For the Health (and Economy) of the Nation: Time to Tax Alcohol Fairly

Like many people with a drinking problem, our nation itself is in denial about what alcohol abuse costs. With a looming ’financial Armageddon’ upon us, it’s time we confront the issue.

I started drinking alcohol to excess at the age of 13. Drinking at this tender age is not uncommon. Among my friends, it was easy to steal a bit of liquor from bottles in our parents’ ample bars, and to go to the beach or hills and drink until we vomited. By high school, some of us were serious drinkers, and by college some of us were alcoholics. Some of us didn’t survive much longer due to accidents, and some died from causes related to alcohol later.

My peers and I saw drinking as cool, partly because so many of our heroes in sports, music, film and television did it, and there were fun-looking advertisements for drinking everywhere. Given my genetic and family history of alcoholism, I was fortunate that I escaped serious harm, and to this day can enjoy a glass of wine with dinner. But I am very aware how much alcohol use and abuse is ingrained in American teen culture and onward.

As with tobacco use, the patterns established in youth can determine one’s relation to alcohol for a lifetime. Upwards of 90 percent of both smokers and alcoholics start using in their teen years. Most, like me, can experiment without long-lasting problems, but many cannot. Thus, addiction — especially to tobacco and alcohol — remains what the American Medical Association has identified as our nation’s most pervasive private and public health problem.

Alcohol abuse costs us a lot. Just how much is unlikely to ever be fully determined, but a local organization has recently made a valiant attempt. Looking just at my home state, California, the Marin Institute, a private non-profit organization devoted to improving alcohol-related policy and reducing harms from drinking, released a 2008 report titled “The Annual Catastrophe of Alcohol in California.” (Disclosure: I serve on the Marin Institute’s volunteer board of directors).

The report makes for sobering reading. Marin found that the total economic cost to California from alcohol-related causes is $38 billion per year — $18 billion for illness, $8 billion in traffic/DUI costs, $8 billion for crime, and $4 billion for injuries. This is about twice the costs attributed to tobacco use. One can quibble with the numbers, but there is no denying that the societal burden imposed by alcohol use is substantial. For the nation as a whole, the costs are astronomical.

Addressing California’s huge budgetary shortfall, Gov. Arnold Schwarzenegger has proposed a 5-cents-per-drink tax increase on beer, wine, and distilled spirits. This would raise more than $878 million over the next 18 months, and be targeted at funding some crucial and under-funded services, including but not limited to addiction treatment.

California alcohol taxes have not increased since 1992, and then by only a penny. Opponents argue such taxes are onerous, or even akin to Prohibition. But taxing tobacco to pay for health costs is now widely accepted, and in fact President Obama has just expanded children’s health coverage with a substantial increase in such taxes.

On a national level, revenues from a similar alcohol tax increase would be very substantial. Perhaps most important, “Increasing alcohol taxes saves lives; that’s the bottom line,” as a recent study by Wagenaar and colleagues from the University of Florida noted in the American Journal of Public Health. 

We should acknowledge the uncomfortable fact that ’Big Alcohol’ is no angel, having long used ’Big Tobacco’-type tactics to market alcohol to kids — most recently in the form of “alcopops”, sweet alcoholic drinks with an obvious appeal to young drinkers. One of the big alcohol companies, MillerCoors, recently settled with a group of state Attorneys General and will stop marking alcohol-fueled “energy drinks,” another category of alcoholic beverages favored by teen drinkers. Again, as with tobacco, there is long history of alcohol marketing to teens in sneaky guises, including via sporting events and youth-targeted media.

A nickel a drink isn’t much — the Marin Institute actually feels 25 cents per drink is a more fair and supportable tax — but would raise a few billion dollars per year. While this would not solve our nation’s financial problems, it sure would help. Given the medical, public health, and economic facts, a fair increase in alcohol taxes is long overdue. We should take a similar approach as we have with tobacco, and use the funds to prevent alcohol abuse and pay for its related harms. After all, not every kid will be as lucky as I was.

Steve Heilig is co-editor of the Cambridge Quarterly of Healthcare Ethics and on the staff of the San Francisco Medical Society. Heilig was a Join Together Fellow and Advisory Board member, and currently serves on the Marin Institute’s volunteer board of directors.