There’s easier ways to make a buck than surgery, but it probably plays into a larger strategy.
For one, they’d rather get you hooked on pills which have a higher ROI and are easier to sell at scale. So, keep doing those puberty blockers for 10 years before you’re old enough for surgery, then keep guzzling artificial hormones etc for the rest of your life after.
Even still, I think we’re talking about small enough numbers of people that it’s not going to motivate a whole lot of effort just to get those patients’ money. But as a precedent for forcing insurance companies and/or the government to spend millions of dollars per patient, it’s a good long term play. Why not spend that much per patient on weight loss pills, ADHD medication, etc?
After the surgery you have someone who will never again be a normal person. They take a person who might never have gone to the doctor despite having insurance where you’re guaranteed to get paid to having someone who requires a lifetime of care that insurance needs to pay for who was pre-selected as having insurance.
There’s audio out there of hospital administrators talking about that exact thing.
They don’t think they’re absolutely evil because they also have been indoctrinated into thinking they’re doing the right thing. That’s despite having something where 60-90% of kids are cured if you do nothing and just let them grow up.