This is why you should just buy it yourself. Public healthcare is great if it works, but there is no sense in putting off your life over 200 a month.
Somebody ought to riot
Maybe gatekeeping doesn’t work.
What do you mean? This system is working exactly as intended.
maybe defunding healthcare more will help?
It's not much better in the US and there isn't a unified "gender clinic" to coordinate things. And travel for surgery and recovery is expensive, especially when most insurance doesn't pay for that and things are so spread out in the US, so most have no option or if near a major city are stuck with the one or two overbooked options close enough to them that they can get a ride to.
I had to travel to another major city to even get on a waiting list for my first surgery since in the major city where I live, the one clinic that has a surgeon was totally unresponsive on how long their waiting list was after taking my doctor's referral.
And I had to pay around $4,000 for a month at an AirBnB plus flights, food, and necessities we couldn't fit in the now strict 50lb weight limits on luggage for me and a care person. I couldn't bring a carry-on since I wouldn't be able to carry it on the way home and you can't put the heavier liquids in there anyway like soaps, shampoos, hair products, lotions, etc. And paid several thousand out of pocket to cover deductibles and coinsurance despite having the most expensive health plan my company offers which costs about $400 every other week from each paycheck despite the fact I work for said insurance company. And that was only one surgery.
Next surgery is a 1 year wait for a consult and no clue how many years before surgery and another one is at least a 3 year wait for consult and at least 4 year wait for surgery after the consult. I can't afford to travel again for those. Had to take out a home equity loan for the first one. And I still have to pay for the mental heath visits for the gatekeeping WPATH letters each time both for the consult and again for the surgery since they each expire after a year. I really wish there was someone to help coordinate it all. For example, if I end up with the waiting lists ending too close to each other I'll have to go back on the beginning of the list assuming the surgeon is still scheduling new surgeries because you can't get too many too close to each other and they're totally separate offices.
And traveling internationally is too dangerous right now with my passport being forced to be my birth gender and my genitals not matching for the x-ray, so unless things improve it is likely I'll be too old to get most of the surgeries by the time I get through the lists. I'm already starting later in life due to lack of care. Plus I need other small surgeries for some unrelated issues which I can't find providers for in my insurance network taking new patients and can't afford to schedule too far out, just in case I get to the top of the gender care surgery wait lists.
The gender clinic is where they get hormones.
I lucked out for surgery and was able to get it at 26 a city over with work insurance and it was a really hassle, but for all the difficulties here getting hormones in the US is actually way easier than most places.
Yeah I will say the hormones are easier here. I had thought the clinics also helped them coordinate surgery, but I don't really know well, just going off of something I read and it's possible that it was just one clinic that happened to offer that service, too.
For hormones here the hardest part is finding a therapist and/or psychiatrist to write the letters and in some places, finding a doctor willing to prescribe and monitor and fill out a support letter and all the paperwork to get prior authorization for the off-label-use dosage since you need more than a cis-woman which is often all that's covered by default and often isn't covered at all by default if your birth gender marker is M. When my plan changed this year I had to start getting the prior auth every 6 months because I exceed the max covered dosage by 3x.
I was lucky to have a primary care doctor that was experienced, though she moved on now. And I found a list of therapists willing to write the support (gate-keeping) letters with only a single, virtual appointment, though I had to pay cash and needed 2 of them (one at least PhD level and one at least MA level) for the surgery. For me the hormones only required one and could be MA level, though. I was on waiting lists for both therapists and psychiatrists at the time, so that list saved me. There's a shortage of mental health providers around here, too.
And the letters technically are supposed to require the mental health providers to know you well, but a lot of providers know that's just gate-keeping. And, some insurance still requires the even older WPATH recommendations that you get one that does and one that doesn't know you. My insurance is only one version behind, though, using version 7, but some use 6 or even 5 still.