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Cosmetic surgery patients: Unfair tax targets?


Dr. Wheeland
The incredible rate at which outpatient surgery has been growing over the past decade is partly a function of increased patient demand for a variety of cosmetic surgical procedures. However, this growth has triggered a response in several state legislatures that may be detrimental to many potential patients who are interested in having cosmetic surgery performed. That legislative response has been to attempt to tax cosmetic surgery procedures.

Who could argue? Who could argue with such a tax? After all, only rich people have cosmetic surgery, right? And these rich people can certainly afford to pay a small tax to have this type of procedure done, right? Well, the simple answer to those questions is a resounding "No!" However, the state of New Jersey implemented a 6 percent tax on cosmetic procedures last year, and several other states — Tennessee, Illinois, Washington, Arkansas and Texas — have considered or are considering similar measures. Some of this revenue would provide support for medically related research or patient care services, but Tennessee would put this money directly into the state's general use fund, and if the Arkansas bill passes, those revenues would be used to decrease the used car sales tax.

Beyond the unfairness of singling out a particular segment of the population for increased taxation, it must be understood that many cosmetic surgery patients are, at best, middle-income individuals and not the wealthy, famous or movie-star types that seem to be portrayed in the media and in various statehouses around the country. On the contrary, many are just ordinary people who must save their money for months or even years in order to pay for a procedure they believe will improve their appearance and may make a difference in their ability to gain employment or improve their position in life.

Discretionary? While this expenditure may be viewed as discretionary at some level, at another level, spending money on cosmetic surgery may mean that these people must do without something else in order to have these procedures. Many of these patients do not drive luxury cars and do not live in the nicest sections of their communities. Rather, they are hard-working people who merely want to improve the way they look and are willing to save their money in order to do so.

One aspect of this issue that has failed to gain much attention is the fact that — while men certainly are having more cosmetic surgery performed every year — the vast majority of these patients still are women. Since when is gender-based taxation considered in any sense to be fair? It simply isn't!

Another exceedingly difficult issue is how to define "cosmetic" surgery. The state of Washington has defined cosmetic procedures as those that "do not meaningfully promote the proper function of the body or prevent or treat illness." While I think general agreement could be reached on defining certain procedures as being cosmetic, I believe many procedures are not so clear-cut. Is the laser treatment of port wine stains cosmetic, especially when it prevents the later cutaneous changes that will predictably occur with time? Is a rhinoplasty to improve a patient's breathing cosmetic? Is injecting botulinum toxin for hyperhidrosis or migraine headaches cosmetic? Is treating a rosacea patient with a red face or nose, using laser, cosmetic? Should the proven psychosocial benefits that result from correcting a perceived appearance problem be taxed simply because the procedure is considered cosmetic?

HIPAA concerns All physicians must now follow the tenets of patient privacy as outlined under the rules of the Health Insurance Portability and Accountability Act (HIPAA). Think how difficult it would be for physicians to protect their patients' privacy when they might be required to submit to an audit by the state to determine compliance. What about the administrative costs of monitoring this type of program? One could logically wonder if the revenue raised by these taxes would offset the cost of administering them.

It isn't fair for states experiencing shortfalls in other sources of revenue to balance their budgets by placing additional taxes on patients desiring cosmetic surgery. State legislatures should not take unwarranted and possibly inappropriate action until a uniform set of policies can be developed that answers the important questions of what is cosmetic and what is not, and whether the revenue generated by these taxes outweighs the costs. The act of taxing a single group of patients who are seeking cosmetic surgery simply because they are easy targets is unfair, injudicious, potentially sexist and wrong.


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