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  • By Lois W. Stern, Editor-at-Large MakeMeHeal.com

    Botox Lady, Plastic

    A 5% excise tax on plastic surgery included in the Senate’s health care reform bill? You must be kidding! Dubbed as Botax, the government’s rationale is an estimated $6 billion in additional revenue over the next decade generated through this proposed tax. Some legislators think this is a clever measure to help close the gap in our nearly trillion dollar budget deficit. But once the veils are all pulled aside, the Bo-tax bill appears to be just another desperate measure to avoid taking a hard look at some of our more blatant health care problems. Isn’t it time for our government to take some fiscally responsible steps toward fixing the mess we are in?

    The Bo-tax bill is poised to tax cosmetic  surgery procedures that are 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 a disfiguring disease. But there is a large gray area that the legislation does not specifically define. What about the woman left with weakened abdominal muscles after birthing her twins? Will her abdominoplasty (tummy tuck) fall under the category of a luxury procedure and be taxed accordingly? Consider the woman whose breasts are intact but asymmetrical in size, or droop so heavily that they need to be uplifted with a heavily wired bra. Should she be taxed for her breast lift, breast reduction or augmentation? Who ultimately decides whether a given procedure is cosmetic or essential? Necessity or luxury? I see a bureaucratic nightmare in the making. Don’t physicians face enough challenges in tending to their patients’ daily needs, supervising staff to modernize and computerize their records, filing bills and insurance claims? Do they really need to be turned into tax-collectors besides?

    If we allow our government to adopt this tax, why should they stop at plastic surgery? Think of all the other non-essential services and procedures that could be taxed. With an additional 5% added to other non-essentials in our lives, perhaps our government could tax haircuts, therapeutic massages, yoga classes . . . and raise many times the estimated $6 billion over ten years.

    Working woman

    We have heard cries of sex discrimination and given the fact that nearly 90% of elective cosmetic surgeries are performed on women, the female gender does appear to be getting the brunt of these proposed taxes. Why women are the major consumers of cosmetic surgeries is a topic for another day, but suffice it to say that the majority of cosmetic interventions have gone mainstream, performed on middle class women in the workplace or those striving to arrive there. In this incredibly tight job market, looking a few years younger, a bit wider-eyed and perkier can reap dividends. There is little doubt that this proposed tax clearly discriminates against women. But of larger concern is how it fosters a prejudice by undermining and trivializing women’s motivations for cosmetic surgery. The proposed Bo-tax has become a mockery, subtly reviving an atavistic attitude of cosmetic surgery as an idle pastime for women endowed with riches and frivolous focus. Yet according to the American Society for Aesthetic Plastic Surgery (ASAPS), about 1/3 of cosmetic surgery is consumed by women making less than $30,000 a year and about 70% by those making less than $60,000 a year.

    To be absolutely fair, the government should not stop here. Why not hear it for the boys as well and impose a 5% tax on Viagra, Cialis, and other erectile dysfunction drugs, hair restoration procedures, gym memberships.. Where does it stop? Why not impose a tax on dental procedures as tooth whitening and porcelain veneers? If our legislators set their minds to it, no doubt they can think of dozens more items to include in this proposed Health Care bill to erode our needs and well-being.

    Without question our nation is facing severe fiscal challenges. Our Washington lawmakers have their backs firmly pressed against the proverbial wall. But if the Bo-Tax seems a foolish solution to our woes, where do we look for the needed income to support our broken health care system?

    We have a persistent problem of illegal immigration with the presence of nearly 12 million illegal immigrants in this country. Without a doubt, many of these illegals are contributing to our society, paying their way and funding their own health care. But all too often their medical care is funded by Emergency Medicaid through the Emergency Medical Treatment and Active Labor Act, signed by President Reagan in 1986. Additionally, this medical care, which is written off as bad debt or charity by local hospitals, has unfairly burdening our health care system. Make no mistake about it, each and every hard working USA citizen indirectly pays for those costs through extra hospital fees and insurance premiums.

    illegeal immigrants, Plastic Surgery

    Consider for a moment the New York Times article dated November 21, 2009: Hospital Falters as Refuge for Illegal Immigrants. Fifteen illegal Mexican immigrants turned to taxpayer supported Grady Hospital, an Atlanta based facility, for their dialysis treatments at a cost of $50,000 per year per patient. Grady lost $3.5 million on their dialysis clinic last year, a situation that clearly was becoming financially hopeless. In an effort to resolve their issues without turning their backs on these illegals, Grady recently entered into a signed agreement with MexCare to pay $18,000 for every patient relocated – ($6750 in travel expenses and escort fees, a $750 administrative fee, and payment for 30 dialysis treatments).

