In Defense of the Nip/Tax

With all due respect to Slate's Christopher Beam, I don’t agree that the "botax" tucked into the Senate health care bill is a bad idea. Much as it pains me to swallow conventional wisdom, the obvious conclusion in this case—that taxing elective cosmetic surgery is a great way to raise revenue for health care reform—also happens to be the correct one.

Tax-policy buffs generally analyze taxes along three dimensions: equity, efficiency, and economic stabilization. Beam goes for the triad, arguing, first, that a tax on elective plastic surgery would unfairly penalize the lower-middle-income consumers who make up the bulk of the market. (Though, with the prevalence of cosmetic procedures among teens and young adults whose parents foot the bill, I question the persuasiveness of his statistic that one-third of plastic surgery consumers earn less than $30,000.) Second, the tax would harm the cosmetic surgery industry and dampen its stimulating effect on the economy. Third, due to the hazy boundary between “reconstructive” and “elective” plastic surgery, high administrative costs would render its enforcement economically inefficient.

These points would be valid for an income or payroll tax. They are almost entirely irrelevant when scrutinizing a sumptuary, or “sin” tax, which is what this one is. The point isn’t to make wealthier people pay more. It’s to discourage some morally questionable or socially harmful behavior. Cigarettes are the paradigmatic example.

One could also argue that the surprisingly paltry average income among plastic surgery recipients actually presents a more potent argument for the botax. This is one instance of paternalism where father Obama knows best. If the majority of those going under the knife cannot afford to do so, the government should dissuade its low-earning citizens from frittering away their scarce resources on larger breasts and firmer calves and encourage them to invest in education instead.

Tags: cosmetic surgery, health care reform, plastic surgery, taxes

Jessica Dweck is a lapsed law student and current DoubleX intern. Follow her on Twitter.

Comments

Sin Tax

By: Xando | Thu, 11/26/2009 - 06:40

If we're going to impose a tax on cosmetic surgery for moral reasons, I'd suggest we should start someplace else first: high-heeled shoes. High heel shoes are thoroughly impractical and exist solely for 'cosmetic' reasons. They also carry more actual health concerns than getting your breasts enlarged. If we want to impose 'morality' on people's looks, let's start by getting women in flats.

I don't think you should

By: Shylo | Wed, 11/25/2009 - 17:17

I don't think you should conflate elective COSMETIC surgery with something like Lasik eye surgery, which is actually correcting a physical abnormality in the structure of your eye. Sure, there are other ways of correcting vision, but the cost of buying contacts or glasses year after year, while cheaper in the short run, is far more expensive than a larger investment in a Lasik procedure. Also, as a glasses wearer, I have to say that they're a real pain in the ass, often uncomfortable and not an option in all situations (I scuba dive - you can't really comfortably wear your glasses under your mask). Contacts can become an issue if you have an over-reactive immune system - people who wear contacts all the time routinely become allergic to them. Correcting a problem with vision should not be compared to augmenting, reducing or changing an appearance characteristic.

Also, about the reason women pay higher insurance premiums, this is mostly due to birth control or reproductive health options. Women are lower risk/lower cost for virtually all accidents and many occupational diseases, and yet we pay higher health insurance premiums because we're the ones with the ability to have babies. To obtain the 'privilege' of not having baby after baby, year after year because we're sexually active, we are made to pay extra to be given access to birth control and/or abortion options. Health insurance hasn't been fair to women for a long long time (or even possibly ever). I would most definitely trade a tax on elective surgeries for competitive, compensated access to birth control.

Botax a great idea

By: jerseygirl | Wed, 11/25/2009 - 14:45

If cosmetic procedures were taxed, then who pays the tax would depend on the competitiveness of the market. You are all assuming that the entire tax would get passed along to the consumer (hence the concern that it will burden moderate income women) but if cosmetic surgery is a competitive field, some of the tax burden will be borne by the health care provider.

Also, another benefit of taxing cosmetic procedures: if this reduces the profits for cosmetic surgeons, then perhaps at least a few medical students will choose to practice other, more useful, specialties.

To the woman who had the breast reduction surgery -- I'm not quite sure why your case is germane to the discussion, other than to note that there are reasons other than vanity for some cosmetic procedures. But your difficulties stemmed from the reluctance of your insurance company to pay for this. Let's say you had to come up with $5,000 for the procedure; would a tax bringing the cost up to $5,500 really have made this suddenly unaffordable?

Response to some of the commenters

By: Jessica Dweck | Wed, 11/25/2009 - 13:24

Kate,
There will always be exceptional cases like yours. As a formerly busty lady, I can totally sympathize with the excruciating back pain, bra welts, and spontaneously snapping straps that come along with a large cup size. For the most part, though, people seek plastic surgery for cosmetic reasons. Of course, as with any law, there will be line-drawing problems.  Is an otoplasty medically necessary--from a psychological perspective--for a child with low esteem due to constant bullying? Should gender reassignment surgery be considered "elective"? (I would hope not.)  Clearly, things may get a little messy. But the difficulty of drafting precise legislation should not stop lawmakers from attempting to execute an otherwise clever idea.

