I did not say I liked it or not...but the title is comparing the cost benefit of hundreds against the cost benefit of a few. 
Wouldn't you expect the total cost of a benefit used by hundreds to be more than total cost of a benefit used by a few? Do you understand the point I'm making.
The cost to cover one person's transgenered medical needs far far out weighs the cost to cover one person's Viagra needs.
The goal isn't to maximize coverage for a single individual, but to maximize the individuals who have coverage.