    It is difficult to find a just balance between humanitarian care and fiscal responsibility once illegal immigrants are housed within our borders. But immigration reform is clearly needed as an issue of top priority in addressing our own broken health care system. The Bo-tax seems trivial, yes even ridiculous, by comparison!

    Health-Care-reform, Plastic Surgery

    Next on the list is the waste in our health care system. According to a white paper released on Oct. 26, 2009 from the financial research firm Thomson Reuters, the U.S. health care system wastes some $700 billion a year—one-third of all spending—on inefficient practices and outright fraud. By reining in wasteful spending, the report said, the potential exists to trim health care costs, which continue to take up increasing percentages of the gross domestic product. This firm identified six categories of waste, with unwarranted use topping the list at 40 percent. Unwarranted use included items such as direct patient care that had little to no value (i.e. ordering the prescription of costlier brand-name drugs when less costly generics would suffice, ordering diagnostic tests unwarranted for specific medical condition, etc.). Dangerous, fraudulent use made up the next-largest category of wasteful behavior at 19% (i.e. misbranding of prescription drugs by pharmaceutical companies and the intentional provision of unnecessary, and in some cases inappropriate, diagnostic services). Other sources of healthcare waste included administrative inefficiency (17 percent), provider inefficiency (12 percent), lack of care coordination (6 percent), and the continued growth of preventable conditions as obesity and smoking-related illnesses (6 percent). The real job of our government is to cut the waste and utilize the remainder more effectively and efficiently. Doesn’t the Bo-tax seem frivolous in comparison? The quick fix 5% Bo-tax revenues of an estimated $6 billion over the next 10 years is infinitesimal in comparison to the wastes reported in our broken healthcare system.

    The dirtiest words around Washington, Pork Barrel politics, are also know by the euphenism, earmarks. Simply stated, Pork Barrel politics involves spending that is intended to benefit constituents of a politician in return for their political support, either in the form of campaign contributions or votes

    Ear-marks, Plastic Surgery

    Typically, “pork” involves funding government programs to spread out among all taxpayers funding or services whose benefits are concentrated in a particular area or amongst a particular segment of the population. Although the current administration and the leaders of both congressional parties had promised to cut back on pork funding, the Citizens Against Government Waste (CAGW) tell a very different story in their annual Pig Book, which they refer to as it “the book Washington doesn’t want you to read.” This watchdog group has issued its book each year since 1991, with a list of member projects inserted in annual spending bills. The past year’s 10,160 projects – valued at $19.6 billion in the cost to taxpayers – represent a 14 percent increase over last year’s spending on “pork”. This despite the fact that the number of these pet projects went down 12.5 percent during the same period, and that Congress now requires members to identify their own earmarks, enabling taxpayers to see the name attached to each project. Of the 10,160 projects in this year’s Pig Book, CAGW identified 221 earmarks worth $7.8 billion that were funded in violation of Congress’s own transparency rules – far more than the projected $6 billion that could be gathered over the next10 years by the 5% Bo-tax bill.

    Capital, Plastic Surgery

    Clearly our healthcare system is broken, but the 5% Bo-tax is hardly a reasonable remedy to fix it. Come on Washington, you can do better – much, much better. It’s time to discard your smoke and mirrors and tackle the serious issues that are undermining our current health care system. Take an objective look at the hard issues and underlying causes that have brought us to this precipice. Then work on some sensible solutions –solutions that fix what is wrong rather than imposing a new tax that makes little sense.

    If you want to help stop the Cosmetic Tax Bill, take a moment to click here:


    Lois Stern, Plastic Surgery

    Lois W. Stern, Editor-At-Large at Makemeheal.com, is the published author of two books: Sex, Lies and Cosmetic Surgery www.sexliesandcosmeticsurgery.com and Tick Tock, Stop the Clock www.ticktockstoptheclock.com/ as well as a number of magazine articles. Her Professional Edition DVD is a popular aid to office staff while interacting with their patients. She and Patty Kovacs are the co-founders of http://coast2coastbeauty.com/CURRENT_NEWS.html. Check it out!

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