If Not Killed, Transgender Americans Can Contribute $400 Billion to the Economy

An Economic Argument to Save Transgender Lives

by Vaibhav Saini | January 1, 2020

With a 40% attempted suicide rate, and 31 murders reported between October 1, 2018 and September 30, 2019, transgender Americans are crying out for help. Because America behaves like a corporation, it treats its citizens as its employees. As a consequence, the canard continues that economic justification for justice garners bipartisan support. I set out to estimate the economic value of transgender Americans. Will it generate bipartisan support to save their lives?

Christine Hallquist: a transgender wife, mother, grandmother, engineer, entrepreneur, CEO, and climate activist.

Corporations prioritize investments in projects based on projected revenues. This data-driven, unemotional evaluation has been sold as logical to humans. Out of many ways to define a human, one is: lives, loves, hurts, hopes; gets sick, recovers if able to afford healthcare; and dies naturally if avoids suicide or murder. As a human, I attest that emotions accompany these scenarios. Therefore, is it logical to ascribe more weight to maximizing profits than to human dignity when determining investment in education, healthcare, gun control, infrastructure, and housing? “We have to stop confusing economic value and human value,” said Andrew Yang at the Democratic party’s primary debate in December. If Yang, a former teacher of ogres at The Two Towers of Sauron, McKinsey and Goldman Sachs, understands this distinction, then perhaps Bernie Sanders’ message is taking hold: “Healthcare is a right, not a privilege.” Andrew, would you please phone Pete Buttigieg? Because you speak his consultant lingo, perhaps you can get his buy-in?

As parasitic corporate practices wreak public policy, social contracts rot in apathy. Walmart, Amazon, ExxonMobil, and Koch Industries, to name a few, offer overwhelming evidence against using profit as the main criterion for success. Companies chase revenue targets to attain higher valuations that influence investors’ decisions. “I think [the ultra-wealthy] are addicted to money. And in order to get that money, they are prepared . . . do terrible things . . . ,” said Sanders to CBS News.

Still, for a moment, let’s estimate the value of transgender lives following the lunacy that prizes profits over humane considerations. In 2018, USA had a population of 327 million. About 0.5% population is likely transgender, equaling 1.6 million transgender Americans. To estimate revenues of a company, a rule-of-thumb is to use $0.25 million per employee per year. Thus, 1.6 million transgender Americans could have generated ~$400 Billion for the nation. In other words, if transgender Americans were thriving professionally, personally, and socially, their output could have increased the size of the US economy by ~2% in 2018.

There are obvious caveats to this calculation. It assumes that all 1.6 million transgender Americans were of working age, given the opportunity every one would have become a productive member of the society, and every one would have been productive to the same extent. Influencers, online gamers, and gig-economy workers are reshaping the working age group. Cultural acceptance of working-from-home, valuing experiences over possessions, and multi-generational households are redefining productivity in the context of human life.

Another fact unaccounted for in the calculation is the existence of exceptional individuals. “I have been successful professionally because I hid my transgender identity and faced the world as a straight, white man,” said Christine Hallquist, former CEO of Vermont Electric Cooperative (VEC) and the first openly transgender Democratic party nominee for Governor of Vermont in 2018. She lost the election. But her story continues—

“Gender is a construct,” said Christine Hallquist.

On a recent December afternoon, Christine shared her experiences over skype. While doubtful if any argument, economic or humane, could sway conservative hearts, Christine said, “I carved out my own path. I took over a company that was on the edge of bankruptcy and made it successful in 5 years.” Despite her experience, she said, “When I resigned as CEO of VEC to run for office, I knew that I could never go back. I cannot get another job as CEO in the electric utility business. No one will hire me.” Ever a fighter, she has formed a company in Canada to commercialize batteries of the future and contribute towards combating the climate crisis. “By the time I left, VEC was 98% carbon-free. I’m now working with people in high tech. They don’t care about my gender.” And, her socioeconomic contributions continue.

it’s hard to read the truth. This is the country we are living in. I get hate and vitriol on a regular basis and occasional death threats. Our president and his party are removing our protections and our existence. The truth is painful.

