If a boy in New York has been convinced to think he’s a girl, the state Medicaid program has got you covered. But if a boy with muscular dystrophy just wants to walk again, he’s in trouble. 

That’s the outcome of the state’s high-cost drug initiative, which empowers the state’s Department of Health to arbitrarily decide which medicines it will pay for and which it will refuse. It can designate drugs as too expensive and thereby deny care, which it has done with a miracle gene therapy called Elevidys that can help children regain mobility.