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Viewpoint: Freeze the Botax

By: Steven H. Dayan, MD, FACS
Posted: December 3, 2009

Editor's note: The opinions expressed in this Viewpoint are those of the author and not necessarily those of Skin Inc. magazine.

As Americans debate healthcare reform and elected officials search for methods of funding the proposed $1 trillion public option healthcare plan, cosmetic medicine has been thrust to the forefront of the conversation as a vehicle for generating revenue. Known as the “Botax,” the tax would charge a 5% tax not just on Botox*, but on all “cosmetic” medical procedures performed by licensed medical professionals.

This is not the first time such an idea has been proposed. A similar bill was signed into law in New Jersey in 2004. However, it has fallen far short of expectations. Having collected 59% less than what was projected and costing three-to-four dollars in government expense for every dollar collected, its failings have resulted in its attempted repeal, led by assembly member and original bill sponsor, Joseph Cryan. However, Governor Jon Corzine vetoed the repeal, and the law remains in place.

Sin taxes

The concept of taxing products and services that are considered self-indulgences is not new. Sumptuary taxes—or “sin taxes”—on cigarettes, alcohol and gambling started as early as the 18th century when the early U.S. government taxed whisky and tobacco. Sin taxes are justified by many as penalizing taxes on socially tolerated ills that are both financially and morally burdensome to the nation. Self-indulging behaviors are tolerated in the United States by a silent majority, despite the fact that alcohol and tobacco use can be deadly. Therefore, to justify the impact on society by penalizing and dissuading those that choose these vices makes argumentative sense. Although sin taxes have been deemed as worthy funding for important initiatives, cosmetic medicine has now been arbitrarily selected to join this celebrated group of self-fulfillment sins, based primarily on misconceptions.

Besides the bureaucratic nightmare, questionable feasibility and overt gender discrimination that relates to this proposed bill, an equally valid concern is the likely violation of personal freedoms, and the negative influence on one of the least publically understood, but perhaps one of the most valid fields of medicine in society. Before hastily including cosmetic medicine within the feast of sins from which to cipher a relatively small amount of revenue, a closer look at cosmetic medicine—its origin, role and impact on American society today—is warranted.

History of cosmetic medicine