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Democrats Propose BOTAX on the Middle Class


As the push for national health care reform nears fruition, the proposal of a tax on elective cosmetic procedures is meeting with some strong opposition.

It's a move they say will raise $5.8 billion dollars over the next 10 years towards the $849 billion estimated price tag of President Obama's health care reform bill at 5% for elective cosmetic surgery procedures. The American Society of Plastic Surgeons (ASPS) has spoken out against this tax calling it "discriminatory, arbitrary and ineffective."

no botax The ASPS says the tax will mainly affect the middle class working women of the US who are the aesthetic industry's largest consumer group. According to a quote from ASPS president Dr. Michael McGuire, 86% of elective aesthetic procedures are purchased by women. 91% of those are between the working ages of 19-64.

It is an outdated concept to believe that the proposed tax will raise prices for the rich and not the middle class the President cared so much about during his campaign. Medical spa treatments such as BOTOX, Latisse, and Zerona as well as surgical procedures like liposuction and facelifts are no longer the exclusive world of the rich and famous. Over the years, the aesthetic industry has adapted procedures to suit the working woman. Procedures such as Fraxel or ActiveFX use fractional resurfacing technology to tighten skin and remove wrinkles while providing a more efficient and quicker healing process than surgery.

All of these improvements that cut the time investment and make treatment more comfortable are designed to suit the working woman who comes in on her lunch break for a treatment. A 5% increase in cost could be a devastating price increase to that consumer group. These women will then be left with the choice to either save up more to afford the procedure which may well cause them to cut spending in other areas, or to avoid undergoing the procedure altogether.

Dr. McGuire went on to say, "The ASPS has, and continues to oppose all taxes on physicians, in any and all forms, due to their deleterious effects of health care costs and access to patient care. Medical care should not be used as a tool to fix broken finances."

Some companies seem to have been preparing for this change. Allergan, the makers of BOTOX, not only sell a cosmetic solution, but Botox also has FDA approval:

  • to treat the abnormal head position and neck pain that happens with cervical dystonia (CD) in adults
  • to treat certain types of eye muscle problems (strabismus) or abnormal spasm of the eyelids (blepharospasm) in people 12 years and older
  • to treat the symptoms of severe underarm sweating (severe primary axillary hyperhidrosis) when medicines used on the skin (topical) do not work well enough.
working mom Some doctors advocate using Botox as treatment for TMJ and even migraines. These treatments are not FDA approved but may be steering Botox and Allergan into a more protected position as taxes on aesthetic procedures seem to be likely in the future.

The ASPS says that in a 2005 survey of people planning to have cosmetic surgery within the next two years, 60% of respondents reported an annual household income of $30,000-$90,000 a year. Most importantly, 40% of those reported a household income of only $30,000-$60,000. Only 10% of respondents reported a household income of over $90,000, which clearly refutes the suggestion that elective surgery taxes are 'luxury' or 'sin' taxes affecting a privileged few.

While women make up the majority of those undergoing cosmetic surgery, men who seek treatment for hair loss will also take a big hit. The International Society of Hair Restoration Surgery (ISHRS) : the world's leading medical authority on hair loss and hair restoration, spoke out against this tax as well. "The median income level of people undergoing hair restoration surgery is $69,700.00," said Edwin Epstein, MD, president of the ISHRS. "Clearly, it's not just the wealthiest men and women getting hair transplants, but average, hard-working people who are tired of suffering from hair loss."

Non-invasive procedures have been holding on surprisingly well during this recession. Many attribute the success to the desire of those who are unemployed to appear youthful when competing in the current job market. It's no longer sheer vanity when a middle aged executive on the brink of a layoff feels the need to compete with the fresh-faced, just-graduated crowd.

Also, patient safety is a concern as patients may begin looking for black market products like DIY Botox or may go out of the country for discounts on their plastic surgery procedures, ie. medical tourism. Healthcare professionals take an oath to care for patients and this tax may damage their ability to do so effectively.

The question also arises as to who determines what constitutes an elective vs. a necessary cosmetic procedure. While the bill holds out that the tax may not apply to a procedure 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" this is a gray area. Who is it that will make the distinction between elective and necessary?

The harm to the aesthetic industry will likely have further reaching effects than may have been anticipated. The companies manufacturing these aesthetic medical products also make other non-aesthetic products. Allergan, the makers of Botox, Juvederm and Latisse, also make Restasis(TM) - a treatment for chronic dry eyes, and the LAP-BAND(R) Adjustable Gastric Banding System. Sanofi Aventis manufactures the filler Sculptra and also Plavix which helps treat Peripheral Artery Disease. As patients begin to choose against cosmetic procedures and the pharmaceutical companies lose money, there may be less funding in their budgets to research and develop other life saving products.

Keith Veseleny, Editor of American Health and Beauty, an online consumer magazine specializing in trends and new technologies in the aesthetic industry says, "Our statistics indicate a steady increase in consumers educating themselves about procedures and taking the first step in their buying cycle since the industry hit its low point in August, 2009." He also stated, "We are concerned that this tax will derail consumer spending in an industry that is just beginning to show signs of a recovery."

By Sara Jordan, Associate Editor