Oh the Agony! No Public Option and There’s a Botox Tax!


Along with the very real awfulness of losing the public option in the current health care reform bill, there’s a new fear freezing faces across America: The Botox Tax! This morning I got a frantic email from Allergan, the manufacturers of Botox and Juvederm injectibles–the former stops wrinkles by temporarily paralyzing facial muscles, while the latter plumps lips and lines.

Allergan wants consumers to help keep America beautiful by writing their senators to oppose a 5% tax on elective cosmetic procedures, which are paid for with after tax-dollars and not covered by insurance.

Buried in the massive health reform bill being debated in the Senate is a provision that would add a five percent tax to “cosmetic surgery and medical procedures” to help cover the $849 billion price tag for health care reform.  The tax would cover any cosmetic medical procedure deemed “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 disfiguring disease.”

The tax could apply to a wide-range of treatments and procedures designed to help enhance a patient’s self-confidence and aid in comprehensive self-improvement, including botulinum toxin and dermal filler injections, laser hair removal, microdermabrasion, dental caps and implants, teeth whitening… the list goes on and on.

This “self-improvement tax” as Allergan positions it, unfairly targets women, specifically those in the middle class, the same group who will be hit hard by lack of a public option.

Indeed, nearly 90% of cosmetic procedure patients are middle class women. In a study on prospective cosmetic surgery patients conducted by the American Society of Plastic Surgeons, 60% of respondents reported a household income of $30,000-$90,000 a year. Most importantly, 40% of the 60% reported income of $30,000-$60,000…

Yet because many perceive the wealthy to be the only beneficiaries of these treatments, the bill’s authors cynically believe they can impose a tax – similar to those imposed on dangerous and unhealthful products like cigarettes, alcohol and the like – with impunity. At the same time, many “life style” medical treatments remain sufficiently appropriate that they are exempted from excise taxes. So, for instance, Viagra is free of an excise “sin” tax. And hair growth drugs used by men would not be burdened with this excise tax.

Now I understand the recent spate of “home cosmetic surgery disasters” on talk shows showing what happens when women try to do their own lip and butt enhancements with whatever is handiest! This could be you if this awful tax is passed. Tyra Banks recently had two women on her show who were rushed to the ER after having their derrieres doctored with injectibles at their hairdressers because it was cheaper than going to a real doctor! And BTW, any injection of industrial grade silicon is not a really sound self-improvement decision.

Further, patients may seek untested and potentially dangerous treatments from unlicensed practitioners to avoid the tax, including seeking treatment across our borders and overseas.

Oh noes! Loss of revenue in the US. And loss of jobs too! If this tax goes through what will happen to the industry and America’s medical innovations?

Manufacturers spend hundreds of millions of dollars and employ hundreds of scientists to conduct well-controlled clinical trials to generate real data on safety and efficacy and obtain an FDA approval for an aesthetic drug.

Meanwhile a few heavy hitters have gotten on board to protest the “Botax” including Terry O’Neill, president of National Organization for Women; Robert Goldberg, Vice President, Center for Medicine in the Public Interest; and the American Medical Association, which issued this statement:

Further, taxing medical services at the federal level is a major policy change. We have serious concerns that this revenue stream would be expanded in the future to encompass a broad array of other health care items and services that may not be considered ‘medically necessary or covered services.’

If the public option was in the bill currently on the floor, I’d be all for the Botax; I’d feel good about that 5% going to help everyone have affordable health care, but without a public option, no way!

And while we’re on the subject of taxes, why the hell is there is still the yacht tax loophole in California?

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