# The low cost of transgender troops

The New England Journal of Medicine’s current issue includes an analysis by Aaron Belkin, Ph. D., director of the Palm Center and political science professor at San Francisco State University:  Caring for Our Transgender Troops –The Negligible Cost of Transition-Related Care.

With Mike Huckabee basically decrying the potential medical cost of having transgender troops serve this country, Belkin decided to estimate how much we were talking about.  Being a retired math professor, I couldn’t resist double-checking Belkin’s calculations.

We start with updating the estimate of the number of transgender troops.  That was estimated at 15500 in 2014, when we had 2581000 service members eligible for health benefits.  As of the end of May of this year, that number has shrunk to 2136779.  Assuming the fraction who are transgender has remained constant, we would now have (2581000/2136799) x 15500 = 12832 transgender service members.  That would be 12800/2136799 = 0.6% of our fighting force.  The Williams Institute at UCLA has estimated that transgender people make up 0.3% of the American population.  Thus transgender people are overrepresented in the military by a factor of 2.

Examining large employers in the US which offer such care to find the utilization rate of transition-related heath care, Belkin arrived at the figure .0044% per year (one in every 22727 employees).  Thus the estimated number of troops requesting transition-related care per year would be .000044 x 2136799 x 2 = 188.038.  Let’s round to 188.

We check our figures for sensibility by looking at the Australian experience.  In the 30 months since Australia has permitted transgender troops to serve, 13 have received transition-related care…5.2 persons per year.The Australian military force size is 58000, so the number seeking transition-related care has been 1 per every 11154 troops.  Applying that to the American force size, we would then expect 2136799/ 11154 = 192 troops to seek transition-related care.  We shall use the 188 in further calculations.

To obtain an estimate of the average cost of transition-related care per recipient, Belkin accessed data from the University of California system…\$29929.  The cost would be lower for male to female patients and higher for female to male.  In contrast the Australian military paid US \$22132 per person requiring care.

Thus our 188 potential transgender troops would ring up a cost of 188 x 29929 = \$5626652…which Belkin calls slightly more than a rounding error in the Pentagon’s budget.

Comparing to the Australian cost 115084 x (2136799/58000) = \$4239851/year, we see that the number above is, if anything, a high estimate.

The \$5.6 million works out to \$5626652/12800 =\$439.58/year per transgender service member.

Since the nature of the military is that costs are spread out across all troops, the \$5.6 million works out to \$5626652/2136779 = \$2.63 per service member per year = 22 cents per month.

Belkin points out that actual costs would be lower, because transition-related care would “mitigate serious conditions such as suicidality that, left untreated impose costs on the military” and one could expect that the availability of treatment would improve job performance.

Additionally the \$29929 cost per claimant was for private-sector health care.  But the military provides medical care much more efficiently and one could assume that transition surgeries would be well within the skill set of the military’s reconstructive surgeons.

One could also assume that transgender service members, having already chosen to serve in the military, would be less likely than civilians to access transition-related care due to the obligations they feel toward that service.  On the other hand if the military covered procedures for family members and dependents, the costs could be higher.  Costs could also be higher if transgender civilians join the military in order to obtain medical care.  That is not an unlikely scenario since recruiters have been known to use the promise of health care benefits to entice non-transgender civilians to enlist.  The low utilization rates in the private sector suggest that few transgender people obtain their employment specifically so that they can access the transition-related health care.

I was particularly surprised at the number in the context of what the military overall spends on health care.

Pete Sepp, president of the National Taxpayers Union, a non-partisan government spending watchdog, said the Pentagon should consider cost-cutting elsewhere if it takes on the responsibility of treating transgender troops.

If transition-related care is deemed a necessity, then preserving other vital health services for the troops should mean finding lower-priority items to cut so service people and taxpayers are protected,” Sepp said. The Pentagon should also consider tapping non-profit groups for funding for transition care.

Because nothing says equality like treating the medical needs of different troops differently, right Mr. Sepp?