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.