I worry about the devolution of medicine from a healing profession into a lifestyle, on demand, technocratic enabling guild. We see it all around us. Octomom, for example, wasn’t infertile. The IVF she wanted had nothing to do with medicine in the sense of helping her overcome a disease or disability. She wanted a lot of babies and she wanted them fast. Similarly, cosmetic surgeons rake in the dough as their colleagues who do much more important work in primary care make far less money.
Brazil has foolishly (in my view) promoted this transition–and the destructive pursuit of human surface perfection–by making cosmetic procedures tax deductible. From the story:
Adriana Pires, a human resources manager in Rio de Janeiro, had a pleasant surprise when she prepared her income taxes: the 8,000 reais ($4,575) she paid for breast implants and liposuction are tax-deductible. As Brazilians race to meet today’s filing deadline, the federal government this year for the first time will allow taxpayers to deduct the cost of boob jobs, tummy tucks and any other type of cosmetic surgery. The measure, retroactive to procedures performed since 2004, may spur the 3 billion reais plastic surgery market, the world’s second-largest after the U.S., according to Brazil’s Plastic Surgery Society. “It’s a medical expense like any other and it’s only fair to allow taxpayers to deduct it,” said Pires, 38, adding that she is considering a lipo touch-up this year because of the tax incentive. She had her first plastic surgeries in 2004.
No, it’s not a medical procedure like treating cancer or setting a broken leg. It is using medical knowledge to enhance lifestyle choices. And think about the human medical resources diverted from true health care by Brazil’s culture of plastic beauty. This is early transhumanism, and it is very destructive to human exceptionalism because it elevates mass cultural measures of beauty into criteria that essentially judge human value. Indeed, that is why people pay so much to not look like their real selves.
May 1st, 2010 | 5:41 pm
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May 2nd, 2010 | 6:56 am
In large part I am in agreement with your view regarding this tax policy. However, as a resident of Brazil I take great exception to your suggestion that Brazilians have a “culture of plastic beauty.” That is a rediculous remark. Do you know Brazilians – in all their diversity?
I would also remind you that a significant percentage of the plastic surgery procedures are being done on visitors who come to Brazil for this purpose. The quality of work and the price make Brazil a top “medical tourism” destination.
Please be carful when waving a broad, critical, cultural brush.
Wesley J. Smith Reply:
May 2nd, 2010 at 10:49 am
Jim Shattuck: I would probably have been better served stating there is a strong sub culture of plastic beauty in Brazil. That seems undeniable to me, at least in the large cities. Thanks.
May 2nd, 2010 | 3:17 pm
I agree with Wesley with regards to the tax policy. I do not think cosmetic surgical procedures should be tax deductible as medical expenses. However, I disagree with him with regards to his other comments.
If I choose to spend my money on a cosmetic procedure and I find someone competent who is willing to do the procedure for the money I pay them, that’s a private transaction between that person and myself. Its no one else’s f8*king business. Its not for anyone who is not a party in the transaction to have any say in the matter.
Wesley J. Smith Reply:
May 2nd, 2010 at 3:38 pm
kurt9: I don’t think the STATE should proscribe the transaction, but I think we all have a right to say how these attitudes are impacting society. I believe that medicine is being transformed in a deleterious manner overall, and society made more hedonistic and shallow. It isn’t just private.
May 3rd, 2010 | 5:02 am
I am a Brazilian, and I disagree with Jim Shattuck’s remarks that Brazilians don’t have a “culture of plastic beauty”. Vinicius de Morais, a great Brazilian songwriter and singer said: “The uglies do forgive me, but beauty is fundamental”.
I wholeheartedly agree with Morais’ statement.
May 4th, 2010 | 9:04 pm
Enezio – I will defer to your wisdom, but I think that beyond the patricinhos and mauricinhos few Brazilians have the luxury of even thinking about this idea…
May 4th, 2010 | 10:29 pm
Medical expenses are currently deductible from U.S. income taxes too, so long as the expense exceeds a certain percentage-of-income threshold. So your criticism of Brazilian tax policy could apply to the U.S. too.
I will not argue the merits of the surgery itself in this posting. But there is a serious pro-life angle to this question that must be considered. Do we really want the government to start deciding which kinds of medical procedures will be tax deductible, and which ones won’t? Sure, today we might happily see the tax exemption removed from Botox (for wrinkles) or breast augmentations. But would it end there? How long would it be until the government decided that tax exemption should not be given to the expensive care needed to take care of the chronically ill, or to chemotherapy of the terminally ill? How long until the government decides that when such care is provided by an insurance plan, it should be considered as income and taxed accordingly? When there is only a single-payer — the long-term goal of the current health care financing reforms — that information will be easily acquired and shared with IRS.
Therefore, I argue that we should tolerate the sometimes irksome thought of a tax deduction for aesthetic procedures, rather than begin a process that might culminate in financial pressure to abandon medical care of the vulnerable among us.
Wesley J. Smith Reply:
May 4th, 2010 at 11:19 pm
Cole: No, the Brazilian policies were for cosmetic procedures, which are not medical in nature in the sense that it is curing an illness or maintaining a chronic condition. Indeed, I don’t think purely cosmetic procedures should be considered medical at all. That is why, for example, a nose job that is not a reconstruction after an accident isn’t covered by insurance, nor are breast implants or tummy tucks.
May 4th, 2010 | 11:36 pm
[...] face, and has started shaving. This is good news. And how more important than the frivolous–and now tax deductible in Brazil–vain striving for beauty perfection through cosmetic procedures. the money for which lures [...]
May 5th, 2010 | 12:52 am
Wesley, I was not addressing what insurance typically covers, but what medical expenses may be deducted from income tax. However, it turns out that your little mistake concerning my point is greatly outweighed by my big mistake on the substance of the question. In short, I was wrong. I wrote from my “store of knowledge” about the tax, and it turns out the store was depleted. In fact, medical expenses for cosmetic surgery are NOT deductible on one’s U.S. income tax. Here’s the pertinent information from IRS publication 502: “Generally, you cannot include in medical expenses the amount you pay for unnecessary cosmetic surgery. This includes any procedure that is directed at improving the patient’s appearance and does not meaningfully promote the proper function of the body or prevent or treat illness or disease. You generally cannot include in medical expenses the amount you pay for procedures such as face lifts, hair transplants, hair removal (electrolysis), and liposuction. You can include in medical expenses the amount you pay for cosmetic surgery if it is necessary to improve a deformity arising from, or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma, or a disfiguring disease.”
My apologies to all who were mislead by my earlier assertion concerning U.S. income tax.
Wesley J. Smith Reply:
May 5th, 2010 at 1:11 am
ColeKoray: Thanks. Let us hope it remains that way.
May 17th, 2010 | 1:00 pm
Any cosmetic surgery that was not “medically necessary” such as a face lift or boob job, I don’t believe should be tax-deductible. If however you had breast cancer and they removed your breasts, then I think a boob job should be tax-deductible.
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