunny attested by 1904 in children’s lessons; Easter rabbit is by 1888; the paganish customs of Easter seem to have grown popular c. 1900; before that they were limited to German immigrants.

    If the children have no garden, they make nests in the wood-shed, barn, or house. They gather colored flowers for the rabbit to eat, that it may lay colored eggs. If there be a garden, the eggs are hidden singly in the green grass, box-wood, or elsewhere. On Easter Sunday morning they whistle for the rabbit, and the children imagine that they see him jump the fence. After church, on Easter Sunday morning, they hunt the eggs, and in the afternoon the boys go out in the meadows and crack eggs or play with them like marbles. Or sometimes children are invited to a neighbor’s to hunt eggs. [Phebe Earle Gibbons, “Pennsylvania Dutch,” Philadelphia 1882]

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  86. James Pearce says:

    @michael reynolds: Yeah, bunnies lay multi-colored eggs or something.

    @James Joyner:

    I’ve tried a couple other steps.

    Thanks for banning Evil James P.

    Signed,
    Even Eviler James P

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  87. HarvardLaw92 says:

    @Davebo:

    By all means, please elaborate.

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  88. Jenos Idanian #13 says:

    @anjin-san: I seem to recall you giving Jenos a pointed and specific warning about sock puppetry not long ago. And this is diminishing the quality of the OTB.

    No wonder my ears have been burning.

    I have categorically denied “sock puppetry.” I’ve stuck with the Jenos name (except for adding the number when I had an undesired avatar), and used no others here. And yet I am repeatedly accused of doing otherwise. You’re even doing it after one of our hosts declared that not only was there no evidence I have done it, but considerable indicators I haven’t.

    Whoops, no, you haven’t. You, as usual, lacked the courage to actually say what you mean. Instead, you just strongly inferred it, but left yourself a loophole to say no, you didn’t.

    And as shown by the Lars example, it’s not an absolute prohibition. Apparently if you’re on the “right” side of the owners and amuse them enough, it doesn’t apply.

    Maybe I’ll comment as “HarvardJanitor92” some time. Nah; the janitors I’ve known have been decent, hard-working, productive, and actually serve a useful function and help people. To compare them to a lawyer would be insulting to the janitors.

    Maybe “aging-sanitarydevice.” That one has potential. “or “Whiny-Ratfink.”

    Nah. I’ve gone a couple of years with this identity here, and no other. I think I’ll stick to it.

    But your almost-but-not-quite accusation… care to actually commit a little and say, clearly, that you are accusing me of sock-puppetry? Come on, show a little guts and put it out there.

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  89. HarvardLaw92 says:

    Great – we’ve managed to enable Jenos’ victim complex.

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  90. Jenos Idanian #13 says:

    @HarvardLaw92: Strange how having several people repeatedly make false accusations might make one feel like a victim… I do try to ignore it, but here it seems particularly appropriate.

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  91. michael reynolds says:

    @DrDaveT:
    I think we pretty much have to believe anyone who carries the honorific venerable.

    I did not know that. Makes sense, though. And it’s an embarrassing admission, but I had never made the connection to the word passover. This despite three easters in France and once upon a time speaking the language fluently.

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  92. Davebo says:

    @HarvardLaw92:

    Seriously?

    Let’s just say federal judges retire, or resign, after a period of “administrative leave” for a variety of reasons.

    Surely you know the numbers of actual impeachments. It almost never gets that far.

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  93. bill says:

    @Neil Hudelson: elective surgery is just that- he/she is in jail for a reason and when “it” get’s out all the power to “it” to relocate it’s parts to suit itself-at “its” expense. spare us the psycho mumbo jumbo that just pads lawyers/doctors wallets. just think of all the free meals to the homeless that would be wasted on this oxygen thief.

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  94. HarvardLaw92 says:

    @Davebo:

    Let’s just say federal judges retire, or resign, after a period of “administrative leave” for a variety of reasons.

    I think you may be confusing administrative law judges with sitting Article III judges. They’re not even remotely the same thing.

    Could you name for me please an Article III judge who has been forced to leave office against his/her will without impeachment being involved?

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  95. HarvardLaw92 says:

    @Jenos Idanian #13:

    Granted, and I’ll step up and admit that I was wrong about asserting that you and James P were the same person. Apologies for that

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  96. dmhlt says:

    @HarvardLaw92:
    I think trolls are a lot like spices. A little bit goes a long way – but they’d be missed if they weren’t there.

    (Maybe I’m just more practiced at ignoring them.)

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  97. Electroman says:

    @bill: “Elective” surgeries are those that are scheduled in advance; i.e. not performed on an emergency basis. Cancer surgery, for example, is almost always elective.

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  98. Pinky says:

    HarvardLaw92 – On any issue, 45% of the US population agree with you, 45% disagree with you, and 10% believe things that if you knew about, you’d be afraid to leave the house. You seem to think not only that anyone who disagrees with you should be dismissed, but also that they’re all the same person.

