Considering that GRS is, many times, quite literally a life saving surgery and therefore very much a medical necessity, I never could understand why most insurance companies refuse to cover it. It seems likely the friend I've mentioned before would no longer be alive if she hadn't had the chance to get that surgery.
Edit: At least insurance did help her pay for the hormones.
Even more so, given the overall size of the population even if we all wanted hormones and surgery (which of course all of us don't) it wouldn't be all that expensive from an insurance perspective. It's cheaper than a lot of stuff they do cover.
Think it is Argentina where they actually implemented that. Basically anyone can have GRS on the state insurance, no hurdles, no x-years living in the new gender required, etc. The predominantly male, conservative opposition raised a howl about the expenses and whatnot, until they were asked for a show of hands how many of them would be going for the chance of genital reconstruction on a whim... :P As far as I know, their expenditures didn't even budge.
That sort of confronting generally seems to work quite well. A trans* friend of mine uses a similar approach when guys start to ask her rather rude questions about having "stuff cut off": she simply describes the process in quite a bit of detail - queue some rather pale faces hugging their beer tightly and apologising for asking.