The Wrinkle about a Cosmetic tax: What is the 'BoTax'?

Thomas P. Sterry, MD

Senator Harry Reid has proposed a new tax on cosmetic procedures as a way to help pay for health care reform.  So, when will a procedure be considered cosmetic and therefore taxable?  I will not argue whether it is fair or not to tax my own cosmetic services since no matter what I write, it would be considered disingenuous by cynics.  What I will discuss is just how this “Botax” will be implemented and the unfairness of that process.  Botox was originally created, and is still used for medicinal purposes, so how will we convince a government agency that it is, or is not “necessary”?  The questions go on and on:


When a cleft lip patient wants a revision of their scar at age 16, is that cosmetic? 

What about if they also need their nostril adjusted because of the same scar?

If a patient needs a breast reduction because their F cup breasts are causing neck pain, is that cosmetic?

Who will make these decisions? 

How will we police the medical industry for this tax? 

How much will that process cost and what will the net gain to the government be?

Will the funds really be used to help pay for health care?

If the Federal government implements this tax, then when will the State do the same? The County? The Town?

And finally, to be very self serving, will I need to hire another employee to be in charge of sorting all this out with each patient who comes into my office? 


The financial impact that this tax could have on my practice is one issue, but the implementation and hassles that it will create in my office the really tough part.

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