Why Florida Is Passing Another Law Regulating Brazilian Butt Lifts

Plus, Texas boom, Harvard update, Biden’s “grand strategy”

How to tastefully illustrate an article about Brazilian butt lifts? Abstraction is your friend.

The flow of talent and capital from high-tax, high-regulation states like New York and California to lower-tax, lower-regulation states like Florida and Texas is a recurring theme around here.

It’s worth a reality check, though, that even the lower regulation states aren’t exactly laissez-faire libertarian paradises. A case in point: “Before concluding the 2024 legislative session, both chambers of Florida’s Legislature passed matching bills aimed at granting the Department of Health enhanced enforcement powers over physician offices conducting specific liposuction or gluteal fat grafting procedures, commonly referred to as Brazilian butt lifts. All that’s needed now is approval from Florida Gov. Ron DeSantis,” the Newhouse family’s Gulflive.com website reports.

That’d be at least the third new law regulating cosmetic surgery in the state in the past 5 years, and comes on top of at least two separate actions by the Florida Board of Medicine, a government agency.

The article by Gulflive’s Jennifer Torres gives a nice job of providing background. “In 2022, the Florida Board of Medicine issued an emergency rule limiting Brazilian butt lift surgeries to three per day per surgeon to avoid fatigue,” she writes. “And this isn’t the first time the Florida Legislature has taken steps to protect patients who undergo the procedure. The state’s first plastic surgery bill, HB 1471, went into effect July 1, 2023, mandating that physicians conducting gluteal fat grafting must utilize ultrasound guidance to ensure fat is only being injected into the subcutaneous space and not any deeper.”

What’s more, in 2019 USA Today reported “Florida Gov. Ron DeSantis late Tuesday signed into law the first major reform in more than a decade to the state's cosmetic surgery industry, giving regulators stronger tools than in many other states. The new law, which takes effect in January, gives the state the power to suspend a clinic's operations or revoke its registration if it determines the facility poses an imminent threat to the public.”

That 2019 USA Today article also reported, “The Florida Board of Medicine earlier this month approved an emergency measure prohibiting the injection of fat into the gluteal muscle, a particularly dangerous technique used in a popular surgery known as the Brazilian butt lift.”

Some of these measures may well be driven by a sincere desire to prevent deaths and injuries resulting from botched operations. Yet there’s already a robust plaintiff-side medical malpractice bar in Florida. You can hardly drive from Palm Beach to Miami without passing a half dozen billboards advertising legal services. Genuinely malfeasant or grossly negligent doctors already might face not only civil malpractice suits but license suspensions or even criminal manslaughter charges.

So what, then, is really going on with the Florida legislature’s annual tinkering with the “act relating to office surgeries”? If you read the bill, you’ll see that the bill is regulating inputs, not outcomes. That’s generally a flawed approach. Outcomes would be things like post-surgery death or infection, or even survey-based satisfaction. Inputs are, well, from the 2024 legislation awaiting DeSantis’s signature: “An office in which a physician performs gluteal fat grafting procedures must at all times maintain a ratio of one physician to one patient during all phases of the procedure, beginning with the administration of anesthesia to the patient and concluding with the extubation of the patient. After a physician has commenced, and while he or she is engaged in, a gluteal fat grafting procedure, the physician may not commence or engage in another gluteal fat grafting procedure or any other procedure with another patient at the same time.” It’s basically a law limiting physician productivity.

Peter Schweizer got at this in his 2014 book “Extortion: How Politicians Extract Your Momey, Buy Votes, and Line Their Own Pockets.” He wrote, “If you are concerned that government action or inaction will severely damage you, you are much more likely to stroke the Permanent Political Class with a check….A milker bill gives politicians the opportunity to ‘milk,’ or squeeze, an industry for money. Whether the bill passes or not, the politicians still cash in.”

By that analysis, the last thing a Florida politician would want to do is fix the deadly Brazilian butt-lift problem once and for all, taking the issue off the legislative table. The industry would stop making campaign contributions or hiring the legislators’ friends, relatives, or former staffers as lobbyists.

The lobbyists have the same incentives to keep the issue alive. Some Florida lobbyist’s kids are probably having their college tuition bills paid by the fees generated by Brazilian butt lift legislation. I looked it up and there are 25—25!—lobbyists registered to lobby in 2024 on this Florida Brazilian butt lift law. They have some incentives to make sure that the legislature at least considers further incremental action on the issue in the year ahead, regardless of whether it will have much effect at all on patient safety.

DeSantis may have taken a less restrictive approach to pandemic restrictions than some other governors, but the “free state of Florida,” as he puts it, doesn’t look that free when it comes to cosmetic surgery.

