Author: has written 5268 posts for this blog.

Jill has been blogging for Feministe since 2005.
Return to: Homepage | Blog Index

120 Responses

  1. catfood
    catfood November 19, 2009 at 1:28 pm |

    I didn’t think “sexist” right away, although maybe I should have. I thought, “totally new collection apparatus.” Are plastic surgeons going to add 5% to your bill now? And then pass it along to the feds? Sounds like paperwork hell, and hard to enforce.

    But yeah, it’s probably sexist too.

  2. CTD
    CTD November 19, 2009 at 1:30 pm |

    “It sounds fine and good on its face to tax unnecessary procedures”

    And who, exactly, are you to determine what is and isn’t “necessary” about people’s medical decisions?

  3. Tom Hilton
    Tom Hilton November 19, 2009 at 1:46 pm |

    If elective cosmetic surgery were banned, would women (in general) suffer or be better off?

    I guess I see cosmetic surgery as not just a symptom of the pressure on women to look ‘perfect’ but also as a mechanism of that pressure; women walking around with boob jobs or liposucted thighs or whatever distort perception in a way that adds to that pressure. From that perspective, I think taxing it is a swell idea. (Also: as you observe, a highly progressive form of taxation.)

  4. CTD
    CTD November 19, 2009 at 1:52 pm |

    Ban away, if it pleases you. It’s your joint.

    You needn’t respond to my question. At the time I asked I hadn’t yet read this:

    “I’m also a proponent of taxing things like soda and cigarettes, which offer zero benefits”

    That pretty much gives me the only answer I need.

    Notions like “benefits” and “necessity” are peculiar to the individual. Just because you derive no benefit from something relative to the costs, doesn’t mean those benefits do not accrue for someone else. Smoking has many benefits for the people who do it. (Why else would they smoke if not?) Nicotine can calm nerves or aid mental focus, depending on dosage and use pattern. For some, smoking aids digestion and enjoyment of meals. Others say it makes them a better conversationalists.

    You may decide that these benefits do not outweigh the risks and cost involved. But you can only make that calculation FOR YOU. Maybe you are an extrovert who has no problem gabbing away, or someone who can easily relax after a stressful day. But many people are not, so they are going to place more value in something that helps them do those things, even if that something has costs associated with it, as well.

    Chemotherapy has no benefit for me right now. Ergo, it has no use, right?

  5. Tab
    Tab November 19, 2009 at 1:59 pm |

    I feel rather mixed on the subject.

    The money has to come from somewhere and, as per the OP, I support the idea of taxing luxury items.
    On the other hand – women are already caught in a double bind, stigmatised as sloppy and ugly if they fail to look ‘perfect’ and stigmatised as vacuous, fake and/or pitiful if they have surgery to try and look ‘perfect’. I’m not sure adding a penalising tax into that really helps the issue.

    Also, I have a horrible suspicion that sex reassignment surgery could easily end up taxed under these measures; a lot of people seem very reluctant to understand that it’s medically necessary for some.
    That is, of course, presuming sex reassignment surgery would even be covered in a future American universal healthcare system, which is probably wishful thinking in itself.

  6. corn
    corn November 19, 2009 at 2:08 pm |

    Let’s turn this around and assume all transactions between people should be taxed. The question then is not what should be subject to taxation, but what should be excluded from it.

    For example, we’ve decided that because of the putative benefits they provide to the community or society at large, non-profit organizations should be exempted from paying certain taxes (e.g. property tax, sales tax, income tax).

    Some states have also exempted “necessities” such as food and clothing from sales tax (with the latter having a “price” cap to differentiate between “necessary” clothing and “luxury” clothing).

    Heretofore, most medical procedures have been exempted from certain taxes such as state sales tax. The proposed question takes the position that perhaps that exemption is too broad, and should be scaled back to not include procedures that aren’t “medically necessary” or “reconstructive” in nature. That is, just because it’s a “doctor” performing the procedure doesn’t mean the procedure should be exempt from taxes. I see this as being analogous to how “food” in general is exempt from sales tax but “prepared food” is subject to sales tax (in my state at least).

  7. metabonbon
    metabonbon November 19, 2009 at 2:27 pm |

    Raising the cost of legitimate mainstream cosmetic surgery might also drive more people to seek those procedures elsewhere. Every once in a while you hear news stories of someone who was disfigured by bad surgery in a cheap underground clinic. This possibility may not necessarily outweigh the benefits of funding public healthcare through luxury procedures, and the populist in me like to see proposals that put the tax burden on those who have the most. But I wouldn’t be surprised to see an uptick in low-cost cosmetic disasters. In a culture that values an impossible beauty standard so very highly, people will go to great lengths to try and achieve it, even when they know the risks.

  8. kiki
    kiki November 19, 2009 at 2:39 pm |

    I’m shocked that these procedures aren’t already taxed. I don’t find it sexist at all.

  9. Andy
    Andy November 19, 2009 at 2:52 pm |

    I read that and went, “Welp. Way to make shit even more expensive for trans people who pursue surgery.”

    It would totally not be exempt. You can get kicked off a lot of insurance plans for being trans. It’s a pre-existing condition… but when it comes to actually helping trans people, it’s all “elective”.

  10. soupcann314
    soupcann314 November 19, 2009 at 2:58 pm |

    This is troubling. I’ve had cosmetic surgery as a result of an injury I sustained in my teens, but how do they define “deformity?” I could still use the body part that was affected, but it was very public and visible and made life hard for me during my freshman year of high school. And yes, my surgery was covered by my parent’s insurance.

    I’m uncomfortable with this, because of my own history and because of the implications for women.

  11. a lawyer
    a lawyer November 19, 2009 at 2:59 pm |

    Insofar as policies with a disparate impact on women are problematic, a tax on a luxury mostly consumed by wealthy women strikes me as pretty trivial. I’d be much more concerned about the trans issue others have raised.

  12. Faith from F.N.
    Faith from F.N. November 19, 2009 at 3:09 pm |

    Tax away as far as I’m concerned. Women are not forced to obtain purely cosmetic surgery. They can either make the choice to not get the surgery, or pay the tax. Just like they can make the decision to get married, not get married, or change their name, or not change their name.

    The only concern that I can think of off the top of my head would be hymen reconstruction surgery for women who need to convince their husbands of their virginity…least they be ostracized, divorced or killed.

    (Note: I understand there are women who truly do not have the right to determine whether they marry or change their name. This comment is not directed towards those women.

  13. czarsketch
    czarsketch November 19, 2009 at 3:15 pm |

    If the reason this is considered sexist is because of the pressure women are under to maintain a certain appearance, doesn’t it stand to reason that by taxing plastic surgery (which is not an addictive substance such as tobacco), fewer procedures will be performed, standards will change ever so slightly, and we will all have a chance to discuss how to decrease that pressure?

    It just seems that you can’t have it both ways: on one hand, there’s the very real pressure of sexist ideals regarding what a woman should look like. On the other, there are procedures that allow those ideals to exist in reality, if not in nature. Remove one of the two and the entire structure has to change, which gives us all an opportunity to be a part of it.

    Plus: if you believe in health care reform, it makes sense to reinvest a progressively collected tax on unnecessary procedures into a fund that provides support for necessary coverage and care.

  14. FashionablyEvil
    FashionablyEvil November 19, 2009 at 3:21 pm |

    Raising the cost of legitimate mainstream cosmetic surgery might also drive more people to seek those procedures elsewhere.

    Well, on a $5000 procedure, that would be a tax of $250. If you’re already spending $5000, would an extra $250 deter you? I would guess not.

  15. Nicole
    Nicole November 19, 2009 at 3:27 pm |

    Andy: I read that and went, “Welp. Way to make shit even more expensive for trans people who pursue surgery.”

    Heh I thought the same thing. You can’t see our surgeries as necessary, that would be legitimizing us to much as people and that just cannot be done.

  16. me and not you
    me and not you November 19, 2009 at 3:36 pm |

    So, I have braces. Insurance considers them elective cosmetic, and won’t pay for them. Up until very recently, I still had 6 baby teeth, with 6 adult teeth underneath. In order to bring down the adult teeth (after removing the baby teeth), the adult teeth have chains glued to them, and they are slowly cranked down. It’s about as fun as it sounds. But that *requires* braces, so that way there is something to anchor the chain to. My baby teeth were full of fillings, and the dentists said that the baby teeth wouldn’t last my adult life–they’re going to have to removed eventually anyway, and at least some of the 6 teeth would need to be replaced. So, my braces, all my oral surgery, is basically preventative medicine, but none of it is covered by my insurance, because I’m too old for the braces to be considered ‘necessary’ etc.

    The issue is how medical necessity is determined. If ALL surgery is taxed, that’s one thing, but if some are, and some aren’t, that’s inevitably going to cause problems. It makes me think of how I noticed in high school that pads and tampons were taxed as luxury items, yet no woman I knew didn’t use pads or tampons.

  17. Ryan
    Ryan November 19, 2009 at 3:41 pm |

    Sounds like it will be sexist and even more transphobic…

  18. leah
    leah November 19, 2009 at 3:50 pm |

    Well my first thought was that this is a gilded cage issue – I mean, most women couldn’t even afford to undergo plastic surgery even if they wanted to. I’m kind of sick of pretending I care about the plight of the rich when rich women rarely care about my plight.

    Then I had some other thoughts:
    1. Where is the line drawn between reconstructive and elective? Would repairing a botched episiotomy or C-section scar be taxed, since they are currently elective under most insurance plans (and also, pretty damn common – but that’s an issue for another post)? (Also more fun news – according to spellcheck, episiotomy isn’t a word. Interesting, that). What about breast implant after masectomy? The way elective and non-elective surgeries are classified is pretty fucked up, and usually in a misogynistic way, which led me to:

    2. Pretty much what Andy said.

    Funnily enough, both issues could be taken care of if we dismantled the patriarchy.

  19. Dominique
    Dominique November 19, 2009 at 3:57 pm |

    It is no more sexist to tax cosmetic surgery than it would be to tax lap dancing, the customers of which, presumably, would be mainly men. When you’re a lapdog for the patriarchy, and you pay for your own oppression, you deserve the sound of the world’s smallest violin.

  20. P.T. Smith
    P.T. Smith November 19, 2009 at 4:01 pm |

    Also more fun news – according to spellcheck, episiotomy isn’t a word. Interesting, that

    Interesting? Not really. Amongst other things, spellcheck doesn’t recognize liminal.

