The Senate Democratic plan to pay for part of health care reform by slapping a tax on elective cosmetic surgery drew jeers Thursday from doctors who specialize in such procedures as breast implants and nose jobs.They maintained the proposed 5 percent levy tucked into the health care bill would be difficult to collect and would punish far more people than rich housewives.This is a tax on working women, said Phil Haeck, the president-elect of the American Society of Plastic Surgeons.Haeck said that 60 percent of women who have cosmetic surgery have annual incomes between $30,000 and $90,000. The wealthy, nonworking Republican suburban housewife, that is not our patient, said Haeck, a Seattle plastic surgeon.Senate Majority Leader Harry Reid (D-Nev.) included the tax which has jokingly been referred to as the botax to help defray the cost of his $848 billion health care plan. The levy is estimated to generate about $5.8 billion over 10 years. It would not apply to people who require reconstructive surgery for disfiguring diseases or treatment for injuries.But about 60 percent of plastic surgery is elective.The tax is not included in the House health care bill, which is largely funded by new taxes on higher income people.In 2007, Americans spent $12.4 billion on 11.8 million cosmetic surgery procedures, according to the American Society of Plastic Surgeons. The top five procedures were breast augmentation, liposuction, nose reshaping, eyelid surgery and tummy tuck, according to the society.Haeck said that revenue estimates from the tax might be overstated since the demand for plastic surgery has fallen by between 30 and 45 percent recently because of the recession.Furthermore, he and others warn that the tax collection could be a nightmare since differentiating between elective and necessary plastic surgeon is not simple. Haeck said, for example, he might perform a nose job on someone both to deal with the medical nasal problem and to straighten the nose for cosmetic purposes. He questioned how the federal government would determine what percentage of the operation to tax.Its going to be clumsy for collection, he said.Officials with another cosmetic surgery group, the American Academy of Cosmetic Surgery, said that the tax would fall heavily on baby boomers, who have increasingly turned to nips and tucks to hold off the aging process.It is important to note that the age bracket that are most likely to vote in elections is the same as those who are electing to have cosmetic procedures, said the release from the academy.The academy said the only state that has imposed such a tax, New Jersey, has not collected the revenue it anticipated.Activating a cosmetic surgery tax is not the solution to funding a health care overhaul, said Dr. Steven Hopping, former president of the AACS.Haeck, at the American Society of Plastic Surgeons, said he expects his association will have to step up the pressure on the Senate to ditch the tax, which he called pretty wacky.