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Nov. 24 2009 - 7:48 am | 179 views | 2 recommendations | 11 comments

Why cosmetic surgery shouldn’t be taxed

An art gallery displays creations of  the 'I A...

Image by AFP/Getty Images via Daylife

Tucked into the heath care bill is a seemingly reasonable tax on cosmetic surgery.  It’s an easy tax to support, like taxes on cigarettes and sodas.  After all, cosmetic procedures are completely unnecessary to our health, by definition, and- like cigarettes and sodas- potentially harmful.  But none of these products are distributed evenly in the population.  In fact, they all tend to be consumed by poor and working class Americans more than the rich and educated ones.  And therefore taxing any of these products is always regressive, a larger burden on the poor than the rich.

Oh, I know.  Everyone thinks it’s rich starlets who get boob jobs and aging starlets who get facelifts.  But look around.  See that cosmetic surgeon down the street?  The walk-in Botox clinic next door?  That’s because cosmetic surgery spread from the rich and famous to the rest of us because of increasing access to credit.  That’s right- the deregulation of banking that happened in the 1980s meant more and more Americans were taking out credit- either on credit cards or with medical credit companies like GE’s “CareCredit.”

What this means is that cosmetic surgery is now primarily consumed not by the rich, but by the working and lower-middle classes, sometimes even by the poor.  According to the American Society for Aesthetic Plastic Surgery (ASAPS), about 1/3 of cosmetic surgery is consumed by people who make less than $30,000 a year.  About 70% of it is consumed by people who make less than $60,000 a year. It is mostly women (90%) and mostly white, middle-aged women (80% and between 35-55 years old).

In my own research for my book (American Plastic, Beacon 2010) I met police officers, teachers, bank tellers and real estate agents.  I also met recent college graduates with $100,000 in student loans taking on even more credit because “I’m going to die in debt anyway so what difference does it make if I take out $10,000 more?”

You may think these women are greedy or stupid to take on debt, often with interest rates approaching 30%, to reshape their bodies.  But they’re not. In fact, they are rational economic actors who understand that looking “better” really can lead to more success in the job market and the romance market.  What these women don’t understand- what few of us understand- is debt.  You sign on the dotted line for your boob job at $8000 but you don’t realize you’ll end up paying almost twice that much if you can’t put any money down.  Easy for Hollywood starlets to plunk their cash down for new boobs, but for the rest of us, taking on debt for a better body is risky business.

If the government wants to control cosmetic surgery, then the answer is to re-regulate the banking industry so these medical credit loans don’t exist.  And the other answer is to tax the obscene amounts of wealth being made by the likes of GE, who is selling medical credit to people who cannot afford it.  Or the cosmetic surgeons income as part of an overall progressive income tax on the top earners.

But to tax working and middle-class women who have been part of the 80% of Americans getting worse off in the past 30 years is wrong.  These women understand that looking better can lead to a better life.  These women are poorer than they used to be.  And not terribly powerful.  That’s why they’re easy to single out.  Why make abortion a part of health care.  Or boob jobs?   Like much of the health care reform being discussed, a tax on cosmetic surgery is unfair to women and unfair to the working class because they’re exactly who is not represented in Congress.

Besides, let’s face it, the government will never be able to decide what is “cosmetic” and what is “necessary” anyway.  If someone is so depressed about the size of their boobs or their nose of their back fat that they stop going to work or school, is the surgery necessary?  If a facelift will keep a husband’s financial support, is it necessary?   Are breast implants after cancer necessary?  What about lifting up sagging flaps of skin after weight lost?  What about stomach stapling for weight loss in the first place?

“Necessary” is an impossible word when it comes to cosmetic surgery because ultimately, almost none of it is necessary for pure physical survival, but we are social animals who increasingly depend on “first impressions” to survive.

The only thing that is necessary is to pass  health care reform that doesn’t imagine the needs of women and working Americans as “unnecessary.”

Cosmetic Tax in Reid Health Bill Has Some Doctors Worried and Confused – ABC News.


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  1. collapse expand

    Nothing should be taxed.

    But if we don’t have taxes…the government folk who live quite well off of other peoples taxes….they would all have to go out and get real jobs.

    No tax is reasonable.

    The father of our country, george washington , as a sitting president, raised an army large than the revolutionary war army to hunt down farmers who wouldn’t pay the whiskey tax….see Whiskey Rebellion…

    You are born into this world as a slave to someone else’s taxes….

  2. collapse expand

    So by this “argument” not having cosmetic surgery should be taxed. hmm. Don’t know if I believe it.

  3. collapse expand

    I thought I was Liberal. I really did. Then I read this, and I have to say, congratulations. You’ve made me realize I never knew what Liberalism really is. I just,…really? You’re serious though, so… How though?

    You say yourself, “`Necessary” is an impossible word when it comes to cosmetic surgery because ultimately, almost none of it is necessary for pure physical survival, but we are social animals who increasingly depend on “first impressions” to survive.”

    At a time when we are on the verge of achieving a halfway decent health care system (but barely) you’re willing to fight for something that even you admit is normally not necessary? You’re addressing two separate issues in your post, neither of which really deals with health care.

