Transhumanism Or Solidarity? Pick One
What the Cass Review reveals about the delusions of gender leftism
The Cass Review finally published this week: the result of a three-year independent investigation into the provision of healthcare to gender-confused children, under Britain’s National Health Service.
It’s a serious effort, authored by someone who clearly prioritises truth and evidence over ideology and optics, to parse the competing wishes of activists, parents, and unhappy children in a field that has become acutely politicised. Whatever its shortcomings and sometimes overdone moments of “false balance”, work of this kind has, to date, been grievously lacking.
There have been plenty of excellent commentary written already: if you don’t have time for the whole 400 pages I recommend Sex Matters’ bulletin and briefing, and Kathleen Stock’s sharp assessment of the consequences of treating children as though they are adults. I wrote a short comment for the New York Post on what it implies for the now-widespread consensus beyond Britain (and, sadly, among some practitioners still in Britain) on “affirmation-only” treatment for trans-identified children. Not to mention the false, invidious, and equally widespread assertion that children will kill themselves unless their gender wishes are obeyed - for which the review found no evidence.
Here though I want to pick up on what Cass reveals about one of the most abiding paradoxes of Left-wing bio-libertarianism. When I say “Left-wing bio-libertarian” I mean those who believe both in state support for the weak and needy, and also that people should be free to remodel their bodies at will for identity reasons.
What Cass reveals is that this group can’t have it both ways.
The moral vanguard of bio-libertarianism largely comprises people who think of themselves as Left-wing. Take this recent essay by the trans-identified critic Andrea Long Chu, in which he argues that children should be able to change their gender at any time, as often as they like, for any reason - and also that this should be paid for by the state. “No single federal program would benefit trans people more than Medicare for All,” he declares.
In response I pointed out the reality, which is that medical interventions (even spurious, elective, or iatrogenic ones) cost money. Doctors and medical suppliers want paying. So someone has to pay for it, and that pot is never limitless, whatever healthcare regime you live under: socialised, insurance-based, or (as in most European states) some hybrid. Importantly, to the extent that you ask the state - really, taxpayers - to stump up, so the state and its taxpayers will have a stake in how those healthcare resources are allocated. Further, in practice this means that states with more socialised healthcare regimes tend to be more conservative on trans issues: the collective incentive is to keep a lid on demand.
The Cass review illustrates this. For the British National Health Service, a fully taxpayer-funded healthcare system, the bureaucratic incentives line up for rigorous assessment of the evidence base before funding any new medical treatment. Even within this structurally conservative healthcare order, the sheer force of gender ideology saw widespread adoption of transhumanist clinical practices on the basis - as Cass notes - of evidence that was at best flimsy. The Cass review represents a ponderous efforts by the vast NHS bureaucracy to self-correct and rein in such excesses. And no wonder: should demand for gender-based elective interventions go on ballooning at the rate we’ve seen over recent decades, the volume of service demanded would require an unworkably large slice of NHS funding. This can’t be justified if evidence and outcomes show no clear benefit.
The Cass report tacitly makes clear the reality - one faced by urgent care doctors every day - that medical resources are often limited, and practitioners are always triaging on the basis of need. And herein lies the paradox. Andrea LongChu-style bio-libertarianism asserts that the basis for healthcare provision should not be need at all - for need can only be assessed against a normative picture of human health. Rather, desire should be the only guiding light. “Give everyone healthcare”, where “healthcare” means “Let anyone change their sex. Let anyone change their gender. Let anyone change their sex again.”. In other words: “healthcare” in this model means “whatever medical interventions I want”.
But ask any practising doctor to weigh “what this patient wants” against “what this other patient needs in order to not die”, and see who gets treated first. The only situation in which they weigh equally is one in which medical resources are limitless. And, as the Cass Review now amply demonstrates, “limitless” emphatically doesn’t describe a socialised, taxpayer-funded one. This theoretically limitless provision is, in fact, far more likely to obtain where the only boundary is patients’ own ability to pay for a procedure: either their own pockets or fundraising abilities, or the willingness of insurers to stump up.
So it’s not actually true that “No single federal program would benefit trans people more than Medicare for All”, as Chu asserts. On the contrary: it’s more likely that no single federal programme would do more to rein in the excesses of American gender medicine than Medicare for All. Socialising healthcare would create a far more robust incentive within American medicine to ask: does the patient really need this procedure, or does he just want it?
More broadly, this highlights perhaps the constitutive paradox in postmodern leftism: a desire both for infinite personal freedom and also infinite subsidy for all the externalities and ancillary costs of that freedom. In practice, this never works. You can theoretically persuade your fellow-countrymen of your right to remodel your body endlessly, if you want to. But you will have a much harder time persuading them to bankroll your every biomedical flight of fancy - especially if this week’s gender whimsy is competing for ward space with cancer patients.
And from this follows an uncomfortable conclusion, for those who are both bio-libertarian and also avowedly Left-wing (which is to say, almost all trans activists). It’s this: that social solidarity is always pragmatic, always limited, always a matter of doing the best with available resources. Like every kind of commons, it relies on people’s willingness to moderate their own desires in light of collective needs and interests. This is radically incompatible with the anti-normative, transhumanist model of healthcare, as a panoply of theoretically limitless upgrades ordered only to individual desire. So the push to re-order medicine to desire rather than normative human health will either fail, when it encounters social limits. Or - if it succeeds - it will destroy those limits: which can only be achieved by destroying social solidarity in public health.
In a system where resources are limited, long as medicine is understood as mostly ordered to health, rather than desire, gender will lose out in triage. Conversely, once a polity accepts that healthcare should be ordered only to desire, you can no longer have healthcare based on social solidarity. Sustaining that solidarity would mean, in effect, writing a blank cheque for anyone who wants to tinker with their own organism. So either the solidarity goes, or the transhumanism. In turn, this suggests is that the proper political home for transhumanism is not on the Left at all - at least not the solidaristic, economic Left.
A growing number of transhumanists themselves already grasp this. It is chiefly gender leftists who remain blind to their role, as useful idiots for a medical libertarianism actively destructive of the social solidarity they claim to espouse.
This is bang on. We don't talk enough about this massive contradiction. I've always struggled to understand how people who call themselves "leftists" are so comfortable with extreme individualism in tramsactivism. The concept of solidarity is fundamental to left wing politics, if everything is all about individual self actualisation and limitless freedom then how can it be called left wing? It's more like libertarianism (but with a bit of good old left wing authoritarianism thrown in when it comes to enforcement!). This contradiction is visible in other areas of leftist politics beyond the trans issue, especially mainstream liberal feminism (not radical feminism, which does know what solidarity is).
I feel like I’m going around blackpilling people on this report which isn’t my intention. But in general, we’ve learned that systems with inherent contradictions can sustain themselves and remain powerful for a surprisingly long time.