  21. Thom
    Thom November 19, 2009 at 4:25 pm |

    Mascara? And I thought you were a feminist.

    ;)

  22. Tom Foolery
    Tom Foolery November 19, 2009 at 4:37 pm |

    Mascara you no doubt paid the patriarchy’s sales tax on!

  23. Bijan Parsia
    Bijan Parsia November 19, 2009 at 4:47 pm |

    My gut reaction is that it is sexist. On the scale of sexist problems with the health care bill it ranks far behind the Stupak amendment in significance (not least because anti-abortion measures disproportionately affect poor women). However, esp. in context, the transfer of wealth from (albeit richer) women to the general pool seems straight up sexist (that it is coupled with denying poorer women coverage for medically necessary procedures (or even “elective” abortions!) adds insult to injury).

    If it were part of a general luxury tax that hit male and female dominated luxuries fairly, then it would be less problematic. But hitting women oriented luxuries (however we might otherwise feel about them) with a tax disproportionately, negatively affects women. (Though, perhaps insofar as it discourages elective surgery, it’s a benefit. Then again, if we wanted to discourage elective surgery, we could have far more punitive taxes! 5% seems to be revenue oriented rather than discouraging.) Hence, it is sexist.

    And I’m willing to bet that it’s an easy target because it is perceived as a female thing (hence frivolous). So, sexist again.

  24. The Flash
    The Flash November 19, 2009 at 5:01 pm |

    I’m gonna bet here that there are more men getting breast reduction surgery than women.

    “Correction of bilateral gynecomastia” is a cosmetic procedure.

  25. Melancholia
    Melancholia November 19, 2009 at 5:04 pm |

    I’d be curious to see what percentage of female elective cosmetic surgeries are in fact paid for by men (husbands, boyfriends, lovers, parents) I know several women actually who have gotten boob/lip/nose jobs from their guys and even a set of twins (no pun intended) who both got boob jobs from their dad for their 18th bday! These are all anecdotes of course so I’d like to see data. It may very well turn out that most of the cost (if not most of the procedures) are actually born by men, or at the very least that the cost of that 91% is shared more evenly between the sexes than you might otherwise think.

  26. eileen
    eileen November 19, 2009 at 5:07 pm |

    I do think this falls more heavily on women, who make less money than men in general.

    Why not tax luxury items used by both men and women? For example why not add a tax on cars that are gas guzzlers, thus offering incentives for people to buy cars that do not use as much gas.

  27. a lawyer
    a lawyer November 19, 2009 at 5:17 pm |

    Why not tax luxury items used by both men and women? For example why not add a tax on cars that are gas guzzlers, thus offering incentives for people to buy cars that do not use as much gas.

    Considering the state of the American auto industry, a new tax on cars would be a political nonstarter.

  28. Lindsay Beyerstein
    Lindsay Beyerstein November 19, 2009 at 5:26 pm |

    Why not just tax the rich? It seems silly to focus on one particular “sin tax” to help pay for health care. The argument for other health care-funding sin taxes is that they either discourage the unhealthy behavior or help to pay for the consequences. A 5% cosmetic surgery tax probably wouldn’t deter anyone from getting cosmetic surgery. If you can afford a nose job in the first place, an extra 5% isn’t going to stand in your way. Cosmetic surgery isn’t a driver of healthcare costs for others the way that smoking or soda consumption is.

  29. Bijan Parsia
    Bijan Parsia November 19, 2009 at 5:37 pm |

    Melancholia, interesting point. I tried some googlefu, but got depressed by this article. This is at least suggestive that poorer women get (and pay for) plastic surgery.

    Ok, here’s some more reasonable articles. 71% seeking plastic surgery make less than $60,000/year (from 2005). 30% with an income of $30K or less; 41% with an income from $30K to $60k.

  30. one jewish dyke
    one jewish dyke November 19, 2009 at 5:49 pm |

    I wouldn’t have a problem with a tax on cosmetic surgery if certain procedures were exempted, but I don’t think the House and Senate are going to ask to see my list:

    sex reassignment surgery
    breast reduction if the woman has the slightest amount of back pain
    repair of any congenital deformity (and no telling someone their deformity isn’t severe enough)
    repair from any accident or another surgery
    breast reconstruction after mastectomy

    I’m not sure about excess skin removal after weight loss. That may be distressing enough that I’d exempt it.

    What’s that leave? Elective breast implants, nose jobs, lips, eyelids that aren’t causing sight issues, liposuction, non-medical use of botox (it is used medically to treat migraines, possibly other conditions). I feel about those the same way I feel about taxing cigarettes and alcohol and gasoline (the last of which I use). They aren’t necessities, if you want them you should pay for the cost of them to all of us. We do all pay for some women participating in the patriarchy. I don’t blame those who do; we all make our deals to get by, whether that is plastic surgery, taking a husband’s name, wearing lipstick, not negotiating a higher salary because you’ve read the studies that say bosses will be tougher on women who do but not men.

    I can desire for SRS to be covered in the health care bill. I can write to my Congresswoman and tell her so. She is trans-friendly, unlike many of her colleagues. Do I believe it’s going to pass? I don’t even know if I believe a health care bill that isn’t just a gift to the insurance companies will pass by the time it’s all over. Obama says just give him something to sign. A handful of Democratic senators and Joe Lieberman say they won’t pass a public option. We might just be forced to buy insurance from the crappy companies that already exist. Damn I wish I still lived in a Kaiser Permanente region. They were the only insurance I ever had that didn’t suck.

  31. The Flash
    The Flash November 19, 2009 at 6:03 pm |

    well, there are some clear lines that can be drawn here: cosmetic surgery that corrects the effects of an accident or non-elective procedure (i.e. mastectomy) aren’t in the same “luxury”/elective category for the purposes of this conversation, right? And let’s even say that trans-related procedures (or at least the first round of such procedures; no sympathy for deciding after a year or two that B-cups just aren’t big enough) are out. And let’s take it further and say that correction of substantial deformity– hare-lips, braces (In the U.S., you’re not taken seriously if you have bad teeth. That’s not gender-linked.), a septum deviated by more than 5 degrees, B-cup breasts or larger for cismen, and anomalous facial growths of more than a centimeter in diameter or more than two in quantity– are also not in this conversation.

    We’re really talking about “normal” looking people with no related health disorders (other than body dysmorphia) who just want a bigger rack, who want tighter abs without the effort, who want to defy the insidious creep of time across their faces and bodies… is it sexist to charge these people extra? Is it sexist NOT to charge these people extra for perpetuating unrealistic beauty standards?

    So here’s the thing about taxation: it mostly links money to money, at least when generating the underlying rationale for a tax. So, for example, the real boost to efforts to tax soda and cigarettes comes from the increased costs these supposedly have on public health costs: lung cancer and obesity-related treatment. You can’t make the same argument here. The costs of plastic surgery haven’t been articulated in economic terms. Why does the state end up spending more money as a result of people getting plastic surgery?

    There’s an answer though, and that is that the costs are economic and systemic, not because plastic surgery patients use more public resources, but because they privatize what would otherwise be public resources: doctors spend time on cosmetic procedures instead of on sick patients, and therefore have less time for sick patients, and have to ration out that time more carefully. (This only goes so far; cosmetic surgery patients probably make healthcare less expensive for everyone else because the margins on cosmetic procedures are so good; they pay a disproportionate part of the overhead for the office.)(also, this isn’t only true for dermatologists/gastroenterologists; almost every specialty has its cosmetic procedure of choice.)

    But is it sexist?

    This is one of those times where “disparate impact” arguments drive me nuts. Because the truth is, there are women who would be greatly helped by taxing these frivolous procedures, and there are women who would be deeply hurt by taxing these frivolous procedures. How many doctors are able to do clinic hours because they’ve taken care of their office overhead that day by doing two hours of botox injections? How many hospitals pay for expanding their surgical wing with the proceeds of liposuction and gastric bypass? For that matter, how many people are able to get affordable cosmetic surgery for the approved reasons listed above because there’s a larger market for the procedure– more doctors doing breast implants for mastectomy patients because they can sustain a non-cancer-linked business with strippers and porn stars (omg it’s poetic license, leave me alone). Unless Congress is taxing cosmetic surgery because “those flighty women shouldn’t be getting themselves all hussied up anyway,” this isn’t really sexist, or not more sexist than obligations applied to non-custodial parents, who are almost all men.

  32. ginasf
    ginasf November 19, 2009 at 6:04 pm |

    Taxing procedures involved in transpeople’s transitions would just be yet more punishment and marginalization of an already abused population. Many transpeople go through hell trying to save up the funds for these life-saving procedures, to the point of getting involved in sex work and exposing themselves to considerable danger. It’s one thing to say “don’t tax SRS” but then one has to define what SRS is. Is it only genital reconstructive surgery? Is it chest reconstruction and hysterectomy/oophorectomy for FTMs or just metoidioplasties or phalloplasties? For many MTF women, facial feminization surgery is a more important than SRS (and certainly more expensive), since being clocked by one’s face can often lead to transphobic violence and discrimination. It’s not unusual for FFS to cost upwards of $40K, which means another state tax of $2K on top of that. As it is now, none of these surgeries can be written off of taxes (there is a long-time pending case in Federal Courts about this which has yet to be rendered with a decision after nearly 2 years) and they are overwhelmingly not covered by health insurance. Calling this surgery “optional” and “elective” feeds back into rightwing fundies who claim being trans is a “lifestyle choice.” As was previously mentioned, many of the people trying to afford these procedures are already low-income and feeling the full impact of job/educational/healthcare discrimination.

  33. RD
    RD November 19, 2009 at 6:09 pm |

    People are talking about exempting sex reassignment surgery, but what about other transition-related surgeries that some people get? Like facial feminization surgery etc. etc. IMO those shouldn’t be taxed either. (And speaking of breast implants, I don’t think breast implants should be taxed for trans women).

    I’m not sure if any of it should be taxed or not but anyway.

  34. Jay@racialicious
    Jay@racialicious November 19, 2009 at 6:53 pm |

    Why not just tax the rich?

    If taxes are too high, the rich will just move. But they do get taxed quite a bit, as Jill said. That being said, luxury item taxes are probably not too much of a problem (and they exist already) as they’re normally factored into purchasing decisions.

    I agree about the health care bill, sadly. It seems hamstrung from the start – they seemed way to eager to appease the insurance companies, but for what? Most (read: almost all) republicans still oppose the bill on principle.

