The Right Prescription
A New Ugly Wrinkle
The “Botax” sticks it to working women.
Is health care reform designed to discriminate against women? On the heels of nearly mandating a “just say no to mammograms screening” for women under 50, members of Congress remained silent about another USPSTF recommendation that women be denied access to routine testing for a biological marker that more accurately predicts the risk of heart attacks than the older, cheaper (and more male-oriented) approach that will be covered.
Now in yet another effort to scrape up cash for the healthcare clunker, Congress is going after a woman’s right to choose, in a manner of speaking. The Patient Protection and Affordable Care Act would impose at least a 5 percent tax (and perhaps 10 percent) on cosmetic medicine that the U.S. government decides is “not necessary to ameliorate a deformity arising from, or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma, or disfiguring disease.”
Of course, thought leaders behind this idea believe that this tax will stick it to mostly rich and vain women who indulge in cosmetic medicine to stay young, firm, and wrinkle free forever. To be sure, according to the American Society for Plastic Surgeons, between 1992 and 2005, annual U.S. cosmetic surgery volume increased by 725 percent, with over $10 billion spent in 2005.
The Real Housewives of New Jersey or Hollywood, however, did not fuel most of that increase. Ninety percent of the growth came from women making less than $70,000 a year. In general they were paying for less expensive non-surgical procedures such as skin rejuvenation, scar removal, laser procedures made more affordable by payment plans, aggressive discounting, and lower prices. While many procedures are called “cosmetic,” that is because insurance simply does not pay for them. It just means people have to pay for them. In fact, the most often cited reasons for having a procedure done were self-confidence, addressing a scar, or feature that caused shame or an effort to improve job prospects.
In 2008, cosmetic surgery declined by 10 percent and nonsurgical procedures increased by 5 percent, reflecting in part a shift to less expensive options.
So the question is, will a cosmetic tax increase revenue and mean better use of health care services or depress both?
The only state that taxes cosmetic surgery is New Jersey. It imposed a 6 percent tax in 2004, and hoped to bring in about $30 million then. It brought in less than $8 million as people went to New York and Pennsylvania. The tax was repealed by the legislature in 2006. Governor Corzine overrode that action and it brought in about $11 million in 2007. Even then, as Slate’s Christopher Bream notes, it costs “$3 in administrative spending for every dollar of revenue.” Apparently people in New Jersey’s tax department have a tough time determining what is “cosmetic” and “reconstructive” surgery.
The tax would cause the delivery of many non-surgical procedures to shift first to unlicensed and non-medical individuals and then to the black market for pharmaceutical treatments. It is already possible to get collagen and Botox injections at your local health spa and chemical peels at the nail salon. Slap a 5-10 percent tax on the transaction and watch the number of back alley Botox parties climb. The amount of counterfeit Botox, Restalyne, Reloxin and Dysport in circulation is growing. The added tax will likely increase that quantity. Finally, the tax could drive down consumption overall. Products such as Restalyne, Botox, Dysport may be regarded by policymakers as “lifestyle” drugs that deserve a “luxury” tax. But together these treatments have sales in the billions and support investigational research of their use for other, often life saving, purposes. Viagra for example is now used to treat pulmonary hypertension in critically ill infants. The multiple uses of Botox, ranging from treating children with cerebral palsy, diabetic pain to migraine headaches would not have been investigated without first being approved and sold widely for removing wrinkles. Call it doing good by looking better.
The so-called “Botax” is viewed as only affecting very rich women with an addiction to vanity. This sexist stereotype ignorantly misses the mark and will not raise the revenue expected. Millions of everyday people choose to pay for cosmetic procedures with after-tax dollars, not because they are conceited or want to look good before flying to Cancun, but because it enhances their lives in understandable and important ways. The “Botax” may not be the most outrageous aspect of the health care reform mess, but it is the one provision that singles out an individual’s choice to do what they will with their own money to their own body — a woman’s choice at that — for utter contempt and punishment. There is something truly ugly about that.
About the Author
Robert M. Goldberg is vice president of the Center for Medicine in the Public Interest and founder of Hands Off My H ealth, a grass roots health care empowerment network. His is new book, Tabloid Medicine: How the Internet is Being Used To Hijack Medical Science For Fear and Profit, was published last month by Kaplan.
