Tuesday, December 22, 2009

Cosmetic Surgery And Tanning Salons

Remember the proposed five percent tax on elective cosmetic surgery to cover some of the costs of health care reform? It has disappeared. Instead, there will be an extra ten percent tax on tanning salons. The initial plan to tax cosmetic surgery smelled to me like a "sin tax": a tax levied on something that is regarded as morally reprehensible or dangerous. Alcohol and tobacco taxes are common examples of sin taxes.

Why did this plan change? Because cosmetic surgery is an income source for many physicians and a tax on it would have reduced demand and hence the physicians' revenues. The American Medical Association doesn't want to see its members suffer. It is, after all, a trade union though seldom viewed as one:

The American Medical Association announced its coveted endorsement yesterday after a series of changes. Among them: eliminating a 5 percent tax on elective cosmetic surgery procedures, replacing it with a 10 percent tax on indoor tanning services; eliminating payment cuts to specialty and other physicians that were to be used to pay for bonuses to primary-care physicians and general surgeons in underserved areas; and dropping a proposed $300 fee on physicians who participate in Medicare that was to be used to fight fraud in the program.

All this changes who ultimately will pay for the reform, by the way. Whoever has enough power will push the payments onto someone else.

What's even more fascinating is the feminist debate that ensued when the cosmetic surgery tax was first proposed.

It's largely women who have elective cosmetic surgery and one might argue that the pressure to have it rises with age, because of age discrimination in the labor market. Now add to that the idea that women should be paying extra for health care for all (while not getting medically required abortions covered themselves). That's just plain wrong. This is the approach the president of NOW took recently.

But one can equally well argue that women who have elective cosmetic surgery raise the bar for all women, making such surgery a requirement for keeping or getting a job in later life, and that getting elective surgery means succumbing to the pressures of popular culture and its biased molds into which all women are squashed.

For an example of how this works, just think of how the image of ideal breasts has begun to resemble a pair of barely tethered helium balloons because of breast enhancement surgery. The more women have such surgery the more likely it is that the artificially enhanced breasts are viewed as the proper ones, and any woman not having surgery as the weird one. Note that I'm not blaming the women who have such surgery. The roots of this phenomenon are in pornography and its spillover effect into celebrity culture and from there into popular culture.

The change of plans made this debate an academic one. On the other hand, it's probably true that tanning salons have more female than male customers, too?