Botax axed

It may seem self-serving to criticize the proposed tax on cosmetic surgery and medical procedures such as Botox injections (hence the too-clever term "Botax"), but there is a long list of reasons why it is unworkable. Fortunately it appears to have been dropped from the health care reform legislation at least for now, replaced by a proposal to tax tanning beds.

So what's the big deal? isn't a "vanity tax" justifiable, just like the "sin taxes" on alcohol and cigarettes? For one thing, it dismisses all cosmetic procedures as being motivated by superficiality and obsession with unrealistic notions of beauty, which anyone in this business can tell you is plain wrong. Cosmetic surgery patients are just moms who want their old bodies back, or those trying to re-enter the workforce and find themselves competing with younger workers. Cosmetic patients are middle income, heart of America folks, and plastic surgeons are employers and small businesspeople trying to do their part to reboot the economy.

Maybe you don't buy that, but there are practical issues too. Here in Washington State there was a proposal two years ago to do the very same thing, and it was dropped as being unworkable. One reason is that it is deceptively difficult to separate what is purely cosmetic, and what is reconstructive or therapeutic. Take the case of breast reconstruction: it is so important to a woman's recovery from cancer after mastectomy that it is a federally mandated insurance benefit. But it isn't a functional breast, just a cosmetic facsimile. Rhinoplasty may be done to correct a breathing problem but a little cosmetic alteration is done at the same time; how much of the expense (including anesthesia and operating room time) is to be allocated to each part?And half of all Botox is used for therapeutic uses. One example of this is patients who have to pay out-of-pocket for it but do it to prevent debilitating migraine headaches. There's an idea for you: tax migraine prevention treatment. Washington State ended up deciding it was just too complicated to sort out, and fortunately the other Washington seems to have done the same thing.

Tanning salons on the other hand, that's an interesting proposal. Earlier this year, the UV lamps used for tanning were officially declared to be a class 1 carcinogen. My guess is that the business is already declining and this will only hasten its demise, with the projected tax revenues evaporating along with it.