Letter to the Editor View all comments (29) | Leave a comment
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Curtis| 12.7.09 @ 7:02AM
It brings up some interesting ethics and red tape questions. Just how oversized does a womans' chest have to before her breast reduction goes from cosmetic to paid for? How bad do your sinus passages have to be before your surgery is no longer a "cosmetic nose job." How big does a deformity have to be before they'll pay for its' removal? How much do you have to weigh before they'll pay to give you a belly band or liposuction ?
The danger is that people are going to intentionally stop taking care of themselves in order to have their procedure qualify as necessary. IE "If I gain ten more pounds, they'll pay for my belly band, and breast reduction." or "Maybe if I stay out in the sun some more, this spot will grow big enough for them to laze off."
Stephanie| 12.7.09 @ 7:49AM
This isn't and has never been about our health.
It's about power and turning this country into a socialist/communist one. Oh! And about stealing more of our hard earned dollars from us.
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Paul from SA| 12.7.09 @ 11:46AM
Perhaps they should impose a massive tax on cosmetic doctors. Or just include it as part of the minimum mandatory coverage every policy must have.
That way it can be free, just like ObamaCare.
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Walking Horse| 12.7.09 @ 2:42PM
Paul from SA..."perhaps they should impose a massive tax on cosmetic doctors."
Since cosmetic surgery is not covered by insurance, the interaction of health care provider and the customer is not muddled by third parties, which goes far toward explaining why cosmetic surgery prices are highly competitive and have not grown at the rates of health care mediated by a massive third party payer bureaucracy.
Go figure .. such an impenetrable mystery, for the politicos.
Paul from SA| 12.7.09 @ 10:30PM
It's nearly impossible to figure out their true motives. After all, they're so hung up how they look!
Laser eye surgery is another good example.
John II| 12.7.09 @ 6:26PM
Confucius say, "I have never seen a man who loves virtue as much as he loves beautiful women."
Very soon we will never see anyone in government who loves either.
c. j. acworth| 12.7.09 @ 6:26PM
A tax on wrinkle removal. What a great revenue raiser. Could pay for Obamacare with the take from Nancy Pelosi alone!
But seriously, folks, this article brings up a question that I have had for some time, which is, is it even possible to reduce the cost of health care at all, in the face of rising demand. The "cost of health care" is usually expressed as some per. cent of GDP. In those terms, I can't see any way to significantly lower the cost, because as people get wealtier, they begin to want procedures that were available only to the truely rich just a few years previously. Cosmetic procedures are a good example. When they were new, they were only within reach of "the rich". Now the middle class wants to join in. When I was a kid (early '60's) I can remember most of the blue-collar working stiffs my dad's age had a gap-toothed smile, including my dad. Caps were expensive enough that most guys just had the tooth pulled and spent the money saved on car parts. Now, folks are more concerned with appearance and the "hole-in-the-face" is a bit more rare. Also, we have a population that is getting older (tell me about it!) that will demand the type of care necessary to maintian quality of life for as long as possible. Givin all this, I would be willing to bet that health care as a per.cent GDP will continue to increase, or at least not be reduced no matter what congress does. In fact, I'd call my broker tomorrow and buy health care stocks if I weren't afraid that the current gang are going to wreck the whole system. But the effects of congressional action on my investment decisions is a rant for another day.
Jim Hlavac | 12.8.09 @ 12:09PM
There is much talk about some optimum spending on health care, and about society paying too much for it, and other similar formulations. However, if the government would not be restraining growth at every turn then we'd have a much larger economy. Thus the cost of health care relative to the size of the economy would fall. By injecting more and more government into it it should be said "health care spending by government is too expensive." It is not individuals, who are going to spend what they desire on the product, that are the problem. Rather it is government's limitations. Clearly, if a procedure is $10 today and $12 tomorrow, but provided by a private entity, then that is $2 more in profit and revenue, to hire more workers and to spend it outside of the health care system, creating jobs and thus padding the bank accounts of all. But if the $2 extra was government spending through tax money, then it takes that amount out of the economy, deducts an overhead charge, put back in the economy and results in no new net growth.
It is not the cost of health care that is the problem, it's who is paying. And since health care is technology driven -- and all other tech sectors prices and costs are going down relative to our earnings -- then it must be whoever is controlling the health care that cannot get the technological cost savings input into the calculation. That would be the government. Oddly, if the government controlled 60% of the computer industry then the same would happen. We would have prices going up, too much spending on computers, and a need to regulate even more supposedly, so that prices can come down. In every part of society that government is not involved in providing costs come down relative to wealth. In every part of society government is involved with their is no improvement and the costs go up relative to wealth. And the problem is that too many people not only think government can control costs, but ought to.
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