  35. Michele
    Michele November 19, 2009 at 7:00 pm |

    The whole concept of cosmetic surgery to look younger is appalling to me, but then I don’t wear makeup nor will the grey hairs that streak through my hair be vanquished. I never got on the “beauty” bandwagon and think that if you can afford the luxury of unnecessary surgery, then you probably have more money than sense and should put some of your $$ into the public bucket o’taxes. Tax away. Obviously I am paranoid and old enough to know that someone somewhere who needs the surgery will get fucked out of it because it’s too expensive, but that’s already happening isn’t it?

  36. cacophonies
    cacophonies November 19, 2009 at 7:15 pm |

    Is it sexist NOT to charge these people extra for perpetuating unrealistic beauty standards?

    I think that’s the point right there. As long as SRS is covered, tax away. It’ll either deter people or it won’t. If it does, then good for them. If it doesn’t, then great, there’s some more money going somewhere hopefully useful.

  37. RD
    RD November 19, 2009 at 7:32 pm |

    And yes the reason I think they shouldn’t be taxed is because they are often very much medically necessary. FFS can also (from what I understand) be about body dysmorphia and the way someone interacts in the world, about fixing what testosterone did to the face, which can be hugely important things. And they can be hugely important things to trans women who don’t have a lot of money too.

  38. Q Grrl
    Q Grrl November 19, 2009 at 7:35 pm |

    Isn’t war a luxury item? A sin of the grossest measure? I’d rather see the Joint Chiefs of Staff taxed for their decisions then women/men who elect surgery.

  39. RD
    RD November 19, 2009 at 7:54 pm |

    It could be seen as fixing the damage that testosterone exposure brought to the face.

  40. The Flash
    The Flash November 19, 2009 at 10:15 pm |

    But cacophonies, didn’t you read the rest of my comment? removing these procedures from the economy has bad effects on women who don’t want to support these beauty models– it makes healthcare more expensive and provides less incentive for people to go into the fields of reconstructive surgery. weirdly enough, cosmetic surgery has a redistributive effect, by subsidizing medical facilities (both private and public) so that other procedures are less expensive, and so that more doctors are available for the genuinely important “cosmetic” surgeries like reconstructive surgery. It isn’t so black and white where supporting bad beauty standards = totally bad. Sometimes being stupid about paying into bad beauty standards has the effect of transferring your money, indirectly, to someone who really needs it (like the doctor’s other patients who benefit from his practice having its overhead covered by your frivolous surgery, so he can charge less).

  41. cacophonies
    cacophonies November 19, 2009 at 10:49 pm |

    The Flash-

    I was being overly simplistic, it’s true. There are so many facets to every seemingly small proposition that, on the surface, seem relatively straightforward and obvious. I’m no expert in anything economic, though, so I couldn’t even pretend to fully grasp all of the implications of potentially taxing elective and “unnecessary” cosmetic surgery. My gut reaction to this is “anything to help get rid of unrealistic beauty expectations!”

    So, to answer your first question more clearly, when I saw that you were talking about where money goes and economics, my brain kind of shut off and I didn’t read the entire comment.

  42. RD
    RD November 19, 2009 at 11:22 pm |

    For trans women who see it that way, as a reason for surgery.

  43. one jewish dyke
    one jewish dyke November 20, 2009 at 12:16 am |

    Is anyone going to change his or her mind about botox injections or a nose job because of a 5% tax? If you can afford non-medically necessarily procedures and run in a crowd where that’s an issue, you’re going to pay a reasonable tax.

    I was in an accident when I was 16. I had 20 stitches in my face. The entire area is also discolored because of the type of injury it was. I see the scar as minor, and have never been interested in having cosmetic surgery to have it fixed. It bothered my mother, probably in part because she was out of the country and I was staying with my grandmother at the time. She once offered to pay for the surgery, and I assure you a tax of 5% would not have made a difference. Now that I’ve had the scar for longer than I lived without it, I think she is used to it.

    I don’t view SRS the same way, or breast reconstruction after mastectomy. While some will — and do — find a way to pay the cost if their insurance won’t, and will find a way to pay a tax on top of the surgery costs, those are surgeries to correct a life- or health-threatening condition. I know my mental health would be seriously compromised if I woke up in the morning with a male body. I can imagine how it might feel every day.

  44. Femnist
    Femnist November 20, 2009 at 3:31 am |

    ‘Taxing cosmetic surgery’ seems to be a good idea at first, but the fact is that there are people who have severe psychological conditions because of a perceived deformity. These people need extensive therapy and have severe confidence issues. At that point, the surgery – let it be breast augmentation or rhinoplasty – becomes a medical necessity. The real question is – Who decides whether a particular surgery is a medical necessity or not?

  45. Anna
    Anna November 20, 2009 at 6:07 am |

    Doctors, usually. Here in the UK we can get plastic surgeries free if a doctor agrees that it’s having a serious impact on the patient’s mental health (I was offered various awful, invasive, non-medically neccessary surgeries when I was fourteen because I was being bullied for walking a bit funny).

  46. Ellid
    Ellid November 20, 2009 at 7:07 am |

    I don’t think it’s any more sexist than taxing the purchase of luxury goods like Hummers or private cabin cruisers, both of which are purchased mainly by men. And I say that as someone who’s used laser hair removal and has contemplated skin procedures to take care of acne scars. As much as women are pushed to look perfect, ultimately the person who has Botox or liposuction or dermabrasion chooses the procedure. Except in the case of severe injury or disfigurement these procedures aren’t medically necessary, and there’s a lot of risk involved in some of these elective procedures (like liposuction).

  47. Faith from F.N.
    Faith from F.N. November 20, 2009 at 8:03 am |

    “Up until very recently, I still had 6 baby teeth, with 6 adult teeth underneath.”

    I was in a somewhat similar situation recently. Only I only lost 1 primary tooth instead of 6. I also did not have the permanent tooth to replace it…so I now I have to pay $3000 to replace the missing tooth. This is considered cosmetic and would not be covered by insurance even if I had it. I do not believe that most dental procedures should be considered cosmetic. Dental health is a very important part of your overall health. Crooked and missing teeth can cause very real health problems. In short, I think the solution in these types of situations is to have people finally recognize that many procedures that are considered cosmetic aren’t. They are medically necessary.

  48. La Lubu
    La Lubu November 20, 2009 at 8:45 am |

    Dental health is a very important part of your overall health. Crooked and missing teeth can cause very real health problems.

    Yes, and the main reason people have these problems is because of lack of dental insurance when they were children. My folks had medical coverage, but not dental. As a consequence, I saw a dentist exactly once as a child—the appointment necessary to start school (and after that, none of the other school districts I attended required a dental report). I lucked out. I had a baby tooth that never descended until adulthood, and the adult tooth came in fine on its own (before getting into the trade, I had no medical or dental coverage, so—no preventative or other kind of care, either!).

    That’s the big problem with only “covering” these procedures for children and teens. There’s a huge populace that didn’t have the benefit of coverage during that time, and deal with the ongoing consequences of that throughout adulthood. If you’re lucky, you can get a good enough paying job to get the braces, crowns or other “cosmetic” items you should have had as a kid—but not everyone is lucky.

  49. Lizzie
    Lizzie November 20, 2009 at 8:47 am |

    I had orthodontic surgery to correct a problem most people couldn’t see. If I didn’t have it, by the time I was 40 I would need dentures due to uneven erosion (according to seven different doctors). Is that “elective” or not? Is my friend’s boob job to rebuild her body post-double-mastectomy and breast cancer “elective”? Technically, absolutely. And if insurance companies can wriggle out of paying for things, they will.

  50. Lizzie
    Lizzie November 20, 2009 at 8:49 am |

    If you are in the kind of business where a truly elective boob job, rhinoplasty or liposuction is de rigeur (stripper, model, aspiring trophy wife) you are in the kind of business where they will pay for themselves. A small tax only slightly alters the cost/benefit calculation.

  51. Josh Jasper
    Josh Jasper November 20, 2009 at 8:58 am |

    I foresee a business in relocating cosmetic surgery clinics to Mexico.

  52. Lizzie
    Lizzie November 20, 2009 at 9:00 am |

    One last thought. Where I come from we have a free-at-the-point-of-need national healthcare service that is, while not perfect, generally amazing. As tax resident there I’d pay less of my income than tax-resident in America (and yes I do love America or I wouldn’t be here, but it’s the people and place I love and not the government’s total indifference to the living conditions of its less fortunate inhabitants).

    The difference is not how much tax my homeland puts on comparatively little industries like plastic surgery. It’s that we don’t spend 50% of our national income on bombs.

  53. Li
    Li November 20, 2009 at 9:29 am |

    I find the idea of taxing cosmetic surgery deeply problematic. Most of the reasons people have outlined above, but essentially it boils down to the deeply contested nature of medical necessity. Now, these contestations are all well and good to nut out here, but there’s a massive problem when you begin to legislate some kind of boundary.

    What model do people propose to draw the line between necessary and cosmetic surgery (leaving aside the fact that some cosmetic surgery IS necessary)? And how are these models going to be enacted? Is it a blanket tax and then you apply for a tax exemption? Is there a list of exempt procedures? Is there a list of people for whom specific procedures should be exempt?

    I don’t see any of these working without just producing a whole heap of extra hoops for people to jump through (I see The Flash’s examples, and think of a doctor saying; “Too bad, your septum only deviates by 4.5 degrees”). There’s a reason I favour the widest possible exemptions in these cases, and it’s because once you start shoehorning people and their motives into boxes, and specifically legislated boxes, you tend to run into a whole heap of problems.

    I’m also pretty squicky about some of the discussion here. I’m not sure that I buy that cosmetic surgery is overwhelmingly undertaken by rich women. I’m also pretty generally getting ableism squickies from drawing lines as to whose bodies it is acceptable to correct using cosmetic surgery. I can’t really articulate it atm, but yeah. Maybe it’s because it kind of argues that ‘normal’ people who engage in cosmetic surgery do it cos of patriarchy but ‘deformed’ people are doing it cos it’s completely natural to want to fix the ‘deformity’.

  54. Athenia
    Athenia November 20, 2009 at 10:33 am |

    Lots of states have a sales tax on food, gas and other things…the idea is that I have a choice to buy those things or not, but in reality, I don’t have a choice. So, is it morally wrong to tax toliet paper? Gas?

