Benefit of transition.

A San Francisco city employee describes how the city's groundbreaking sex-change benefit policy will help her and many others

When the San Francisco board of supervisors approved a proposal on April 30 to cover some of the costs of sex-change operations for transgendered city employees, no one cheered louder than Claire Skiffington. The male-to-female "tranny," as Skiffington calls herself, has already spent more than $20,000 on surgery and related medical care out of her own pocket, a large sum for a career city employee.

"This city has always been a magnet for people who have been beaten down, and abused, "said the 56-year-old mental health services coordinator for the San Francisco health department. "We were standing on the shoulders of people who moved here from all over the world for a better life long before I did."

Transgender activists did not get everything they wanted, however. The measure pubs a cap of $50,000 on the cost of gender reassignment, including therapy, hormone treatment, and surgery, all of which can add up to hearty $100,000. New costs incurred by the policy will be covered by current and retired city workers, who will be charged an additional $1.70 per month. The Advocate caught up with Skiffington shortly after the board's historic vote.

What did you think of the debate by the board?

It was almost three hours of bickering. Boy, politicians can be boring. They make bureaucrats like me look interesting.

Some argued that the change in policy would be too expensive.

The critics were using spastic arithmetic. There are only 15 transgendered employees of the city, yet they were projecting 35 [operations] per year. Fewer than haft of us will need or want surgical procedures, which is the expensive part of the coverage.

On the other hand, some transgender activists objected to the cap and the one-year waiting period for surgery.

I knew going in we wouldn't get everything we wanted but that this would be a great start. There will be a two-year study of the costs of the policy, and then we can revisit the cap. Once the economists stop scaring the homes, we can have a better debate.

Supervisor Tony Hall charged that it was unfair for the city to pay for some employees to have sex-change operations but not assist others who are "not satisfied with the size of their existing appendages."

He seems to feel the system was going broke because we are getting a special class of services that nobody else can take advantage of. That's just not true. Anybody can use this coverage. Many people don't need vision coverage, but it's there for everyone who might eventually need it.

Some argued that the resources would be better spent on other things--health care for the homeless, for instance. How important is the medical care this affords transgendered people?

You have to live 365 days a year in your body. If you are not comfortable with your gender, it's like living in hell. You can't live your lift? properly; you can't blend into society at large. You are completely out of place. No one should have to live like that. Let's put this kind of coverage in the preventative column. It's better to teach someone to ride a horse properly than to have to treat a broken leg every few months. This will lead to healthier lives, healthier people.

You began to identify as a female a decade ago. What does the policy mean to you personally?

I've had enough [surgery] done on my body in other parts of the country and in Europe that I could legally change my birth certificate from male to female. But I've had to use my own savings. There was a time when there were loopholes in some insurance policies where you could get it done, but the insurance executives shut them down. Now it takes a lawsuit to get it done or you pay for it yourself, which isn't fair to people who can't afford it. I lacked the gumption to do something I'd known I needed to do until fairly late in my life. This kind of coverage will eventually become routine, and we will all be better for it.