    The first is that it is the working class, and lower-middle who would suffer from such a tax. But as you said, these are not needed procedures. No one will die if they don’t get work done. It is these people’s choice to do it.
    The second issue ties directly to the first. You say that women do need it, as looking more attractive opens up more doors for them. That’s great. What does it have to do with health care though? This bill is about making sure people don’t die from lack of access or go bankrupt anymore. Not about protecting women from a sexist society. You’re goal is laudable, but unhelpful in this particular debate.
    I am a firm believer in a lot of rights. I am forced to argue constantly with people who deny what I see as rights. Its weird to be on this end of it. So it goes though, huh?
    For what its worth, I would be all for addressing the social change needed to challenge the underlying attitude you’re alluding to, i.e. the more attractive a woman, the better her job situation is. Having said that, it does work that way for both sexes. With a fight over how to find resources for life or death medical care, we shoot ourselves in the foot championing plastic surgery, especially for the poor.

  4. collapse expand

    Sorry, but this argument doesn’t wash with me. There’s something inherently wrong with society if the norm becomes plastic-surgery enhanced “beauty”. I’m very much a live and let live kind of person–if someone wants a nose job or a facelift, great that’s their choice. But to make it non-taxable or part of a government health plan at the taxpayers’ expense–I don’t think so.

    We’ve become a nation obsessed with looks at the expense of character. Form over substance. Personally, if I wanted to live in L.A. and surrounded by surgically-enhanced Barbies and Kens, I would. But I like my fellow human beings to be just that: human. It’s really not so bad.

  5. collapse expand

    Of course we can define necessary cosmetic surgery.

    Is your nose too big, too small, or a little crooked but otherwise functioning normally? Sorry – surgery is not necessary for you. Does this make you depressed? Well, your health care plan should cover the mental health services you need to deal with that.
    Is your septum such a wreck that it interferes with your breathing, maybe even causing sleep apnea? Or was it damaged as a result of some kind of injury? Then your surgery is necessary.

    I’m a little surprised by your equating boob jobs with post cancer reconstruction. The former is a vain attempt to be more attractive, while the latter is an attempt to be made whole after losing a part of your body to disease. Surely there is a reasonable difference here. No?

  6. collapse expand

    Actually, all this argument did was make me think of course we should tax these things, because part of the problem with this country is teens/20 something’s taking out loans on things they don’t NEED with hopes they’ll become a superstar because they have bigger, perkier breasts to combat their lack of, y’know, talent or skill or work ethic or whatever. I think facing another couple hundred dollars in taxes on top of loans might do well to scare off those taking out money they don’t already have because they don’t like the way their eyes are centered or some tripe. Most of this is psychological anyways, and part of that is the way this society has come to put pressure on “weak willed” persons in it to get them to buy more shit like this they don’t need/can’t afford. And then there’s the celebs that get “routine maintenance”, but I have no doubt they write this stuff off as a business expense or something to that extent anyways.

  7. collapse expand

    We don’t need healthcare to protect anyone; why don’t all concerned people just agree to provide the government with a single dollar a week to cover the unfortunate or the lazy or the tightwad? It seems that “charity” never gets an answer from these concerned citizens–unless it’s at the expense of someone else! One’s appearance should never be the only reason for employment. And homely people tend to marry homely people, so leave well enough alone.

    • collapse expand

      Well, I guess that’s it then. You figured it out. All that was needed was some random person, posting anonymously on the internet, to declare that we don’t need health care to protect anyone. The debate is now over. You and your amazingly concise, thought changing philosophy have beaten back the godless hordes of satan worshiping liberalism.

      On to less sarcastic thought, one thing I always find interesting is the throw away line I’ve heard more than once, basically saying that private charity should take on this responsibility. Aside from the fact that there is no charity in existence with the infrastructure to handle such an undertaking, there is an undercurrent in all these statements that is cropping up more and more. Listen to Beck, Hannity, or Limabaugh talk about charity and volunteerism. Hell, listen to any street level teabagger. Suddenly, the sub-text is that it is un-American to care about others. Sure, charity is an option, but its for communists and socialists. Those more concerned with others than themselves are looked down on. A “real” American would take care of himself only. You’re doing it too, with your “charity” in quotes like that.
      On a last note, there is a very small, very nasty part of me that would love to see you get your wish. This is the same part that would laugh hysterically to watch you realize that your fever dream of selfishness as a virtue can only take us back to the days of might makes right. Your way leads back to the jungle. Not realizing that makes you flawed like everyone else. Realizing it, and championing it anyway, makes you contemptible. Only one of these is forgivable.

      In response to another comment. See in context »
      • collapse expand

        Your glib language and personal attack on me do nothing to profit your case. It is true that it is in my nature, as well as all others, to selfishly protect one’s own interests. While few will admit it, self-sacrifice is not a way of life sought even by the quasi-rational person. I am willing to take my chances and pay my own way; when my finances are done, then I shall have to face the consequences of my ill-fortune. So be it.

        In response to another comment. See in context »
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    About Me

    I'm an academic who does not believe in abstract knowledge. Like Marx, I think the point isn't just to describe the world, but to change it. Unlike Marx I don't have Engels sending me my monthly rent. So I have a day job teaching sociology at Middlebury College. In my real life, I'm a fighter (taekwondo) and a writer

    (Salon, Legal Affairs, NPR's "All Things Considered") and now this blog. My second book, American Plastic: Boob Jobs, Credit Cards, and the Spirit of Our Time, is a critique of neoliberal capitalism through cosmetic surgery. American Plastic will be published by Beacon in 2010.

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