  55. A.W.
    A.W. November 20, 2009 at 11:05 am |

    Li,

    “I’m also pretty generally getting ableism squickies from drawing lines as to whose bodies it is acceptable to correct using cosmetic surgery. I can’t really articulate it atm, but yeah. Maybe it’s because it kind of argues that ‘normal’ people who engage in cosmetic surgery do it cos of patriarchy but ‘deformed’ people are doing it cos it’s completely natural to want to fix the ‘deformity’.”

    There is that. There’s an undercurrant of “Of course they’d want to fix this.” Someone above mentioned having a cuttoff point for facial disfigurement, and I’ll tell ‘em right now that if the hemangiomas were flat on my face when younger instead of, well, – not -, I wouldn’t’ve cared how large it was, the physical side of the discomfort would’ve been gone. I grew up with the questions, was used to them. Didn’t get mean about them until much later, so ‘fixing’ it wasn’t on my radar. And it wouldn’t’ve blocked my eye, so even better. And you just know, in my hypothetical scenario, that if it the hemangiomas – were – flat, and it – was – covered by insurance and I – didn’t – get it lasered that people would be constantly asking why it wasn’t gone and recommending ‘helpful treatments’. Like they do now for anything out of the ‘norm’, funnily enough. My cousin has a birthmark, a very pretty bluish-purple, covering half of her bottom leg. Pretend that there’s treatment to totally change the color to the rest of her skin tone – would people consider that that needs to be taxed? It’s a birthmark, much more than a few centimeters and no doubt gets her annoying, repetative questions much like my hemangiomas did. Does absolutely nothing, mind, it’s merely color. I’m betting a lot of people (here and elsewhere) would say ‘no’ as they’re simultaniously questioning said birthmark and offering helpful tips that “an aunt of a friend of mine had done…” to dull it. To me, “anomalous facial growths of more than a centimeter in diameter or more than two in quantity” (sorry to pick on you, Flash, but it’s a good jumping off point) wouldn’t’ve made a difference if it was flat – I wouldn’t’ve had it removed if given a choice. In fact, I didn’t get particularly bitter until a few years – after – they were removed when I realized that people were still going to ask what happened to my face. If anything, for disfigurements that aren’t physically uncomfortable, it isn’t so much cuz people want to ‘look normal’ – it’s so others will finally shut the hell up about it. For me, it’s a scar – no one needs to know, still doesn’t stop ‘em from asking. Unless you’re physically pristine (and few people are), people are going to ask questions.

    The idea here that the questions they asked me before and after removal are so radically different from the questions they ask (general) you about your odds and ends is utterly ridiculous. The difference is that people who don’t have ‘em think they can be nosy at your leisure because yours are noticable upon the first glance instead of the fifth or sixth one. And it’s a theme in the comments, because plastic surgery is often far from a ‘miracle cure’ for people who need or want things changed. When someone gets something done, so far as I know, there’s often something else to take its place. A scar, a lisp, a brace, pins – what have you. So the funny part that y’all are arguing about, this idea that all people want to be normal as possible? No. Just no. It often doesn’t happen like that, because your normal is an impossible ideal that we’ll never meet. A lot of the time people just want (general you, again) to – stop – with the helpful tips and none-of-your-business prying. And the current beauty standards certainly don’t help. Incidentally, does anyone realize they’d be failing to tax people who fixed ‘disfigurement’ because it – also – helps to conform to current beauty standards?

    There’s definitely a current of ableism in this thread, among other things. I get bitter at a lot of things – particularly those horrid infomercials that promise to lessen scaring. I – loath – those. Other people feel they need them, and/or surgery, so I refuse to say that their choices are going to be lumped under ‘cosmetic’ and taxed – especially with the atmosphere women and men have to currently put up with wrt ‘disfigurement’. A lot of times, people are still going to be nosy, rude buggers no matter if something gets ‘fixed’ – it’s a bit of a moot point in that regard.

    Quite a few ‘disfigurements’ aren’t payed for by insurance anyway. Mine sure as hell wasn’t and nowhere would it have been considered a mild birthmark. Didn’t matter though – still wasn’t covered – an aunt was kind enough to scrounge up funds and pay for it. Which took several years. So this idea that people can separate what ‘needs’ to be corrected and what doesn’t is especially ridiculous when some people who – aren’t even dealing with this shit – are putting forth their opinion. We (royally here, because I’m just that cheeky) don’t want to hear it. Go find something else to tax, because attempting to tax plastic surgery is a gigantic Fail.

    And others mentioned trans things, so I won’t even go into that one. Very, very glad that was brought up, issue’s home.

  56. A.W.
    A.W. November 20, 2009 at 11:14 am |

    Ugh, missed a word. “Go find something else to tax, because attempting to tax plastic surgery is a gigantic Fail.” That was supposed to be “taxing – some – plastic surgery”.

    It’s just, so what if someone wants a nose job when their nose, by current beauty standards, is perfectly fine? First, it’s not particularly feminist to judge what others consider their own body procedures and whether or not it’s ‘necessary’ enough to tax, (either tax the whole or don’t, but don’t pretend my surgery was any more necessary than theirs – I’m quite sure some of those hypothetical nose jobs had heavy emotional impact, which isn’t to be discredited) and second, the rest of us are going to get caught in the “You don’t really – need – that” crossfire. Which there is unfortunately quite a lot of.

  57. The Flash
    The Flash November 20, 2009 at 12:18 pm |

    Also very interesting… I think the undercurrent to what you’re saying is that in this conversation, we’re accepting that reinforcing sexist tropes (like by getting breast enlargement when you’re already ‘normal’ looking) may be worth taxing, but we’re accepting at face value an ableist idea that if your physical being deviates from ableist notions, your desire to conform to ableist models of the human body should be respected. Do I have that right?

    but also curiously, I think the model that you’re pointing out is that we’re respecting an individual’s decision to conform to ‘normalcy’, but not to try to extend beyond it. In fact, that’s kind of where the trans argument comes in; that we’re respecting the desire of trans persons to get themselves to a point of being within the boundaries of ‘normal,’ i.e. not a man trapped in a woman’s body. But we’re not honoring the desire to get beyond ‘normal’– to have larger breasts than normal, to be thinner than normal, to defy normal aging processes. And so, yes, it’s ableist to say that a person’s desire to get to these norms is worthy of special respect in this system, above and beyond trying to have superhuman characteristics. But at the same time, it’s an attempt to keep the conversation from depriving the disabled of important procedures for enabling their participation in mainstream society. So if you’re saying that we should outlaw elective surgery AND have an ableism revolution… well, we’re going to have to deal with the healthcare package before we get anywhere near having an ableism revolution.

    Is there a non-ableist way to ever address disability? There’s always either a philosophical condescension or a tangible deafness to the challenges of disability, right? But I guess that’s only true in an ableist system.

  58. Li
    Li November 20, 2009 at 2:12 pm |

    The Flash, the point is that many women who use plastic surgery aren’t doing it to have bigger breasts than ‘normal’. Many of them might be doing it because they feel that their breasts aren’t normal, because their weight isn’t normal, because their bodies can’t meet their expectations. Drawing a line based on who’s trying to get to normal and who’s trying to exceed it doesn’t work precisely because it needs an acceptable definition of normal, and there isn’t one. Normal is contested. It’s complex.

    I don’t think we should outlaw cosmetic surgery at all. I think we should get out of the game of legislating a tax on it because it’s either 1. You draw the line at all cosmetic surgery, which increases costs and inaccessibility for all the examples given by people above. Or 2. You draw a line to exempt the examples above through some kind of legal magic, reify a bunch of judgements that put people in either the legitimate desire to change their illegitimate bodies or in the illegitimate desire to change their supposedly legitimate bodies box, and create even greater accessibility problems for anyone whose situation falls near the dividing line.

  59. Bitter Scribe
    Bitter Scribe November 20, 2009 at 2:21 pm |

    This is like trying to tax so-called “junk food.” No matter how stringently you think you’ve defined it, there always will be borderline cases that drive people crazy.

    Years ago, my state started taxing sales of medicine at lower rates than general sales, leading to no end of confusion. Are condoms “medicine”? KY Jelly? As one frustrated pharmacist told me (for a newspaper article), “All of a sudden I’ve got to make moral decisions at the cash register.”

  60. A.W.
    A.W. November 20, 2009 at 2:37 pm |

    “Also very interesting… I think the undercurrent to what you’re saying is that in this conversation, we’re accepting that reinforcing sexist tropes (like by getting breast enlargement when you’re already ‘normal’ looking) may be worth taxing, but we’re accepting at face value an ableist idea that if your physical being deviates from ableist notions, your desire to conform to ableist models of the human body should be respected. Do I have that right?”

    Er, if you’re talking to me – no. That wasn’t what I meant. If someone is going to tax surgery on the basis of ‘need’ vs ‘not need’, then the only people who can figure out if you really need a procedure is you. Which was why I took a chunk of your sentence and used it as an example of why you think I (since my circumstances were in your example) should’ve been exempted from tax and why I thought the whole premise of exemption was flawed. I wouldn’t have wanted removal if criteria had been just a bit different but funnily enough I would’ve still been exempted from the tax if I chose to get what I would consider, in that hypothetical flat-hemangioma scenario, an elective procedure. The opposite applies to others who feel they’d need surgery or some such when others would consider it elective. I don’t need creams et al to get rid of scarring, I’m as fine with it as I’ll ever be – someone else might want or need more surgery to change – whatever -, and they’re welcome to it. I just get a bit bitter that an ideal is being promoted in mainstream beauty that many, many people wouldn’t be able to achieve even if they wanted to. Ergo, either tax the whole damn thing or forgo it.

    “but also curiously, I think the model that you’re pointing out is that we’re respecting an individual’s decision to conform to ‘normalcy’, but not to try to extend beyond it. In fact, that’s kind of where the trans argument comes in; that we’re respecting the desire of trans persons to get themselves to a point of being within the boundaries of ‘normal,’ i.e. not a man trapped in a woman’s body. But we’re not honoring the desire to get beyond ‘normal’– to have larger breasts than normal, to be thinner than normal, to defy normal aging processes.”

    I’m trans – get thee to a 101 site, you’re oversimplifying and skewing that whole bit erroneously. Transition isn’t about looking ‘normal’ and the ‘man trapped in a woman’s body’ is an oversimplified cis-centric trope. Further, cis people certainly aren’t honoring transition as a whole. Far from it. As for people not honoring the idea to get ‘beyond normal’, normal is a skewed perception. There’s barely a recognized middle ground of ‘normal’, which shifts depending on who you ask because the current beauty standards are so skewed. But no, people aren’t honoring the desire to get ‘beyond normal’ (whatever that is) or they wouldn’t be so nosy or give such helpful advice. Why are you defining ‘beyond normal’ as just bigger breasts, being thin and wrinkle-free? If normal is the middle ground, then it’s sandwiched. They’re not honoring it twofold – some people want to tax cosmetic and surgical procedures for only some of the population when anyone in the population may or may not need it. Then there’s the fact that – not one person can figure out what surgery is truly ‘elective’ on someone else’s part -. Which stands to bear repeating.

