Updated

In the midst of cash-strapped Californians approving new taxes to prevent further cuts in essential state services, San Francisco health officials appear to have found the money to fund what they say is a much-needed service to residents living in the City by the Bay:

Sex changes.

The gender-switching surgeries are part of a comprehensive program for treating transgender people that the city's Health Commission green-lighted on Tuesday and announced two days later. Backers say it will help ease the mental anguish of people who feel they are trapped in bodies of the wrong gender, but critics wonder why the taxpayers should foot the bill.

“Taxpayers cannot afford this, as there are unintended costs and unintended consequences unrelated to the actual surgery, such as their longer-term hormone treatment, psychology needs and other longer term health issues,” said Thomas Moyer, a City by the Bay resident and author of “A Conservative Survival Guide to San Francisco.”

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Under Mayor Ed Lee, the city's current budget topped $7 billion for the first time in history this year. In addition to the local tax burden, residents have seen their cash-strapped state slash an array of services.

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The idea of taxpayer-funded sex change operations came out of talks between public health officials and transgender rights advocates who wanted mastectomies, genital reconstructions and other surgeries covered under San Francisco's universal health care program. City

Public Health Director Barbara Garcia said the program could be in operation late next year, once her department has studied how many people it would serve, how much it would cost and who would perform the surgeries.

Transgender advocates hailed the vote.

“All Americans, in consultation with their doctors, should be able to receive the medical care they need to live healthy lives,” said Kristina Wertz, program director for the San Francisco-based Transgender Law Center. “That’s why we applaud San Francisco’s decision to allow transgender people the ability to receive the medical care they need to be healthy.”

But Moyer said people should pay for their own sex changes, and public money would be better spent elsewhere.

“This surgery is not an essential health function, especially when it would be taking money away from those suffering from chronic illnesses like cancer, Aids, and heart disease,” Moyer said. “We are already stretched too thin as San Francisco is facing a budget deficit and won't be able to afford the costs of this.”