'Botax' Could Nip and Tuck the Cost of Health Reform

WASHINGTON (Nov. 19) -- Looking good may soon cost more.

Tucked away in Section 9017 on page 2,045 of the 2,074-page Senate health care reform bill is a 5 percent excise tax on elective cosmetic medical procedures. The "botax," it's been called.

The levy would be charged on any aesthetic improvements that are "not necessary to ameliorate a deformity arising from, or directly related to, a congenital abnormality, a personal injury from an accident or trauma, or disfiguring disease."

Face lifts, tummy tucks, breast implants, nose jobs, laser hair removal and, of course, botox injections, could all be taxed. Reconstructive surgeries for children with cleft palates, burn victims and women who have undergone mastectomies would be among the procedures exempt from the tax. There were 4.9 million reconstructive plastic surgery procedures performed in 2008.

The congressional Joint Committee on Taxation estimates the new tax could generate $5.8 billion over the next decade. One economist called the measure "comic relief" in a health care bill expected to cost $849 billion by 2019. Plastic surgeons aren't laughing.

"I don't think this is good at all, but not because I'm a plastic surgeon," said Phil Haeck, president-elect of the American Society of Plastic Surgeons, which will lobby against the levy. "It's an unfair tax on women."

Of the 12.1 million cosmetic surgeries performed last year, 91 percent were on women, according to the group's statistics. Overall spending on plastic surgery was $10.3 billion, down 9 percent from 2007 thanks to the recession.

Rumors of breast implants and collagen lips typically swirl around the likes of Britney Spears and Angelina Jolie. But Haeck said most plastic surgery patients are working women with annual household incomes of $30,000 to $90,000 and "not the ultrarich who could afford the tax."

Haeck noted that since New Jersey became the only state to tax cosmetic surgery, passing a 6 percent levy in 2004, it has collected far less than anticipated. He also questioned how the tax would be applied in "gray areas" such as breast reductions to relieve back pain. And he said the measure could violate patient privacy laws.

"Patients don't want the government snooping in their charts asking to know if they had a face-lift," Haeck said.

Roberton Williams, a senior fellow at the Tax Policy Center, said that while the botax "strikes me as bizarre," it has a reasonable chance of surviving in any final bill. He noted that the IRS can easily collect the tax without invading patient privacy by using medical codes already required by health insurance companies.

"They need money wherever they can find it and this seems like a good place -- unnecessary surgery," he said. "These things are done by choice, not out of medical necessity. Why not tax them?"