Plastic Surgeons Angry at Tax in Health Care Bill

Written by Jan Jaben-Eilon Monday, November 30 2009

Plastic surgeons would like to take their sharpened scalpels to the proposed health care reform bill under discussion in the U.S. Senate. Tucked away in the 2,074-page bill that senators began debating after the Thanksgiving holiday, is a new 5-percent tax to be paid by patients who have any elective cosmetic procedure. Plastic surgeons couldn't be angrier.

Ever since the Senate voted Saturday night, Nov. 21, to open discussion about the proposed health care reform, individuals and groups have begun combing through the extensive bill proposed by the Senate to determine whether the legislation will indeed cut health care costs while extending coverage to millions of uninsured Americans.

Along the way, these groups are discovering sections that have not received much public attention. One of those sections - which would tax plastic surgery - was added to the Senate bill after a different bill on health care reform was passed by the U.S. House of Representatives weeks earlier. The Senate debate will almost assuredly be long and will result in a proposed bill that may or may not resemble the initial proposed legislation.

Still, plastic surgeons are not taking any chances. Dr. William Silver, president of Atlanta-based Premier Image Cosmetic & Laser Surgery, sent out 4,000 emails to patients explaining the proposed tax and urged them to contact their U.S. Senators through a website.

Dr. Silver, who has been in practice for 34 years, contends the proposed tax is discriminatory against women and against the middle class. According to studies by various groups such as the American Society of Plastic Surgeons, 86 percent of cosmetic surgery is performed on working women.

"There's a popular belief that plastic surgery is a luxury for the wealthy," he says, but research indicates that of people planning to have cosmetic surgery over the next two years, 60 percent have household incomes of $30,000 to $90,000 and 40 percent of that 60 percent is in the $30,000-$60,000 income bracket. Only 10 percent of respondents reported household income over $90,000.

"These data clearly refute the suggestion that elective surgery taxes are 'luxury' or 'sin' taxes affecting a privileged few," states Dr. Silver's email.

Discrimination is not the only concern, however, of plastic surgeons. The new 5-percent tax provision in the Senate bill would require physicians to become tax collectors and would hold them liable if patients fail to pay the tax.

"This is an incredible burden on a physician's office and takes their attention away from taking care of their patients," says Dr. Silver. He also contends that the provision "leaves the question of medical necessity up to the state tax auditor."

That's what concerns Dr. Diane Alexander, with Artisan Plastic Surgeons in Atlanta.

"A lot of the surgery I do is not just cosmetic. I've had women with deformed lumpectomies who needed reconstruction of their breasts. Some women have had terrible scars or birth defects or skeletal deformities. At least 50 percent of what I do is medically necessary."

Both doctors are concerned that women who struggle to pay for their plastic surgery might not be able to afford an additional 5-percent tax. Alexander says some plastic surgeons might need to lower their fees to compensate. Already, Silver says that for 25 years he's been involved with a group called Face-to-Face through which he provides pro bono cosmetic surgery on women who are victims of domestic violence. Would he be required to collect taxes for these services?

If plastic surgeons are going to be required to collect taxes on services, an entirely new avenue of taxation, then where would this go next, asks Dr. Alexander. Will attorneys' services be taxed as well?

"This is opening up a whole new area of taxation in this country by starting to tax services in addition to goods," she says.

While not a plastic surgeon, Dr. Dorothy Mitchell-Leef wonders how this new taxation would work. If insurance companies cover only part of a surgery, is the other part taxed? Will insurance companies be required to pay taxes on the part they do cover?

A physician with Reproductive Biology Associates in Atlanta, Mitchell-Leef's work focuses on women. "As health care reform comes up for discussion," she says, "women need to be heard. What is really in this bill? Do you know what it will do to people? Are we really looking at the fine print? I'd like to see women say, 'Wait a minute. We're 50 percent of the population, and this will not only affect us but also our daughters and granddaughters.'"

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Jan Jaben-Eilon was a founding staff writer of the Atlanta Business Chronicle. Since then, she has been the international editor of Advertising Age magazine and has written for such publications as The New York Times, International Herald Tribune, Washington Journalism Review, and Consumer Reports. She is the author of soon-to-be-published (There is) Life After Cancer. Jan and her husband have homes in Atlanta and Jerusalem.