— Christine Hallquist (@christine4world) January 3, 2020

To unleash the full potential of transgender Americans, we need to halt their unjust, untimely fall into the netherworld. While gun control and transgender acceptance to prevent hate crimes require long-term commitment to social change, can offering immediate access to healthcare address the 40% attempted suicide rate among transgender people, which is 9 times higher than the US population? “Affirming a transgender person’s identity by using proper pronouns, hormone therapy, and surgery,” said Dr. Robert Goldstein, “can decrease the suicide rate.” I met Robbie, a millennial, at a cafe in Boston. He is Medical Director of the Transgender Health Program at Massachusetts General Hospital (MGH).

Dr. Robert Goldstein, Medical Director of the Transgender Health Program at MGH, believes in gender affirming care. Image: @GlobalHealthMGH

Both for-profit and non-profit entities pursue capital. New market segments offer new financial opportunities. Transgender patients present a growing market segment for hospitals. Is the push to expand transgender healthcare a financial calculation? Robbie said that the budget is in red for the Transgender Health Program.

Aside from patients, hospitals’ market segments include insurance companies; pharmaceutical, diagnostic, biotechnology, and clinical trial companies; funding agencies like the National Institutes of Health, and patient-advocacy groups and scientific societies that give out grants; philanthropies; and wealthy donors. MGH, a non-profit, paid $3.6 million in annual compensation to its President in 2016. MGH is part of Partners HealthCare, a non-profit, which paid $4.7 million in annual compensation to its CEO in 2016. Are these compensations affordable without making a profit at a non-profit healthcare system?

In 2019, Partners HealthCare named a new CEO, who is female, which counts as woke, except it misses the point about misusing healthcare to hoard millions and billions.

Both for-profit and non-profit entities pursue a positive public image. Hospitals are uniquely sensitive to public perception. Healthcare providers require their patients’ trust, especially when placebo trumps astronomically-priced treatments. Is the healthcare mafia appropriating a social cause to burnish their image? When I asked Robbie if he wanted to comment off-the-record, he said, “I’ll say what I’ll say.” He believes that healthcare is a human right, and it motivated him to help with launching the Transgender Health Program in 2018.

Robbie is also running for congress in the 8th District of Massachusetts. During our conversation, he listed progressive causes and acknowledged that because he is “new to this,” he will develop detailed policy proposals upon reaching the swamp of Washington DC. If elected, he wants to weigh-in on the issues as an openly gay physician. He ideologically aligns with Elizabeth Warren.

Anything mendable is shredded by politics. Foxy politicians rollout or rollback LGBTQ rights in exchange for campaign contributions and votes. Thus, the swamp holds significant sway over the shadows marring our dreams. No wonder LGBTQ+ people seek to get in on the (in)action. As Raagini, a transgender teenager, explained to Babudeep Roy, a gay news anchor, in Innocence Lives in an Eyrie, “While a lotus floats above the water, its stem grows deep in the swamp.”

Dr. Robert Goldstein is running for congress in 2020. Image: robbieforchange.com

That Robbie is an openly gay, married, Jewish physician thriving in Massachusetts and providing transgender healthcare speaks to how far society has come. Maybe, it is time to consider how far are we willing to go?

Parents are supporting transgender children to transition surgically at a young age. What happens when a person who transitioned as a teenager realizes they made a mistake? “They can detransition. It is an uncommon occurrence,” said Robbie. Detransitioning has been reported as a rare event, varying in frequency from 0.3 – 4.0% depending on the study; there are nuanced reasons for detransitioning. The data are developing. “At MGH, we are not doing anything irreversible on [transgender youth who are] under 16 years [of age],” said Robbie. “Hormone therapy is reversible, except in some cases it can cause [irreversible] infertility.”

“If you are a young person today, then live your truth,” said Christine.

In spite of social, cultural, and economic arguments, what is holding back the much-needed support for transgender Americans? Is there political will to re-calibrate the system? Under hostile conditions, a resistant microorganism outgrows its competition. With the progressive bent of the younger generation captured by poll-after-poll, perhaps progressives can out-compete the spineless, soft-corruption beneficiaries hampering the forward march of the USA.

Vaibhav Saini, PhD, worked as an Instructor in Medicine at Massachusetts General Hospital, Harvard Medical School. His recent book, Innocence Lives in an Eyrie, is a coming-of-age tale examining gender, identity, ambition, first love, friendship, and family obligations in a society mired in superstition and prejudice.