Perhaps the governor will veto the legislation, giving the politicians an opportunity to take another pass at it next year. Law or no law, the mere specter of the law imposes a cost, requiring doctors to devote time and money to monitoring legislative action or to hiring someone to do it for them. Those costs wind up getting passed along to patients and making health care more expensive. One might even say these regulatory expenses wind up “lifting” the costs of every product in which health care is included as a cost, and injecting “fat” into a system that could be more lean.

Texas boom: Who knew that musician Paul Simon, “a lifelong liberal New Yorker, now spends most of his time in Texas”? Apparently so. The New York Times speaks of “the singer’s ranch in Wimberley, Texas.” Also, Bill Gates has a blog post from Texas, where he is “in Corpus Christi and Houston this week to meet with some of the remarkable innovators building America’s clean energy future.” He writes, “If you want to catch a glimpse of our country’s clean energy future, you should head on down to the Lone Star State.” So interesting that this “clean energy” action is happening in a state with zero income tax and a Republican governor, more so than, say, in John Kerry and Maura Healey’s Massachusetts or Gavin Newsom’s California.

At Fed Chairman Powell’s press conference this afternoon, he took a question about a letter from Senator Warren and Senator Whitehouse complaining that high interest rates were preventing investment in countering climate change. You can focus on the interest rates or you can focus on the state income tax rates. Maybe Senators Warren and White House can consider writing letters to the governors of the non-Texas states complaining that the high tax rates are slowing investment in the clean energy future.

Harvard update: At Law & Liberty, Harvard history professor James Hankins, who has taught at Harvard for almost 39 years, has a somewhat pessimistic take on the chances of turning the place around. “No, I don’t see any prospects right now for fundamental reform at Harvard,” he writes. “The only way to steer the ship back into port and keep it from leaking more prestige, public support, alumni loyalty, and financial stability is to appoint a strong young president committed to our traditional purposes.”

He has an update also on the apparent decline of language instruction at Harvard: “When I came to Harvard in 1985, I heard the (to me) astonishing boast that it was possible to learn over 150 languages here if you could locate the persons who knew them, who were usually squirreled away somewhere in the bowels of Widener Library. Now that number is 45, somewhat fewer than are taught at the University of Michigan, and considerably fewer than the 75 taught at Yale. Such, apparently, are the fruits of ‘multi-culturalism.’” Forty-five languages may still seem like a lot, but it’s a lot less than 150. Maybe if you count computer programming languages you can make up some of the losses?

If you think Hankins’ take is too grim, take a look at the video posted by Harvard Chabad of a Harvard employee on campus tearing down posters of kidnapped Israeli. Warning: the language is foul. I guess you can argue that the poster kiosks need to be regularly cleaned, but the employee seemed to be targeting the posters of the Israelis and taking them down on something other than the announced schedule. You might think that given the lawsuits and the congressional investigations and the press attention this is something Harvard would be more careful about, but apparently not. And the trust has so eroded all around that the Jewish organization is left to staking out the custodial employees and the poster kiosks, and posting public video, to try to understand what is happening and to communicate it to the world. It is sad what has happened to Harvard. As the video shows, it reflects not only a rise of antisemitism or anti-Israel views in progressive or highly educated spaces, but also an institution that is so decentralized, slow-moving, and unresponsive to pressure that it’s hard to accurately describe it as well-managed.

Biden’s “Grand Strategy”: Tom Friedman writes: “The only way Israel could build a regional alliance — and enable President Biden to help line up regional allies — was if Israel was simultaneously pursuing a peace process with non-Hamas Palestinians. That is the necessary cement for a regional alliance against Iran. Without that cement, Biden’s grand strategy of building an alliance against Iran and Russia (and China) stretching from India through the Arabian Peninsula across North Africa and up to the European Union/NATO is stymied.”

The idea that Biden’s grand strategy is an “alliance against Iran” is odd. If he wanted an alliance against Iran, why’d he withdraw from Afghanistan, which borders Iran? If he wanted an alliance with Iran, why’d he support as Obama’s vice president, and then seek to re-enter as president, a nuclear deal that involved hundreds of billions of dollars in sanctions relief from Iran? Why was he initially so cold toward the Saudis, a critical part of any anti-Iran alliance? Anyway, blaming Netanyahu or Israel for the stall-out of a Biden’s anti-Iran alliance doesn’t make much sense; why not blame Biden? If such an alliance is indeed his grand strategy, why doesn’t he announce it publicly?

Recent work: The New York Sun has posted my latest weekly column, headlined, “Outgoing Irish Leader, at White House, Marks Saint Patrick’s Day With a Call for Hamas Victory.” The subheadline is “Biden stands mum as Taoiseach mangles Kennedy legacy, blames Israel for ‘catastrophe’ in Gaza.”

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