In the early 1980s, new laws allowing cosmetic surgeons to advertise their businesses helped popularize plastic surgery. At the same time, trickle-down economics enriched the rich and encouraged the stagnating middle classes to go into debt to keep up with their wealthier neighbors. Now, in a service economy, where your value as a worker is closely tied to your appearance, working class moms and dads have more cause to go under the knife. In this way, deliberate government policies dating back to Reaganomics helped fuel the revolution in plastic surgery.
Debt for cosmetic surgery is the subprime-mortgage crisis of the body. When it came to owning the perfect body, however, financial institutions targeted not urban homeowners but working- and middle-class white women. Medical credit companies and even the cosmetic surgeons who profited from them encouraged some Americans to take on large amounts of debt at extraordinarily high interest rates in pursuit of a better body as a path to a better life. But the economy and culture of both the subprime-mortgage industry and cosmetic surgery could never have happened without a political and ideological revolution in the United States that brought about the deregulation of credit and allowed medicine to become a for-profit enterprise. Letting more Americans assume greater debt--and simultaneously allowing medicine to sell itself--meant that plastic surgery was paid for with plastic money by Americans hoping that reshaping their bodies would reshape their lives.
A 2005 poll conducted by the American Society of Plastic Surgeons found that 30 percent of plastic surgery patients earned less than $30,000 a year, while another 41 percent earned between $31,000 and $60,000.
One surgeon, from a very blue collar town in California, where the unemployment rate is about twice the national average, framed it like this: "There's a fallacy in the public. They think it's all rich people who do aesthetic procedures. But my patients have jobs, regular jobs and know the value of money. They price shop. They're teachers and real estate agents and bankers, but they're also people in entry-level jobs working in the mall."
Another surgeon, this one from New York State, told me: "My patients are not what you'd expect demographically. I don't practice in Miami or Dallas. A lot of my patients work in bars. But if you're a woman who has a few kids and you've taken care of yourself, but lost a lot of volume in your breasts, we can fix it. ... And if you lost half your money in the bank, is it better to invest in the bank or yourself?"
As these quotes illustrate, plastic surgery, once only for the wealthiest Americans, is now available to the rest of us not because we are getting richer, but because we have more and more opportunities to take on debt.
Medical credit for plastic surgery is big business for the banks, which are financing not just cosmetic surgery, but also cosmetic dentistry and veterinary bills. Since the deregulation of the industry, banks no longer rely on actual money or equity to make their profit. Instead, the bulk of their money is made from interest rates and fees. This "financialization" of the banking industry, where it's no longer about equity but rather financial products, created unprecedented profits for banks. Between 1990 and 2005, bank profits increased 400 percent. Even after the economic collapse of 2007, banks have managed to stay profitable by charging higher interest rates and fees.
The banking industry is not just making a lot of money off credit; they actually make more money off poor people than rich people. Under the guiding principles of Chicago school economics, credit was opened up to all sorts of people who previously did not have access to it: students and retirees, then the working poor, and by the 1990s, even the recently bankrupt. But since these people were "risky," credit rates had to adjust accordingly. Miss a payment or have a bad credit history and your interest rate balloons up to nearly 30 percent. That means that if you're poor, you might end up paying double for your $8,000 boob job over the course of five years of paying it off. That's not surprising. That's how credit, in unregulated markets, works.
In the unregulated market, the credit industry is able to squeeze profit from some of the poorest members of society like blood from a turnip. The Federal Reserve estimated that in 2004 a working-class family (household income less than $30,000 a year) paid 56.1 percent more on an auto loan than a wealthy family (household earning more than $90,000) did. In other words, boobs, like cars and home mortgages, cost more for the poor than the rich. And if you somehow managed to pay this exorbitant interest rate by making yourself sick working all the time, no worries: your friends in medical credit are increasingly willing to pay for lifesaving medical treatment, like insulin and hospital stays, for the 47 million uninsured Americans and the 16 million underinsured Americans. The result is a lot of profit for credit companies charging the highest interest rates that the market will bear to "help" poor and working-class Americans get medical care so that they can live, and facelifts so that they can dream.
Adapted from Essig's book American Plastic: Boob Jobs, Credit Cards, and Our Quest for Perfection.