The 'Botox Tax': A Troubling New Wrinkle

Apparently, it's not that easy. In addition to the well-known plans to tax high-end health insurance plans and to raise taxes on high-income earners, Section 9017 of H.R. 3590 imposes a 5 percent excise tax on elective cosmetic medical procedures. This tax would apply to any such procedure performed by a licensed medical professional that is not needed to ameliorate a deformity caused by an accident, trauma or disfiguring disease. In other words, if you undergo a procedure just to make yourself look younger or thinner, then you have to pay extra. And you must pay the tax regardless of whether the procedure is covered by insurance or not. Moreover, if the person receiving the treatment refuses to pay, the person providing the treatment must pay it.

The outrage has already emerged. As my colleague Patricia Murphy warned, "For the 'Real Housewives' reading along at home, that's a tax on lifts, nips, tucks and shots." Meanwhile, over at Sphere, Andrea Stone argued that the Botox tax would have many unintended consequences. With these two shots across Congress' bow, the debate is now underway.

Those receiving the treatments might feel they are being unfairly singled out to pay for health care reform. But our lawmakers had to find revenue for it somewhere. And why not tax procedures that are entirely elective and largely undertaken by those affluent enough to afford them? After all, the tax does not apply to non-elective plastic surgery. It seems sensible from an economic point of view.

But from a political point of view, the tax is disastrous.

As the Wall Street Journal reported, a CEO of the drug company Medicis says the tax is a step on the slippery slope that leads to "taxing people who color their hair."

Moreover, it strikes at the heart of many Americans who spend millions to make themselves look and feel better. Some 5 million Botox injections were given last year, nearly a quarter of a million people went through liposuction to remove excess fat, and more than 300,000 women had their breasts enlarged. All told, Americans spent more than $10 billion on these elective procedures.

The idea of taxing cosmetic surgery surfaced over the summer. As Politico then reported, a Senate committee aide said that Treasury Department economic adviser Gene Sperling proposed the excise tax. Senate Finance Chairman Max Baucus (D-Mont.), whose committee worked long and hard on health care reform, dismissed the tax at that time.

Much has changed since then, and pressures to find revenue to fund the nearly $1 trillion overhaul without raising the federal deficit led Reid to reconsider the Botox tax in the latest version of the bill. Congress' Joint Committee on Taxation estimates that it will raise $5.8 billion over 10 years.

The hue and cry over this issue, which is one of the smallest revenue provisions in the bill, is likely to distract attention from the important elements in the legislation. That amount is a drop in the bucket next to the $149.1 billion expected to be raised from taxing the so-called Cadillac employer-provided health insurance plans or the $53.8 billion raised from levying a 0.5 percent hospital insurance tax on high-income individuals.

Moreover, at least for Botox injections, these estimates might be too high. Although millions of injections were given last year, one "TARP wife" (i.e., her husband works for one of the 400 companies that has received federal bailout funds) confesses in Portfolio.com that in light of the financial crisis, getting Botox injections seems "somehow decadent in this new era."

On the one hand, this tax (projected to raise only $300 million next year) seems not worth fighting for. On the other hand, considering that the median earnings for the 100 million workers with full-time jobs is just $738 a week, those who can afford a $500 Botox shot are not likely to even notice a $25 tax.

Unfortunately, when talking about tummy tucks and wrinkle-reducing injections, appearances really do matter.