  61. Ursula L
    Ursula L November 20, 2009 at 2:50 pm |

    This strikes me as having the same sorts of problems as when abortions were legal only when “medically necessary” and hospitals had committees to review each woman’s case and determine if she really “needed” an abortion.

    There are just too many variables that go into each medical decision, and each person’s medical condition. What is minor for one person can be very distressing for another, and it is quite hard to determine from the outside what is, or isn’t, appropriate. One person might be terrified of surgery, and content to live with a situation that is unbearable for another person, who would welcome a surgical remedy.

    The same goes for taxing “junk food.” What is junk for one person is sometimes essential for another. For example, at one of the group homes I worked at (for developmentally disabled adults) several of the residents were very spastic from CP, and the constant spasms burned many, many calories a day. Their diets were full of what would be considered “junk food” in many people’s diets – because they needed to eat foods that were very calorie dense, just to maintain a minimum weight. An extra-thick milkshake, with heavy cream instead of milk, sounds like junk food, but in their case, it was healthy and needed.

    If you’re going to have a “sin tax” then you need to be very, very sure that it actually is a sin, for everyone affected by the tax.

  62. A.W.
    A.W. November 20, 2009 at 3:00 pm |

    “If you’re going to have a “sin tax” then you need to be very, very sure that it actually is a sin, for everyone affected by the tax.”

    This this this.

  63. Mike the Mad Biologist
    Mike the Mad Biologist November 20, 2009 at 3:54 pm |

    If you taxed hairplugs, I think this tax would wind up going away.

  64. Bijan Parsia
    Bijan Parsia November 20, 2009 at 4:25 pm |

    I don’t think it’s the case that a sin tax need to be uniformly a sin to be worth doing. It depends on the number of people for whom the sin is not (merely) a sin, and the effects on them as well as the overall effects. Of course, “sin tax” is or should be a misnomer: moralism isn’t the point, but public health. Public health is a numbers game, after all. Compare with compulsory vaccination (you have obvious exceptions such as known compromised immune systems, but the overall benefits still justify it).

    Ursula, your example is better for the non-uniform sin case. This person is in a group home and they are under care…an easy place to exempt or otherwise compensate.

    Similarly, not everyone who smokes develops lung cancer. Play with a risk calculator. It’s not like being a smoker (even in the worst case) is a death sentence (“In the next 5 years 1493 of 10,000 smokers like you will die of all causes compared to 1517 of 10,000 nonsmokers.” Here’s a case where being a smoker minorly benefits you though, of the ones that die, far more will die of lung cancer.) But it’s still worth discouraging all the smokers from not smoking, just for the lives lost/shortened overall. (Of course, probably even moreso in terms of overall health, quality of light, and treatment expense.) At least some smokers live as long as they otherwise would, but are deprived of the pleasure of smoking (or endure the pain of being an ex-smoker).

    (Now this isn’t quite analogous since, arguably, smoking isn’t “essential”, at least in the way that the milkshake was. But smoking has lots of mental health benefits, or so one can argue and your earlier argument seems to apply just as well.)

  65. Zoë
    Zoë November 20, 2009 at 4:34 pm |

    If you think about it, many parts of our society still glamorize smoking, and in some subcultures–like factory or construction work–smoking is a way to fit in, be liked, and (in many cases) get more breaks during the workday; and yet we still tax cigarettes. On the other hand, we have put a lot of restrictions on cigarette advertising, so hopefully the societal pressures to smoke will lessen rapidly. I think I am okay with taxing plastic surgery as long as some restrictions are put on the media in terms of advocating exaggerated physical “attractiveness” (can you say “Ralph Lauren”??)

  66. thetroubleis
    thetroubleis November 20, 2009 at 7:16 pm |

    Bijan Parsia, what about someone with CP who has an in home carer or lives with relatives? Why should they pay a tax on something necessary?

    Really, the ableism in this thread is astounding.

    I hope people see why deciding what isn’t and isn’t necessary is problematic.

  67. thetroubleis
    thetroubleis November 20, 2009 at 7:30 pm |

    Also, what would you have to do to prove you were buying “junk food” for a “good” reason?

  68. voluptuouspanic
    voluptuouspanic November 20, 2009 at 8:36 pm |

    I do research on the social construction of the female body. I just wanted to address this question about “normal” bodies and cosmetic surgery. If you look at the research (Debra Gimlin is a name to look up_ on women who get elective cosmetic surgery, they’re frequently doing it in order to increase their power within interactions. Not exactly bucking the system, but giving themselves a little more. We live in a society that values a very specific type of female body (able-bodied, pretty, white, slender and toned, etc). I think that as long as we live in a society that only values one kind of appearance for women, it’s going to be sexist to tax cosmetic surgery.

  69. Bagelsan
    Bagelsan November 20, 2009 at 10:18 pm |

    The way I see it, an argument can be made that *every* law or tax is ableist or classist or sexist or something-ist, but we still need to have most of those laws and taxes around, albeit often in a slightly altered form (maybe the alternative is *more* -ist, like affirmative action as a not-very-good-off-the-top-of-my-head example. It prioritizes certain groups over other groups but only to correct a huge amount of the opposite prioritizing.)

    I don’t have a problem with taxing a lot of cosmetic surgeries. I don’t think it’s sexist, and while I *do* think it could easily be ableist or classist I don’t think it *has* to be. It would take a lot of fussing and tweaking and exceptions but I don’t want the perfect to be the enemy of the good here; I think that using elective surgeries to help fund healthcare is better than our current situation of tax-free elective surgeries and little to no healthcare. Ultimately I think this is a relatively painless way to help solve a much worse injustice.

  70. thetroubleis
    thetroubleis November 20, 2009 at 11:25 pm |

    But, who defines elective? How “bad” does it have to be for surgery to be considered legitimate?

  71. Coffeegirl
    Coffeegirl November 20, 2009 at 11:53 pm |

    I pretty much agree with Bagalsan in post #75. I don’t see any problem taxing elective cosmetic surgeries, and if there has to be a primary -ism attached to it, I’d say it’s more classist (sp?) than sexist.

    And it could get sticky when you get into what exactly constitutes elective vs. non-elective surgeries, etc. But the bottom line is, as I see it, if the tax money is going to something worthwhile and helpful to the country in general then I see no more problem with this than I do with the cigarette tax.

  72. Li
    Li November 21, 2009 at 2:13 am |

    Ok, I really don’t get the whole elective-surgery-is-like-smoking thing. Elective surgery is part of the health system. It’s also, in general, not giving people cancer. Maybe people could explain why they think that this is a good comparison? I’m not getting it.

    The construction that it’s either this tax or no healthcare is quite frankly, bullshit. Do you know who has heaps of money? The military. You could totally pay for healthcare by BUILDING SLIGHTLY FEWER DEVICES TO KILL PEOPLE.

    I’m going to explain how I see it.

    Here is a line of body modifying ‘surgery’ (for want of a better term).

    Triple bypass My nose ring.

    The triple bypass stops someone dying. My nosering does not. But they’re essentially both body mod practices. Cosmetic surgeries fall in a whole bunch of different places on the line depending on the type and the reasons for getting them. For the sake of moneys though, we generally put them around the middle. Now, there’s a legitimate division somewhere on here for what gets funding/tax exemptions/whatever, generally around medical worth (which, around the middle, gets pretty complex, and medical worth is a concept hugely influenced by a bunch of social ideas yadda yadda).

    What this tax does is shift that division closer to the left hand side of the line. There will be medically valuable stuff taxed by moving the line. There will be stuff that might not be particularly medically valuable. There’s a massive crossover though, this is a spectrum, not two neat boxes. What I think is sexist is using the Oh Those Superficial Women trope to justify stuff that is going to tax important parts of people’s healthcare.

  73. Li
    Li November 21, 2009 at 2:15 am |

    Sigh, browser totes thought the line was html.

    Triple Bypass /———-/ My Nose Ring.

  74. thetroubleis
    thetroubleis November 21, 2009 at 8:31 am |

    Coffeegirl, you really can’t see how this is extremely ableist as well?

    First, it assumes that PWD want to fix their bodies, then it polices who is really disabled.

  75. EntoGeek
    EntoGeek November 21, 2009 at 11:19 am |

    I dont believe there should be any luxury tax or “vice” tax on anything. How presumptuous to say someone else can play parent to other adults. As for pastic surgery specifically, I would never trust another person to decide what was medically necessary for me. When I was 17, I had a gastric bypass. My parents paid for it. To me, it was “medically necessary” because I was morbidly obese but had no serious complications from it yet. Now, I have done damage to my body but avoided some of the most serious co-morbidities. (I have an eating disorder, so I’m also kind of sensitive and easily angered by the whole “fat people are a burden on society” rhetoric.) Three years ago, I had a body lift. That’s a pretty big all-in-one plastic surgery payday for any doctor, and my parents and I paid for it. Why? At 21 years old, I could lift the skin on almost any part of my body and make a parachute. It hurt to run. I had little burst blood vessels from the skin bouncing when I moved. There was always a possibility of yeast infection under the flaps if I stayed to sweaty. Even now, I still dont have the perfect tight skin some women in their 20′s do (or at least we are led to believe), but I can be active without suffering. I cant imagine where I’d be right now without these surgeries. I’m grateful my parents were able and willing to help me out, but what about others like me who have no outside means? It is no ones place to tell another person what is “medically necessary” in ANY situation.

  76. Margaret
    Margaret November 21, 2009 at 11:24 am |

    I work in Canada as a staff accountant doing tax returns.

    I was surprised to find out that in Canada, elective plastic surgery counts for the medical tax credit.

    In other words; money spent on plastic surgery reduces the amount of income tax you have to pay!

  77. Natalia
    Natalia November 21, 2009 at 11:46 am |

    I plan on getting cosmetic surgery as I age. Maybe I’ll change my mind, but as it stands, it’s in my long-term agenda and I hope I can afford it. I don’t think that any one of us can cheat the natural process of aging, but considering my stress-filled life, I don’t know how well I’m going to age. I’d like to have options when confronted with the extent to which I am weathered.

