Cosmetic and Plastic Surgeons Oppose Bo-Tax

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Earlier this week, Senator Harry Reid and other democratic leaders in the Senate unveiled The Patient Protection Affordable Care Act (can read here in pdf form). The price tag for the proposed bill is reported to be $849 billion over 10 years, according to the nonpartisan Congressional Budget Office. The costs are to be offset by reductions in the growth of Medicare and new taxes.

One of the new taxes has been dubbed the Bo-Tax and was first mentioned back in the summer. Then it was proposed as a 10% tax on elective and cosmetic procedures. Now it is proposed as a 5% tax on those procedures.

Senate Democrats argue that the tax will generate $5.8 billion over the next 10 years to be put towards the estimated $849 billion cost of the bill. The American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS) oppose this tax, calling the tax discriminatory, arbitrary and ineffective.

As defined by the Internal Revenue Code of 1986, "Any procedure which is directed at improving the patient's appearance and does not meaningfully promote the proper function of the body or prevent or treat illness or disease." These procedures would be the target of the proposed tax and would include not only Botox, but cosmetic procedures such as liposuction, rhinoplasty, tummy tuck, breast augmentation, and face lifts. It would also inclued teeth whitening and hair transplants.

Even though Americans may spend more than $10 billion each year on cosmetic surgery, most of these patients are female (86%). Of these women, 91% are between the working ages of 19-64. Plastic and cosmetic surgery has become mainstream in the United States.

In a 2005 ASPS 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.

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"This tax is effectively a “Soccer Mom” tax that will adversely impact mainstream American wives and mothers, who are the majority of plastic surgery patients," said Renato Saltz, MD, President of the American Society for Aesthetic Plastic Surgery (ASAPS). “As doctors, we understand and appreciate the need for health care reform, but taxing physicians and cosmetic surgery procedures to pay for the reform is not realistic or beneficial."

The ASAPS and ASPS also contend that such taxes have been proven arbitrary and difficult to administer as evidence by the experience in New Jersey, the only state to have imposed a cosmetic tax. Since it passed a 6% tax on elective medical procedures in 2004, the NJ Department of Taxation has experienced a 59% shortfall based on projected revenue estimates. Eight other states have considered similar tax legislation– and they all wisely rejected them.

Finally, though the bill claims that the only procedures that would be taxed are those 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,” The Plastic Surgery Societies contend that such distinctions aren’t always obvious. Because the line between ‘cosmetic’ and ‘reconstructive’ surgery is not always clear, such a tax would leave the determination of medical necessity up to state tax auditors – a completely inappropriate proposition.

“As doctors our first concern always needs to be patient safety,” said Dr. Saltz, “for those patients here in this country, as well as those patients who may now be encouraged by this tax to obtain their procedures abroad.”

“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,” said Dr. McGuire. “Medical care should not be used as a tool to fix broken finances.”

The American Society of Plastic Surgeons represents more than 7,000 physician members and is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.

The 2400-member American Society for Aesthetic Plastic Surgery (ASAPS) is the only plastic surgery organization devoted entirely to the advancement of cosmetic surgery. ASAPS is recognized throughout the world as the authoritative source for cosmetic surgery education. U.S. members are certified by the American Board of Plastic Surgery. Canadian members are certified in plastic surgery by the Royal College of Physicians and Surgeons of Canada

Sources
ASPRS Press Release

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