Published December 6, 2009 By Dr. Adam Lowenstein

Congress is currently debating a 5% federal taxation of users of cosmetic medical treatments like you. As a plastic surgeon, I urge you to oppose this tax for several reasons outlined here. Please get involved!

The tax is punitive and places an additional burden on the middle class – According to the American Society of Plastic Surgeons (ASPS), sixty percent of patients considering a cosmetic medical procedure are squarely in the middle class, earning between $30,000 and $90,000 per year. This tax would come on top of increased payroll and income taxes sure to result from health reform’s $849 billion cost, and would penalize those who have made a well-educated and informed decision in consultation with a specialized physician to opt for cosmetic medical treatments.

The tax discriminates predominantly against women – Data from the ASPS shows that 91 percent of patients seeking cosmetic medical procedures are women.[1] And many of these women are seeking treatment to improve their appearance to enhance their self-image and self-confidence which helps them succeed at work and in other areas of their lives.

The tax does not serve the goals of health reform – President Obama has stated that the goal of health reform is “to enact legislation that offers stability and security to those who have insurance and affordable coverage to those who don’t, and that lowers costs for families, businesses and governments across the country.” Since these procedures are generally not covered by insurance, the proposed tax will not reduce the cost of health care nor will it reduce insurance premiums. Further, it will increase administrative costs for physician offices.

The tax puts cosmetic procedures in the same category as cigarettes and alcohol – So called “sin taxes” on cigarettes and alcohol were imposed to try to change unhealthy behavior and cover the significant costs that these products placed on the health care system. This is logical. But a tax on cosmetic medical procedures is illogical because they are healthy and merely a responsible form of self-improvement. Furthermore, these procedures do not impact the heath care system since patients pay for these procedures themselves and they are not covered by insurance. People should have the freedom to decide what is best for their personal health care, including their own aesthetic appearance and therefore be free to correct, alter or enhance their appearance responsibly, in consultation with a physician, without being forced to pay an extra tax.

The tax will be impossible to effectively and equitably administer – It is not clear which procedures will be subject to the tax and which will not. The line between “cosmetic” and “reconstructive” surgery is not always clear and leaves the decision of medical necessity up to tax auditors- a completely inappropriate proposition. Further, the same procedure performed on two different patients could lead to different conclusions concerning application of the tax.

The tax discourages innovation and promotes dangerous and unregulated alternatives – Because only drugs and procedures regulated and approved by the Food and Drug Administration (FDA) will be subject to the tax, manufacturers may choose to circumvent FDA regulation to avoid the tax. Further, patients may seek untested and potentially dangerous treatments from unlicensed practitioners to avoid the tax, including seeking treatment across our borders and overseas.

For all these compelling reasons, I urge you to help stop the cosmetic tax.

You can express your opposition to this tax proposal by reaching out to your local Senator by calling 1-877-221-8207 or visiting the American Society of Plastic Surgeons website at The time to act is now– the Senate is currently debating the bill, so please voice your concerns today.

[1] American Society of Plastic Surgeons Annual Report;

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