    They aren’t necessities, if you want them you should pay for the cost of them to all of us. We do all pay for some women participating in the patriarchy.

    Sure, and women also pay for the fact that my mother, who’s never had any cosmetic surgery and smokes, is still good-looking in her 50′s. My father’s friends compare their wives unfavourably to her all the time. I doubt I’ll look like that when I’m in my 50′s. Most people do not.

    The thing is, the responsibility is once again shifted onto her shoulders in that scenario, as opposed onto the shoulders of all of us who only value people based on arbitrary physical characteristics.

    How do you quantify harm? Do you allow for the fact that harm goes both ways? My mother’s looks have brought her more than praise, they’ve also brought her serious pain. Unwanted attention can suck. Being constantly approached by shallow people can suck. Other women calling you a “whore” can really suck. I’m sure it’s great to be beautiful, but everything has its consequences.

    Just as surgery – elective or otherwise – has consequences.

    This issue is not black and white. For many reasons. And I don’t think the stuck-up attitude many people have about it (hey there, Dominique) helps clear up this issue.

  78. Ursula L
    Ursula L November 21, 2009 at 12:18 pm |

    Having an exemption from a “sin tax” for people who can prove medical need is inviting a major government intrusion into the private realm of individual medical decisions.

    How much would the individual need to open their private health concerns to public scrutiny, in order to be able to get needed treatment without being penalized by a “sin tax”? How much could third parties interfere? Say, deciding that they won’t provide the “sin” product/service for anyone, or second-guessing medical prescriptions to give an individual access to a medically necessary “sin”?

    Consider the “pro-life” pharmacies that refuse to dispense birth control when it has been prescribed by a doctor, or to stock Plan B, or the difficulties with abortion access since it is regulated separately from ordinary gynecological services (leading most gynecologists to not provide abortion care, and the restriction of access to a few clinics.)

    When some people decide that certain types of medical care are potentially “sinful” and that the particular medical treatment ought to be regulated as a potential “sin”, the result is, quite frankly, bad. It puts a stigma on people needing the type of medical care, no matter how medically legitimate their need. It makes getting the care more expensive and more difficult, no matter how urgently you may need it. It reduces the number of practitioners willing to provide the care, and go through the extra bureaucratic steps required to provide the care legally.

    As feminists, we consider it very important that individual medical decisions not be restricted by government regulation of medical care as a “sin” – access to sexual education, birth control, gynecological and obstetric care, abortion care. Also appropriate treatment for trans individuals. Or access to vasectomies for cis men wanting birth control more reliable than a condom. Or the right to refuse treatment, even against medical advice. Or the right to adequate pain management, even at risk of addiction or side effects. Etc.

    Dig through the Feministe archives and look at all the situations where people have blogged here about their need for various forms of medical care, and having their access to that care being interfered with by misguided policies that are supposedly for the public good.

    Getting into the game of saying “this care is good, and should be freely available, that care is a “sin” and can be restricted” is a loosing proposition for feminists trying to protect reproductive rights and medical autonomy. If we believe in individual autonomy for medical decisions we need to stand by that belief. We weaken our argument that women deserve autonomy in our medical decisions if way start to argue that not everyone should have autonomy in their medical decisions, and that it’s okay to stigmatize some types of medical care as a “sin.”

    What is the difference between a rightwinger thinking they can decide which woman “deserves” an abortion, and which should be forced to go through a pregnancy against her will, and someone deciding that this person “deserves” the plastic surgery they want, while that one should be forced to live with the situation they want surgery to address?

    ***

    So I would say, yes, it is sexist.

    It’s sexist because it is a policy of intervention in individual medical autonomy, and it is undoubtedly easier for many people to accept because it will mostly affect women, and there is already a cultural bias that women can’t be trusted to make their own medical decisions, and that women don’t have full medical autonomy. It plays on the stereotype of women as irresponsible in making their own medical decisions, and the need for social control of women’s bodies, whether it’s social control of sexuality, social control of access to birth control, social control of access to abortion care, or social control of access to plastic surgery.

    The entire framing of the discussion is sexist – from the use of images of women, to the reliance on stereotypes about women wanting plastic surgery for vain or frivolous reasons. (Why not focus the discussion on, say, men who look for penis-size-increasing treatments? Men’s bodies just aren’t seen as fit for public control and public criticism in the same way as women’s.)

    If it wasn’t sexist, you’d see as much focus on men getting cosmetic treatments, and the types of treatments that are targeted towards men, as you see discussion of how it affects women. Not having how it affects men as part of the discussion is a way to make it seem a “special interest” (women’s) issue, instead of a “human” issue. Many people dismiss women’s issues, and having the tax be “about” women means that people (particularly men in power) will not take the way it affects individual autonomy seriously, because they’re used to treating women’s autonomy as an easy point to give up at the negotiation table. (Stupak-Pitts amendment, anyone?)

    You could make a similar argument about weight lifting as you do about cosmetic surgery. Sometimes, it’s healthy and medically wise. But many people get involved with weight lifting out of pure vanity – stereotypically, men wanting to look “built.” Weight lifting can have serious health problems – people weight lifting when it isn’t suitable for their medical condition, people suffering injuries from unwise weight-lifting practices. It’s closely tied to social pressure for men to look a certain way – not being the weakling getting sand kicked in his face. These have significant public health consequences – paying for the treatment of weight-lifting related injuries, etc. So why not put a “sin tax” on weight lifting – on buying weights, paying a personal trainer, etc, to help offset the public health problems related to weight lifting? You could have an exemption or waiver for people in specific situations where it can be considered medically necessary by an outside authority – but if they do it themselves, for their own vanity and good-looks, tax it!

    Yes, that’s silly. But why is it sillier than taxing surgery, something that is already subject to more medical control to make sure it’s done properly than weight lifting? How much of it is that weight lifting is considered “masculine” by popular culture – and therefore best left to an individual decision, while cosmetic surgery is considered a feminine vice, and like women’s bodies, suitable for public control?

  79. taggles
    taggles November 21, 2009 at 3:29 pm |

    double standards for women as they age is the bottom line here. jill I remember the whacking you took over your “not a problem” response to Letterman’s sexist work place.
    women being too hard on women and the complexity of problems they face in a convoluted world is indeed complex subject.

    here is a link that I hope you read. It is about women failing to see the full picture of what and how society limits women and how women themselves are to blame at times. The rapeification of women by women.

    http://www.femisex.com/content/the-rapeification-women-women-tehran-us

  80. octogalore
    octogalore November 21, 2009 at 3:47 pm |

    On its face, this doesn’t bother me too much. It is the extensions, some of which have been discussed above, that are problematic.

    It fits too neatly into the theme these days of getting cost benefits on the backs of women — eg, mammography, breast exams, Stupak, etc. I agree with folks above that trans rights could be affected here, as could surgery that is more recovery-oriented.

    RE the “let’s just tax the rich” bright idea. Right now the tax burden of the top 1% exceeds that of the bottom 95%, so I think that’s quite progressive already. Especially in high-tax states like CA and NY, we’re seeing businesses relocate and clients relocate their multistate business to lower-tax states. These days, it’s much easier to move business than it used to be, given how much has become electronic. Additionally, higher taxes cause employers to streamline and cut jobs and salaries. Tax revenues decrease when the total tax burden on the top 1% edges above 45-50%.

    I do agree with Jill about taxing inherited wealth. That isn’t as disincentivizing in terms of innovation, and doesn’t hurt jobs to the same degree. Raising income tax above the current level, though, would not really get at the “wealthy” as much as the productive.

  81. Andrea
    Andrea November 22, 2009 at 10:15 am |

    Do you honestly think it would be so impossible to differentiate between “medically necessary” and not “medically necessary” cosmetic surgery? I tell you what, if such a tax actually deterred some of the uber-rich women I see walking around Madison Ave with plastic faces from doing that to themselves, they’d have been better off.

  82. Natalia
    Natalia November 22, 2009 at 11:06 am |

    Do you honestly think it would be so impossible to differentiate between “medically necessary” and not “medically necessary” cosmetic surgery?

    Based on how the health care already functions (or rather, not functions) in the U.S.? Absolutely.

    I tell you what, if such a tax actually deterred some of the uber-rich women I see walking around Madison Ave with plastic faces from doing that to themselves, they’d have been better off.

    “That’s just like, your opinion, man.”

  83. Andrea
    Andrea November 22, 2009 at 5:23 pm |

    I don’t know, to say that it’s simply not possible seems a little defeatist. I have zero problem taxing an industry that preys off of the negative body images forced down women’s throats. Of course things would need to be worked out, and allowed for, and exempted, but that doesn’t mean it couldn’t be done. And let’s not base everything off the current health care system, because then there’s nowhere to go. We have to actually work towards something, not just throw up our hands and say we’re simply not going to try.

  84. Andrea
    Andrea November 22, 2009 at 5:28 pm |

    Sorry Natalia, I thought we were expressing opinions around here. Forgive me for not having very much empathy for the plight of the billionaire on Madison Avenue.

  85. thetroubleis
    thetroubleis November 22, 2009 at 5:32 pm |

    Andrea, the problem is that it’s a body policing opinion. Some folks would say the same thing about the scarification I want done.

  86. Andrea
    Andrea November 22, 2009 at 5:40 pm |

    Well yes, higher taxes on certain activities and amenities does amount to a degree of policing. But we’re not talking about making anything illegal. There are plenty of countries (Norway, for one) where junk food is taxed at a higher rate and elective surgeries aren’t given quite the same amount of consideration as completely medically necessary ones. But everyone has health care. People don’t die because they’re being denied necessary procedures. A 5% increase on elective cosmetic surgery to help insure that? With precautions taken to help insure that people who need the surgery can still get it (since, you know, they’d actually have health care), seems like not such a bad idea to me.

  87. thetroubleis
    thetroubleis November 22, 2009 at 5:58 pm |

    I meant your opinion on what rich women look like.

    I still have a serious issue with this and I know how much health care reform is needed.

  88. Andrea
    Andrea November 22, 2009 at 6:06 pm |

    Umm, okay. I’m not talking about all rich women. I actually have just one rich woman in mind who I see all the time by my school on the UES, eating bonbons from La Maison du Chocolate and wearing her fur. I was mostly just kidding. Would my heart bleed for her if she had to pay 5% more on that incredibly obvious nose job so the Latino kids in my neighborhood had health care? No. I know, everyone wants health care reform and no one wants to pay for it. Well someone has to. Personally, if I had the cash for a nose job, and the inclination to get one (I have neither, by the way), I’d be fine paying a few extra hundred dollars for the good of the community.

