Judith Warner on the politics of everyday life.

The health care reform bill currently being debated in the Senate contains a provision known as the Bo-Tax — so called because it would levy a 5 percent tax on cosmetic surgery procedures. The idea is to tax those who indulge in medically unnecessary procedures in order to pay for medical necessities for everyone else.

This sounded like a refreshingly good idea to me, until I read that Terry O’Neill, the president of the National Organization for Women, is against it.

“Now they are going to put a tax on middle-aged women in a society that devalues them for being middle-aged?” she complained to The Times.

Could this possibly be the voice of NOW, the country’s premier women’s rights group?, I wondered. Could this be the same feminist movement that in 1968 filled a “Freedom Trash Can” outside the Miss America Pageant in Atlantic City with bras, girdles and false eyelashes to protest the “ludicrous ‘beauty’ standards we ourselves are conditioned to take seriously,” as Robin Morgan, an organizer of the protest, put it at the time?

Yes, standing up for the rights of middle-aged women to have access to cosmetic enhancement is part of the work of contemporary feminism, O’Neill told me this week. It’s the sorry consequence of a number of sorrier truths: The economy is terrible. Middle-aged women, many of whom reduced their working hours, limiting their earning power and ambition, when they had kids or, later, found themselves having to care for their parents, are in a particularly vulnerable spot these days, as they’re increasingly called upon to supplement or take over the lion’s share of family money-making. And any number of studies have shown that people with better (read: younger) looks have a better chance of getting a good job. Particularly women.

“I am 57 years old. I really sympathize with women who are out of the job market, wondering, will anyone even take me seriously?” O’Neill explained. “The women’s movement is not overly concerned with the more superficial aspect of clothing or beauty or fashion trends. The more important question is whether we are participating fully in the lives of our communities. And middle-aged women really aren’t. I know a lot of women whose earning power stalled out or kicked down as they entered into their 50s, unlike their male counterparts’, whose really went up.”

And now a lot of men are out of work. Which means that, in this economy, getting the old face and belly looking tighter may, for many middle-aged women, be as crucial as having an eye-catching résumé.

“I’ve met women who’ve had to lie their ages down as much as 20 years to get or keep jobs as everything from waitresses to high-level consultants,” Gloria Steinem, who herself had cosmetic eye surgery some decades ago, told me this week. “They gave up pensions and benefits because they couldn’t produce documents, and employers colluded because they saved money.”

How disfiguring it can be when reality bites.

We are constantly hearing about the different phases, themes, lives and deaths of feminism. First wave, second wave, “victim,” “raunch,” etc.

“Looks are the new feminism, an activism of aesthetics,” Alex Kuczynski wrote in the introduction to her 2006 book on America’s obsession with cosmetic surgery, “Beauty Junkies.” At first glance, this seems ridiculous. And yet it says something true enough about the way many younger women understand feminism at a time when organized, real-world activism has hit wall after wall of political impossibility. Sneaker ads teach that feminism is all about taking control — of your figure.

This is what happens when equal pay stalls, abortion rights wither, and attempts to improve child care and workplace flexibility die on the legislative vine year after year. Women’s empowerment becomes a matter of a tight face and a flat belly. You control what you can control. And so many middle-aged women feel particularly out of control now, as indeed they are, in these life plan-wrecking economic times.

“Bag-lady syndrome,” the fear many women have that their financial security will disappear in a heartbeat, leading them to live out their remaining years on the streets, is shockingly pervasive. In 2006, before the current economic crisis hit, 90 percent of women surveyed by a Minnesota life insurance company said they felt financially insecure; 46 percent of those women overall said they had a “tremendous fear of becoming a bag lady,” including 48 percent of those with an annual income of more than $100,000. These days, more women than men — following a recession in which the men, overwhelmingly, lost the jobs — report being significantly stressed about money.

The inner bag lady, wrinkle-faced and unkempt, is no joke. She’s the worst-case scenario future. And while it’s easy to point to her as an irrational creation of women’s overly self-doubting imaginations (how else to explain the fact that wealthy, successful women like Katie Couric, Lily Tomlin and Steinem herself have all admitted to carrying around the fear — long after it was even remotely rational — of finding themselves one day, in old age, out on the streets?), she points to something very real: women’s economic status in this country is not what it should be. Middle-aged women with families shouldn’t be so scared.

I wonder if we haven’t entered into a period of what should be called “adjustment” feminism. The women’s movement is having to adjust to the realities of life in our culture, where many of its basic goals — including the very basic liberation of women from their pop culture status as a “mindless-boob-girlie symbol,” to borrow a phrase again from Robin Morgan — have stalled or are even backsliding. This week, for example, not only brought a public statement by the head of NOW acknowledging that the fight to have women valued for their inner beauty is essentially a wash; it also found NOW in the very bizarre position of urging senators to preserve the dictates of the Hyde Amendment, which for over 30 years has guaranteed that Medicaid funds would not be used to pay for most abortions for poor women. The House of Representatives’ recently-passed the Stupak amendment, which effectively prohibits both private health insurance plans participating in the future-envisioned insurance “exchange” and whatever public option may come into being, from offering abortion coverage to any woman, and the Stupak-like proposals currently circulating in the Senate are so much worse, after all. Hyde suddenly seems bearable.

Or maybe we should talk about having entered into the middle age of feminism — a moment when stock is taken, dreams are deferred and real life is faced in all its ugliness. Because to do otherwise is no longer youthfully idealistic, just foolhardy. Because you’ve got to hold onto what you’ve got, consolidate your gains and avoid potentially disastrous future losses.

With so much male unemployment, so much underemployment, so many people “lucky” to have jobs with reduced hours and benefits, women need good work options like never before. We need flexibility with security, options that will let us build wealth while taking sufficient care of our families.

Barring this, I guess we’ll go for eye lifts and Botox.