Why cosmetic surgery shouldn’t be taxed
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.”