  89. thetroubleis
    thetroubleis November 22, 2009 at 6:29 pm |

    Umm, I wouldn’t be taxed on plastic surgery anyway, because I have no plans on getting any. Thanks for implying I don’t care about other people.

    I guess all the letter writing and calling I’ve done counts for nothing.

    The issue is, this opens up some policing in realm of what is and isn’t necessary when there are other ways to fund this.

  90. Andrea
    Andrea November 22, 2009 at 7:04 pm |

    O.K. The example I used was one rich woman on the UES. How many times do I have to say that, do you think? I never implied anything about you, I know nothing about you, and frankly, I don’t care to. I said FOR ME, I would be willing to pay a tax on an elective surgery if it meant the kids in the projects (who I tutor every week, but thanks for playing the who-does-more olympics) had access to health care. Judgement calls are made every day in every facet of society about what is and is not necessary, about what should and should not be taxed and at what rates. Just as I am not adverse to taxing huge SUVs, even if they are “necessary” in some small set of instances, and just as I am not adverse to taxing luxury clothing, even if they are “necessary” for some jobs, I am not against taxing surgeries that are deemed unnecessary by a specific set of standards if those standards are made in good faith and take into consideration instances where cosmetic surgery is, indeed, necessary. Sheesh.

  91. Andrea
    Andrea November 22, 2009 at 8:13 pm |

    I did not mean to imply anything about you. I’m sorry if that’s the way it came off. I am speaking about my own priorities when I say that, for me, I would be willing to pay a tax on an elective surgery if it meant the kids in the projects near where I live had access to health care. Judgement calls are made every day in every facet of society about what is and is not necessary, about what should and should not be taxed and at what rates. Just as I am not adverse to taxing huge SUVs, even if they are “necessary” in some small set of instances, and just as I am not adverse to taxing luxury clothing, even if they are “necessary” for some jobs, I am not against taxing surgeries that are deemed unnecessary by a specific set of standards if those standards are made in good faith and take into consideration instances where cosmetic surgery is, indeed, necessary.

  92. Andrea
    Andrea November 22, 2009 at 8:29 pm |

    And just one last point, in any system that privileges universal health care, there is going to have to be a gradient of services according to what is deemed more or less necessary. That’s just the nature of the beast when you’re talking about running a program with limited resources, as we inevitably are. I would rather see necessary medical procedures available to a wider population, even at the expense of non-medically necessary ones, again, with the definition of what is not necessary reached in good faith

  93. Natalia
    Natalia November 23, 2009 at 7:14 am |

    Andrea, I quote the immortal genius of The Big Lebowski for your benefit because I believe that the attitude being expressed here over what others do with their bodies to be worthy of ridicule. I doubt most people participating on this thread would be too pleased with some jerk telling others to “get on the treadmill, you fat slobs,” or whatever, but then we also somehow know what some other woman is “better off” doing or not doing in regards to her face? I don’t buy it.

    I also believe that a tax that helps reinforce our society’s issues with sexism, transphobia and ableism is going to be a problem.

  94. Andrea
    Andrea November 23, 2009 at 8:22 am |

    OMG, I don’t give a crap what people do with their faces. If you want to spend your money on plastic surgery, be my guest. I said over and over again that if standards are put in place in good faith to ensure that those who actually need the procedures are able to get them, I have no problem with a 5% tax on procedures which aren’t necessary. That is all. I’m allowed that opinion, just as you’re allowed to save up and get all the plastic surgery you think you need.

  95. A.W.
    A.W. November 23, 2009 at 9:46 am |

    Andrea,

    Your opinion, however, is full of -isms on this issue. You’re entitled to your opinion – and others are entitled to point out where you’re astray. Nature of the internet.

    “I said over and over again that if standards are put in place in good faith to ensure that those who actually need the procedures are able to get them, I have no problem with a 5% tax on procedures which aren’t necessary.”

    That’s ableist, transphobic and yes, sexist. Good faith here is a judgment on what someone else might or might not need, when ‘good faith’ originally was supposed to mean – the benefit of the doubt -. You’re not qualified to make a ‘good faith’ decision and neither are any other group of people for an individual’s medical decisions. That’s how we got into this mess in the first place, people thinking they can make accurate medical decisions for others. There’s ‘good faith’ in the medical community – now -. Do you know what it does? It puts trans people entirely on the ‘don’t really need it’ line (at least in the usa), severely hampers trans people in other countries, heaps scorn and sexism on women (on both sides of the divide) who get cosmetic surgery by drawing lines on whether you ‘need’ it or not and it’s very, very ableist. Pretending some procedure is both necessary and – wanted – (aka – ‘actual need’) when it very well might not be and isn’t is – rude -. It’s claiming that whomever is stick-something-here would want it ‘fixed’ when you have that line between ‘need’ and ‘you cheated, you vain —-’. Besides which, I can’t think of anyone off the top of my head who wants a pity-non-tax. All cosmetic surgery is, is something to help someone move along to look more like (general) you. Well, frivolous-in-your-eyes cosmetic surgery also makes people to look more like ‘general’ you. And before anyone says “But what about all those boob jobs, they’re not ‘natural!” I’ll point out right now I’ve been accused of having one myself, so no love lost on the vain, petty vibe others give people who think they had work done. Since I haven’t had one done and I’m part of the general population, if a surgery would make some woman look more like what I unfortunately received at puberty then that, too, is considered normal. The surgery that people are complaining is frivolous just tweaks peoples features. Nothing out of the norm there, since the ‘need to have’ surgery does the same thing. Tax the whole bloody thing or – don’t -, but don’t go picking out who ‘deserves’ to pay less.

  96. Andrea
    Andrea November 23, 2009 at 10:01 am |

    Fine, good, let’s tax the whole thing then. Taxes are the only way we’re going to pay for universal health care. Tax absolutely everything, I’m willing to pay. But what’s really sexist, abelist and transphobic is millions of people in this country not having access to basic care. Under a plan like this, I would want to see gender reassignment surgery covered as medically necessary. And guess what, under any universal health care system, certain procedures are going to have to be labeled more “necessary” than others. That’s how universal health care works. In Norway, for example, procedures that are life-saving are given priority over those that aren’t. It might not be fair, and you might have to wait in line longer for certain things, but people don’t die because they can’t get the care they need.

    “Pretending some procedure is both necessary and – wanted – (aka – ‘actual need’) when it very well might not be and isn’t is – rude -. It’s claiming that whomever is stick-something-here would want it ‘fixed’ ”

    What does “stick-something-here” mean? And making something available and mandating it are two different things. In any healthcare system, there is going to have to be a dividing line between “medically necessary” and “not medically necessary.” Maybe not in Utopia world, but in the real world. Look at any other system for universal health care. They operate according to that line. So if a rich person’s nose-job is taxed so that someone can get gender reassignment surgery, I am for it. If a woman’s boob job is taxed so that another woman can have maternity care, that’s fine by me. While we’re at it, tax the viagra, tax the hair plugs, tax it all. But to think we can operate a health care system where lines aren’t drawn? Well, good luck with that.

  97. Andrea
    Andrea November 23, 2009 at 10:15 am |

    What’s really transphobic, abelist and sexist is tying healthcare to work when transphobia, abelism and sexism often prevent just those people from keeping a job with benefits!

  98. A.W.
    A.W. November 23, 2009 at 10:51 am |

    I suppose this is the time, Andrea, where I point out I’ve low vision and I’m currently working with Blind and Visual Services to acquire a job. I just finished my work eval last August, in fact. I’m also transexual and currently perceived to be a woman most of the time. Your recent reply had jack all to do with the topic. Just because there’s transphobia, sexism and ablism in the workplace doesn’t mean that it negates the transphobia, sexism and ableism your opinion is promoting. Short version – check your privilege.

  99. Andrea
    Andrea November 23, 2009 at 11:04 am |

    I responded directly to a quote of yours. It has everything to do with the topic. I have a cousin who, when she got cancer, was fired from her job, lost her insurance and will soon die. So yes, I believe that tying health insurance to work is very sexist, abelist and transphobic. Why should elective surgeries be exempted from taxes in the way medically necessary ones are, when they could help pay for things people actually need (gender reassignment surgery included, in my ideal world). Did you even ready my first reply? The second was an addendum.

  100. A.W.
    A.W. November 23, 2009 at 11:27 am |

    ““Pretending some procedure is both necessary and – wanted – (aka – ‘actual need’) when it very well might not be and isn’t is – rude -. It’s claiming that whomever is stick-something-here would want it ‘fixed’ ”

    What does “stick-something-here” mean?”

    Stick something here would be, well, whatever. When someone says ‘cosmetic surgery’, the first thing most people think of is, say, a nose job. The second thing they think of is reconstructing someone’s face due to accident. I was including any and all possibilities wrt ‘stick something here’. Incidentally? I don’t trust current cosmetic surgery statistics, or why it’s reported that people are getting things done. I’m willing to bet most cosmetic surgery would be filed under your ‘need’ box – that is, if people on the board would agree it’s necessary. Which they don’t, because so far insurance companies and state medical weasels out of everything they can. Did you miss the multiple replies above where people explained that their own shit is thrown under ‘cosmetic’ and listed as – optional – or – unnecessary – when it is nowhere near, even by your own judgment?

    And I’m aware of how universal healthcare works. We’re not there yet. We’re not even – close -. But deciding on what’s taxed falls into the trap of who’s deserving. Think ‘tampons’. It sounds like you think people are going to run out and get, say, face lifts if suddenly it qualifies as medical. Which is funny to me considered the attitude people currently have about plastic surgery, noted for viewing again in this thread.

    So instead of pretending that, under your regime, only certain things are deserving, tax it across the board if you insist on taxing it at all. Plenty of things are taxed that are necessary. Tampons, for instance, again. Cosmetic surgery isn’t only thing the gov. can get money from to pay for healthcare, so lets not pretend supplying universal healthcare is an all or nothing deal via cosmetic surgery. People mentioned some viable alternatives above.

    I mean, really, to reiterate the previous multiple comments (including mine) where surgery was weaseled out of by insurance (in fact, I was never insured as a child, was considered high risk, along with previous condition) so what, exactly, makes you think people continuing to draw lines on what cosmetic prodecures are necessary is a viable alternative? Because I wouldn’t put it past them to exclude me, along with many, many other people – off – parts of their ‘universal healthcare’. I mean, my God, there’s a hell of a lot more going on wrt surgery than the to-you unneeded nose job, and it all falls in the same area.