Natbel,

Jill Filipovic over at Feministe.com tackled this issue last week. http://www.feministe.us/blog/archives/2009/11/19/is-taxing-plastic-surgery-sexist/ I am similarly torn as to whether it's sexist per se and, if it is, whether that is relevant when the issue is discriminating against those who undertake medical and financial risks to look a bit prettier. Regarding your criticism of the final paragraph, I would like to point out that this was likely not a choice between burdening lower-middle income plastic surgery patients and not taxing anyone. Health care reform is expensive, and the money has to come from somewhere. If you're trying to single out some health-related economic activity to tax, it's hard to deny that elective cosmetic surgery stands out as an attractive candidate.

Thanks for reading, everyone.

JD

In fairness

By: rcwilliams83 | Wed, 11/25/2009 - 12:10

In fairness, aren't women statistically higher-cost consumers of health services than men are? I could be wrong, but I believe I've seen statistics to that effect. (It's why women's health insurance premiums are higher than men's are.) If so, it doesn't necessarily seem unjust for health care to be funded by taxes that fall disproportionately upon women.

Regarding Lasik, I halfway agree with you. On the one hand, it's much more clear to me that improving the workforce's eyesight creates wealth rather than just shifting it around, since it would correlate with increased productivity in all sorts of occupations. That would be a reason not to tax it. On the other hand, eyesight can be improved by less expensive, and not much less effective means, e.g., by corrective lenses. So I can see where you're coming from.

But politically, taxing cosmetic surgery is an easier sell than taxing Lasik, and the money to pay for health care reform has to come from somewhere.

Wrong, wrong, wrong

By: natbel | Wed, 11/25/2009 - 11:49

First off, I agree with a previous poster about the incredibly offensive and naive tone of the paternalistic last paragraph. Right, lower income people aren't savvy enough to not spend money on Botox without the government actively discouraging it, but if they don't spend that money on Botax, they'll "invest it in education." ??? I'm not sure anyone would make that swap, regardless of education level, income, etc.

Second, this seems like a dangerously slippery slope, with either grossly unfair contradictions that favor certain industries or the beginning of increased taxes on anything the government finds frivolous. Why is Botox and plastic surgery taxed but not Lasix? There really aren't pressing medical needs for Lasix, no matter how much people enjoy no longer wearing glasses and contact lenses. What about hair color and highlights? What about make-up?

Finally, and I can't believe that no one else has brought this up, women are larger consumers of plastic surgery and cosmetic treatments (like Botox) than men. This proposed tax is basically a tax on women. They could have broadened the definition of taxable procedures to things like Lasix surgery that are used more equally between men and women, but they didn't. Why should women be bearing the brunt of paying for healthcare????

With caveats

By: kate | Wed, 11/25/2009 - 09:26

Having just undergone a breast reduction that was deemed medically necessary by my doctors, but was not seen as necessary by my insurance company, I am a little reluctant to wholeheartedly endorse this.

In addition, that final paragraph on paternalism is strikingly insulting--most vice taxes, as well as luxury taxes, disproportionately affect those who cannot afford the items/services in question. Taxes rarely dissuade people from engaging in vice, no matter the cost (hence the rampant abuse of alcohol and the continually high rates of smoking among the lower classes). This is exactly why a lot of people in the lower socioeconomic rungs hate Democrats, and refer to the liberal "elites"--the very idea that you know better, and should attempt to restrict people's freedom to spend their money as they choose. It also betrays a lack of understanding about the poor--part of the reason that people tend to "fritter away" their money on things aside from education is not because they haven't been adequately "dissuaded" from it by high prices.

I'm not particularly poor, though I am a PhD student, and I could not "afford" the hugely expensive surgery, but I took out loans and got it anyway because my shoulders already had quarter-inch deep grooves, and my back hurt 24 hours a day. So I will be paying it off for the next dozen or so years, for the "luxury" of less pain in my late 20s.

Who am I to say that someone in more dire financial straits doesn't have good reason to "invest" in bigger breasts? I mean, jeez, one could point out that studies show that pretty people get better and higher paying jobs, as well as a number of other perks. Until society has "seen the light", um, cosmetic surgery IS an investment.

I agree too.

By: rcwilliams83 | Wed, 11/25/2009 - 07:56

I agree too. Beam's main point was that beautiful people are paid more, and that people being paid more is good for the economy, so we shouldn't place barriers in front of people who want to become beautiful. But it seems to me that Beam was conflating two unlike propositions: (a) beauty creates wealth, and (b) the economy redistributes existing wealth toward the more beautiful. If Beam had given me any good reason to believe that proposition (a) were true, I might agree with his tax recommendations. But if, as is more intuitive, we're really talking about a zero-sum game in which the market picks the pockets of the homely to pay bonuses to the beautiful, it doesn't seem to me that the government has any good reason not to dampen the effect.

Botax

By: Madge | Tue, 11/24/2009 - 23:09

Taxing plastic surgery that is not medically necessary is not so much a sin tax as it is a luxury tax. It is also a brilliant idea as a revenue source for funding a public option. I can't imagine that it wouldn't have public support with the possible exception of plastic surgeons and Hooters franchises. Speaking as a rapidly aging 56 year old, I see it as a win/win proposition.