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January 12th, 2010
No, This Isn't Racist At All...

DERMATOLOGISTS and plastic surgeons may find themselves off the hook. Last weekend, the Senate replaced a 5 percent tax on elective cosmetic procedures with one on indoor tanning services in its proposed health care bill.

In recent weeks, doctors and industry groups lobbied against the so-called Bo-Tax, a play on Botox, arguing in part that it discriminated against women, who receive the majority of cosmetic surgery and anti-aging injections. The site Stopcosmetictax.org, financed in part by Allergan, which makes Botox, stated that “it is unfair and insulting” to impose a penalty on cosmetic procedures sought primarily by women as if the procedures were unhealthy, like smoking.

Dr. David M. Pariser, the president of the American Academy of Dermatology, said his association proposed that an indoor-tanning tax be considered in place of the cosmetic tax, and that it contacted the offices of senators. “We made the case this will reduce health care costs by hopefully reducing skin cancer in the future — that’s the point — and also raise a little revenue now,” Dr. Pariser said.

The 10 percent tax on indoor tanning services, which the Congressional Joint Committee on Taxation projects will raise $2.7 billion over 10 years (compared with the estimated $5.8 billion the cosmetic tax would have raised), is designed to offset some of the expense of providing health insurance for millions more Americans.

Supporters of the tax hope it will discourage the use of tanning beds, which have been linked to skin cancer. Indoor tanning before age 30 has been associated with a 75 percent increase in the risk of melanoma, the deadliest form of skin cancer, according to a review of medical literature last summer by the International Agency for Research on Cancer, part of the World Health Organization.

“In the past, taxes on addictive substances like tobacco and alcohol have decreased usage,” said Dr. June Robinson, who has studied young people’s attitudes about indoor tanning. “That’s the dream.”

Dr. Robinson, a clinical professor of dermatology at the Feinberg School of Medicine atNorthwestern University, said she was so thrilled when the proposal was announced that she couldn’t sleep. “I feel like sending a dozen red roses to a certain senator from the great state of Nevada,” she said Monday, referring to the Senator Harry Reid, the majority leader, who has shepherded the health care bill.

But for owners of the estimated 20,000 tanning salons nationwide, the proposed tax is anathema. It represents a further restriction on their businesses, which are already drawing criticism in some states that have restricted teenagers’ access to tanning beds.

“We are the convenient scapegoats for the cosmetic surgery industry,” said Lewis Shender, the chief executive of Hollywood Tans Group, with roughly 180 salons nationwide. He said that the highly fragmented tanning-bed industry, mostly composed of mom-and-pop operators, “doesn’t have the resources or influence” of doctors.

If one objection to the Bo-Tax was that it singled out women, opponents of the tanning tax say that women are also singled out. Most salon owners are women, as are most clients, said Kathe Ray, a moderator for TanToday.com, a forum for salon owners. “They are still discriminating against women,” said Mrs. Ray, the owner of a tanning salon near Detroit. “It’s just changed industries. It hasn’t changed the end customer.”

Come July, when the tax is to take effect, any provider of indoor tanning, presumably including gyms that have only a bed or two, must add the 10 percent tax to their services.

It is likely that salons will absorb the tax themselves rather than burden consumers, said Dan Humiston, the president of the Indoor Tanning Association. Operators like Mr. Humiston, who owns 33 salons in upstate New York, have already had to substantially discount services to retain clients, he said. “The idea that we are going to pass this tax on to our customers, it’s untenable,” he added. “I do not see that happening.”

Roel Kunst, the director of operations at Portofino Sun Tanning, which has six salons in Manhattan, agrees. “A 10 percent tax is a huge tax on regular people,” he said. “In this climate, I am not able to pass it along.”

But even if the pocketbooks of some tanning bed users aren’t hit, Dr. James Spencer, a dermatologist in St. Petersburg, Fla., who specializes in skin cancer, said the levy still stigmatizes tanning beds in the eyes of consumers. “The political message here is this is a sin tax to have the social effect of discouraging you to do it,” said Dr. Spencer, who has studied the risks of tanning beds.

Dr. Robinson foresees the indoor-tanning tax dissuading first-time users and people considering “event tanning” before a prom or wedding. But she isn’t hopeful that the “twice-a-week tanner” will stop. “They are truly addicted to the feel-good tendencies from having a tan,” she said. “They will spend money on that, and not spend it on other things.”

Taxing tanning-bed services makes sense to Dr. Darrell S. Rigel, a melanoma researcher and a past president of the American Academy of Dermatology. “The rates of melanoma are rising among young women, who are the biggest users of tanning beds,” he said. “We are seeing melanomas on these women where the sun doesn’t normally shine but where tanning beds shine,” namely on breasts and pubic areas.

Overexposure to ultraviolet light has risks, said Mr. Humiston of the Indoor Tanning Association. But, he said, the benefits of moderate exposure to UV light, including its stimulation of the body’s production of vitamin D, shouldn’t be discounted. “It’s such hypocrisy that dermatologists are gleeful about putting a tax on something where there’s an actual benefit,” he said. Botox does nothing more than make people look better, he added, “and that’s not going to be taxed?”



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