This health care overhaul, if it happens, is going to be insanely expensive-around $1 trillion over ten years. One way to pay for part of it might be to impose a "vanity tax" on cosmetic surgery. Here's the idea:In meetings this month, Obama administration budget director Peter Orszag and U.S. treasury department economic adviser Gene Sperling suggested to Senate negotiators an excise tax on tooth-whitening, hair transplants and other cosmetic surgery procedures not deemed medically necessary, news media reported. Senators appear cool on the idea of a "botox tax" however.New Jersey has had a vanity tax like this since 2005. The state adds a 6.5 percent charge to the cost of botox, breast implants, nose jobs, and the like. With more than $10 billion spent on cosmetic surgery last year, a similar nationwide vanity tax would give us $650 million per year for universal health care. That's not insignificant.Plastic surgeons tend not to like the idea, though, because it would hurt their business. And some worry that, because women account for 91 percent of cosmetic surgery patients, there's a gender bias in the tax. On that point, Kim Gandy, president of the National Organization for Women, has said: "In general, I'm opposed to most things that impact women disproportionately, but disproportionate use isn't a good measure if a tax is unfair or not. I can't imagine someone arguing against having a luxury tax on yachts because more of them are bought by men."Taxing these unnecessary procedures to help get basic care for more Americans seems like a great idea. And to the extent that a vanity tax restructures incentives so that fewer medical students end up doing cosmetic surgery, all the better. It would be important, though, to make sure that reconstructive surgeries and breast reduction surgeries, for example, are exempted from the tax.And, of course, as a culture we should do what we can to ditch this fixation on physical perfection anyway.