    Aboug grs as it stands, under – all – the current universal healthcare systems I’m aware of ‘gender reassignment surgery’ (I also loath that phrase, my gender is not getting ‘reassigned’, same as it ever was, tyvm) it’s considered medically necessary, but – only – if you jump through bunches of cissexist hoops. So on the off chance that people are under the impression that universal healthcare for trans people is just peachy in other countries and using it as an example of how things can actually go right – No.

  101. A.W.
    A.W. November 23, 2009 at 11:30 am |

    “Why should elective surgeries be exempted from taxes in the way medically necessary ones are, when they could help pay for things people actually need (gender reassignment surgery included, in my ideal world).”

    But they’re not exempt! You’re missing that. Mine was not exempt on taxes. Several other people on this thread Were. Not. Exempt because they were considered ‘comsetic’. – ie; Uneeded. Exempt is a dream world. Only the very bottom gets exempt, and even then not all the time. It’s a damn fallacy on who’s ‘deserving’ and who – isn’t -.

  102. A.W.
    A.W. November 23, 2009 at 11:31 am |

    And yes, I read you – after the fact. My pc goes down to the last post and for some godforsaken reason it skipped it the first time ’round, so I replied above.

  103. Sheelzebub
    Sheelzebub November 23, 2009 at 11:48 am |

    I’m going to park this right here–I am leery of us taxing things we don’t necessarily like or approve of in order to pay for things. If we agree that part of our social contract is to make health care accessible to all, and we agree that the best way to do this is to fund this through taxes, then I think as progressives we should be on board with a progressive tax (i.e., the wealthiest individuals are taxed more heavily, and corporations do NOT get a free pass as they all too often do now). It beats the hell out of targeting individuals who may make life choices some of us don’t agree with.

    Because here’s the thing: I may have a personal twitch about, say, breast enlargement surgery or botox. But I’m more concerned about us turning the conversation over to what is acceptable and what is not–when the actual focus needs to be the most practical, efficient, and fair to way to fund health care. And I’m sorry, I know I’m a totes pinko for saying this, but I have no problem with taxing people proportionally according to their incomes. I have no problem with taxing corporations–and taking away the loopholes most corporations use now.

    It is neither practical or efficient to tax procedures we do not like, it opens the door to all kinds of hair-splitting crap, and it moves the conversation away from health care to a manufactured moral panic, like the fat panic, the smoking panic, and the slut panic we’ve had.

    Living in a civilization means that people will have different parameters for what is acceptable to them, and other people will make choices that are unpalatable. We need to deal.

  104. Andrea
    Andrea November 23, 2009 at 11:54 am |

    Actually, I have read all of the comments above, and you’re definitely right about what insurance companies will weasel their way out of (read: absolutely everything). Sometimes I trip myself up by equating universal health insurance with universal health care. As long as our healthcare system is based on a for-profit business model (insurance companies), those things aren’t going to change, no matter what we tax or don’t tax because money will always be the bottom line. I thought if there were a way to make exceptions for actual need, taxing people who can obviously afford certain procedures might not be a bad way to go. I mean, we tax make-up and “age defying serums” (whatever that is) and I just don’t see the difference between those things and the non-medical use of botox. I’m not suggesting banning anything. I think pretty much everything should be taxed for the good of the community as the baseline, yet I understand exempting things like non-profits and medical procedures, and various necessities. I don’t think the given should be un-taxed until taxed, but the other way around. And the reason I think that is because those with the most resources tend to use the most resources, and should pay to help support those without. So if I can pay to send my child to a fancy private school, (as my parents did for me), I’m willing to be taxed on that purchase so others will have the same opportunity. And if I elect for a surgery for purely cosmetic reasons, I’m willing to be taxed on that purchase for the good of the health care system.

    Obviously this is a polyanna viewpoint, because most Americans abhor taxes, have been raised to believe in the power of the individual rather than the good of the community etc. (I’m not directing that comment at you, I’m saying in general). This is why I would include surgeries for transexual people (I’m sorry, but you didn’t give me a phrase to replace “gender reassignment surgery” with and I don’t want to guess) under the rubric of “necessary”. I keep using the example of Norway, because that’s the system with which I’m most familiar, but they liberally tax goods and services not deemed “necessary” so that they can maintain a completely free and universal health care system (not to mention a completely free and universal education system).

    The big difference, however, is that their health care system is not for profit. They don’t reduce people’s health to a bottom line. Ours is. So in conclusion, I’m sorry that I’ve obviously very much offended you, I wasn’t as careful in explaining my position as I should have been. In my ideal health care system, the game wouldn’t be deny, deny, deny, but provide, provide, provide because health care would not be for-profit. People flat out don’t get rejected for medical care in Norway, but they do have to pay for it. And I would not be at all surprised if they taxed their botox.

  105. Andrea
    Andrea November 23, 2009 at 11:57 am |

    Sheelzebub, yes! Close those damn loopholes and set up a more progressive tax system. Couldn’t agree more.

  106. jemand
    jemand November 23, 2009 at 12:04 pm |

    If I had any sort of belief the current legislation would fix *anything* in the current health care industry, I’d say go ahead, tax everything medical, what the heck, tax money is going to be paying for a lot of these procedures *anyway.* But no, all we’ve got is a gift basket to the industry and we’re arguing over cosmetic surgery.

  107. Andrea
    Andrea November 23, 2009 at 12:47 pm |

    Jemand, sad, but true.

  108. ginasf
    ginasf November 23, 2009 at 3:03 pm |

    I just want to remind some of the people posting here that to exempt SRS alone from this taxation doesn’t prevent trans people from being punished for their identities, basically taxing transition and increasing the costs of attempts to be safe in an often hostile world. Yes, genital surgery is very important for many transpeople, especially in a country where legal gender change is mostly linked to the state of ones gentialia (some states allow FTMs to change gender if they’ve had top surgery or a hysterectomy). But this doesn’t address how important social gender appearance is in terms of safety and employment. For MTFs, one’s facial appearance (and voice) can make all the difference between getting employment or being totally ostracized. For FTMs breast surgery can be almost as crucial (albeit, because of the ability to bind, I might say not on quite the same level in terms of ‘outing’ people). For FTMs, having a hysterectomy can prove a crucial aspect of future health, since there is some evidence long-term testosterone usage isn’t good for female reproductive organs. So how are these somehow elective surgeries while genitally-related surgeries aren’t? These are complex issues which require, yes, a lot of community feedback, not mere quick statements from those outside these situations that “oh, GRS is okay but everything else is elective.”

  109. Andrea
    Andrea November 23, 2009 at 3:40 pm |

    I don’t think anyone is saying “GRS is okay but everything else is elective.” If such a thing were to work, all kinds of allowances and exceptions would have to be made. I personally don’t think any of the surgeries you’re describing are elective. It seems that this could easily be taken into account, as you’ve summarized it succinctly and clearly in one paragraph. Clearly this language needs to be written into the bill, and I fully support that. Whether it will be or not is another matter.

  110. ginasf
    ginasf November 23, 2009 at 5:23 pm |

    Andrea, as it currently is, gender-related procedures / therapies / meds overwhelmingly are NOT covered by health insurance. Nor, as I mentioned in a previous post in this thread, are out-of-pocket expenses even deductible from taxes. So the most likely reality of any tax on plastic surgery is there will be NO exemption for trans-related procedures and they will continue to be viewed as elective cosmetic surgery. That’s reality. It will, in effect, be a transition tax on an already marginalized people, some of who are already selling their bodies in an attempt to transition. And do you honestly believe for one second the HRC, conservative anti-tax groups, feminist orgs or other large GLB groups are going to step up to the plate and put themselves out for this issue? You are aware that, as of this year the HRC ‘Equality’ Index still bestows a 100 top score to companies which include virtually no trans health benefits? (and HRC’s policy changes in that direction remain very vague)? So what is it we’re talking about… a very real possibility of a “luxury tax” and, most likely ZERO exclusion for transition-related costs and procedures. I’m not talking about theory, I’m talking about someone having to turn tricks for another several months to afford a tax on what they consider life-saving surgery.

  111. Andrea
    Andrea November 23, 2009 at 5:29 pm |

    Ginasf, you’re right, unequivocally. If there were a way to assure that only those for whom this would actually be a luxury tax are taxed, then I’m all for it. I am, on principle, not against taxing luxury surgeries. However, since it’s obvious that no concession is going to be made for trans-related procedures, then I’m against the bill. But NOT, and I repeat, NOT because I’m uncomfortable with taxing luxury cosmetic surgeries which are actually luxuries.

  112. Dryxi
    Dryxi November 25, 2009 at 12:17 pm |

    The part of this that bothers me most is “surgery.” How are we differentiating surgery from procedure? Here’s my example:

    I have suffered from Polycystic Ovary Syndrome for 14 years. It was undiagnosed until this May, and even with the diagnosis, my insurance will not pay for anything except a very basic drug regimen. I have suffered with obvious hirsutism since I was 10. This has negatively impacted my entire life. I have been battling depression, and have had to be talked down from suicide on more than one occasion. Unfortunately, no one else seems to understand what it would be like to be a bearded lady, and how demoralizing it is to be the butt of everyone’s jokes. I would absolutely *love* to get some permanent hair removal, but I can’t afford it. I work an entry level job because I was too ashamed and depressed to finish college. My insurance company claims that hair removal is a “cosmetic procedure” and that I don’t need it. I’d love to see the women who work there wake up and have to shave their faces every morning.

    Now hair removal isn’t “surgery,” but with undefined language, its not hard to see a jump from “surgery” to “procedure.” The last thing I need is for this procedure to be made more expensive.

  113. FCJ
    FCJ November 26, 2009 at 10:08 am |

    aren’t a lot of rich ladies’ husbands the ones paying for these procedures anyways?

  114. Donna
    Donna December 10, 2009 at 10:17 am |

    How about a tax on Viagra? football games? automatic weapons? chewing tobacco/pipes/cigars? all of these are much more in the male marketplace, and have a negative health impact….I agree w/the gals that think this unfairly singles out women, the numbers speak for themselves….and yes, the marketplace is murder, so if a little botox will make a gal look less worried and more confident, and more able to GET A JOB in this economy, than I think it’s “medically necessary” if it converts into a job with health benefits….

Comments are closed.

The commenting period has expired for this post. If you wish to re-open the discussion, please do so in the latest Open Thread.