    Over on the Rolling Stone thread, a few different people took the occasion to complain about Bush and about the men’s rights crowd. It doesn’t seem possible to me that different people would independently make those same jumps. Well, they did.

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  99. DrDaveT says:

    @Pinky:

    On any issue, 45% of the US population agree with you, 45% disagree with you, and 10% believe things that if you knew about, you’d be afraid to leave the house.

    Thanks, Pinky — I’m going to steal that and use it frequently.

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  100. DrDaveT says:

    @James Joyner:

    But I’m arguing in the context of the existing system, not the ideal system, and think it odd that we prioritize prisoners over prison guards.

    As others have noted, prison guards are not wards of the state. They also have jobs with health benefits. If you’re going to argue in the context of existing systems, that’s a huge part of that context. If you’re going to argue that they shouldn’t be wards of the state for some purposes, that opens the door to other wishful thinking.

    Further, even if we had “Medicare for all,” or some such baseline, we wouldn’t necessarily fund every procedure

    Probably not — but the complaint that we’re providing benefits for convicted felons that veterans, prison guards, and Mr. Rogers don’t qualify for would go away.

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  101. bill says:

    @Electroman: semantics- skirting the issue doesn’t make it go away. the state paying for some freaks choice to be even freakier is what this about.

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  102. James Joyner says:

    @DrDaveT:

    Probably not — but the complaint that we’re providing benefits for convicted felons that veterans, prison guards, and Mr. Rogers don’t qualify for would go away.

    I’m not sure about that. I take HarvardLaw92’s word for it that the law has evolved such that prisoners are considered entitled to even extraordinary interventions like heart transplants. But, presumably, they’re subject to the same cost-benefit analysis as other patients, since there’s an extreme scarcity of hearts. It would certainly seem reasonable to me that, in making that calculation, that one’s being in prison for life—or on death row!—would be a negative factor in assessing which of two people in otherwise similar medical circumstances would get the heart.

    In terms of sex changes, there’s no scarcity of which I’m aware (I presume there are plenty of qualified surgeons and that they’re not overwhelmed with cases). So, yeah, the prisoner would be entitled to whatever everyone else was.

    But what if sex changes were in that tier of services not covered by the state but available to those with the means, either out of pocket or via suppplemental insurance? We’d still have to debate (or judges would decide) whether prisoners were entitled.

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  103. Electroman says:

    @bill: No, you said “Elective surgery is just that” as if it was evidence for your central point (and I’m not saying you don’t have one). To point out your fallacy isn’t “semantic”.

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  104. DrDaveT says:

    @James Joyner:

    It would certainly seem reasonable to me that, in making that calculation, that one’s being in prison for life—or on death row!—would be a negative factor in assessing which of two people in otherwise similar medical circumstances would get the heart.

    I will grant you death row — it would be a travesty indeed to spent lots of taxpayer dollars to transplant a heart into a convict who was to be summarily executed soon after. (Although you might be able to re-harvest the heart, depending on the means of execution. And death row waits can be longer than the typical survival period for heart transplant recipients…)

    But for life imprisonment… why should it matter to you? Is life imprisonment not enough of a penalty for you? We need to also deny such convicts medical care that we provide to everyone else, or establish higher bars for them to qualify?

    I hate to break this to you, but the residents of our prisons are Americans too.

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  105. James Joyner says:

    @DrDaveT:

    We need to also deny such convicts medical care that we provide to everyone else, or establish higher bars for them to qualify?

    I’m just talking about the specific case of organ transplants, where a serious scarcity exists that creates a competition and a triage process. And, yes, I think a decent citizen who has avoided committing felonies and who will contribute to society should get a higher priority in that context than a convicted murderer.

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  106. Jenos Idanian #13 says:

    @DrDaveT: But for life imprisonment… why should it matter to you? Is life imprisonment not enough of a penalty for you? We need to also deny such convicts medical care that we provide to everyone else, or establish higher bars for them to qualify?

    I’ve read a bit about the politics of organ transplants. The panels that make the decisions on who gets the finite resources that are organs have quite a number of criteria they use. “How much will the patient’s quality of life improve,” “how much may they benefit their families and societies,” and “how will they benefit from getting the organ” are some of the questions they ask. An inmate serving life without parole won’t benefit society much with a new kidney or heart.

    That’s a key factor here. We’re dealing with finite resources here. A heart or kidney that goes into a prison represents a person not in prison who has been denied that organ.

    To a lesser degree, the same holds true for sex reassignment surgery. There are only a finite number of such procedures that can be performed, because of the limiting factors, and not just money. There are only so many doctors who can perform them, and performing them on inmates costs more than on non-inmates. (Either the medical personnel must leave their hospital and travel to prison, or the inmate must be securely transported to and from the prison, just to name one factor.)

    In an ideal world, those costs wouldn’t be relevant. But this isn’t an ideal world.

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