Earlier this week, I wrote about a joint legislative hearing in which California pretended to conduct fact-finding on a proposal to fund $26 million worth of transgender medical services for children. Beyond what we learned about the topic, though, the hearing was also a revealing look at the way Democrats manage debate, and at the weak and helpless way Republicans too often react. Democrats steer, and Republicans ride the bus. This clear dynamic becomes especially obvious in a state where a Democratic supermajority can and does steamroll its opposition, not feeling the need to be subtle. They have the confidence to reveal who they are.
Legislators arrived at the meeting with a package of written background material that was supposed to prepare them for the discussion. When the Republican Assemblyman Joe Patterson questioned a witness, a well-known doctor who runs a transgender clinic, Democratic Assemblywoman Dawn Addis intervened:
“It sounds to me, assemblymember, like you’re starting to question the doctor about her personal perspective, and things that you’ve read outside of the hearing, outside of our preparatory materials.” She caught him thinking for himself, and put her foot down: He asked questions that departed from the premises and evidence contained in the joint subcommittee’s pre-meeting report.
You can read those acceptable preparatory materials yourself, since the legislature posted them with the agenda. They establish the facts that frame the debate, making it irresponsible for a legislator to do research outside those materials:
And so on, in a set of claims that are established as incontestable. “61 percent of youth on gender-affirming hormones were somewhat or very concerned about losing access to this care.” Don’t ask questions outside of that material.
The Trevor Project is a pro-trans nonprofit in West Hollywood, and explicitly an advocacy group. But the opening of a debate in a state legislature establishes the organization as the experts who provide the factual floors, walls, and ceiling within which debate can occur. It’s like starting a debate on eating steak with an expert report from the Vegan Society.
This ludicrous façade of neutral expertise set the tone throughout the hearing. Here’s part of the opening testimony from Mary Watanabe, the director of the California Department of Managed Health Care:
“Plans are required to use the clinical criteria developed by nonprofit associations for the relevant clinical specialty when making medical necessity determinations. For services to treat gender dysphoria, health plans are required to use the World Professional Association for Transgender Health, or WPATH, guidelines.”
Transgender health isn’t a clinical specialty, by the way, and you can’t do a residency in it (though fellowships are beginning to appear), so this framing makes no sense on its face. The Accreditation Council for Graduate Medical Education “does not consider education in transgender health as a required component of residency education programs,” so doctors aren’t even assured training in the topic.
Again, the language of clinical specialty and medical determinations dresses up the advocacy of an organization that defines itself this way: “We envision a world wherein people of all gender identities and gender expressions have access to evidence-based healthcare, social services, justice and equality.” So California’s posture is that they’re just following the science and trusting the experts, which might strike you as familiar framing, while the supposed clinical expertise guides a process to a not-at-all-neutral conclusion. They’re just listening to the medical experts, you see?
It’s like an association of doctors who perform breast implant surgeries has released a very important clinical report on the safety and desirability of breast implant surgeries, which then become a state mandate. The doctors from the transgender medicine organization say that, in their clinical judgment, transgender procedures are very good.
Here’s the testimony of Tyler Sadwith, the chief deputy director of Health Care Programs at the California Department of Health Care Services:
The only topic of the debate is “medical necessity, consistent with clinical guidelines” established by associations of medical professionals. Should we use a scalpel to turn boys into girls? That’s not a value judgment or a debate, because it’s just a clinical decision to be made by trained experts.
Now, when he wasn’t being silenced and chided, here’s a sample of the arguments Patterson actually made:
Against a long stream of claims about medical expertise and objective clinical standards, which Democrats framed as the scientific foundation of trans medical interventions, the Republican legislator who spoke at the hearing used “I” language: “I, too, care about people and want to protect them … Um, and, you know, and when it comes to this topic, it is one that I am very concerned about, um, for different reasons. It should come as no surprise to anybody up here.”
Then he conceded the foundational premise of the debate, talking about evolving opinions around the world on the topic of “gender-affirming care for children.”
Patterson went on to tentatively slip his own argument from authority onto the table, only to pull it right back off: “And I don’t, you know, there’ve been studies after studies, and we could cite ’em, and I’m sure every single study that I give would be somehow discredited by some facts, or, you know, I mean, we could have this debate forever. Um, but there is a lot of scientific evidence that gender-affirming care for children, particularly surgeries, is problematic, and that is why a lot of countries are abandoning it.”
So Democrats and Democrat-aligned bureaucrats talked in serious tones about clinical standards and scientific evidence and medical expertise, after which a Republican said that he could cite some studies, but they’d be discredited. He did it while repeatedly conceding the premise: “gender-affirming care for children.” Children have a gender that rides alongside the accident of their biological sex, and it can be affirmed. Incredibly, this was the Republican argument in opposition.
And finally, while Democrats said that discussion must conform to the correct materials and approved facts contained in the preparatory report, establishing a body of fact claims that couldn’t properly be disputed, the Republican framed the discussion as a debate, accepting the premise that the other side was advancing equally worthy arguments that could prevail in the end.
Similarly, Patterson had a chance to question Dr. Johanna Olson-Kennedy, a quite controversial pediatric transgender practitioner who was forced out of the big children’s hospital in Los Angeles. Patterson referred to her, accepting three questionable pieces of framing in one sentence, as “one of the global preeminent leaders on treating children with gender dysphoria, or trans youth.”
1.) She’s a top global expert, 2.) she’s “treating” children, and 3.) children have gender dysphoria. The Republicans have finished their argument, ladies and gentlemen.