1. NABCA Board Meeting Paying the Tab: The Case for Higher Alcohol Taxes Philip J. Cook Duke University January 10, 2009

2. Portfolio of Alcohol Policies Complex problem, multifaceted solution o Treatment, education o Policies for risky circumstances (DUI, pregnancy, work) o Harm-reduction policies o Supply side policies (“alcohol control”): tax, minimum age, marketing, licensing

3. The main argument One important instrument has been neglected  Alcohol is too cheap  Best solution: raise excise taxes

4. Two mechanisms for improving the public health through tax The excise-tax revenue could be earmarked for prevention Higher taxes  higher prices  reduced use and abuse regardless of how revenues are spent

5. Recent trends

6. Retail prices trending down CPI change for package sales, 25 years All alcohol: - 11.7% Spirits: -12.3% Beer: - 8.8%

7. Meanwhile, remarkable decade in cigarette excise taxation 1998 – 2008 Federal excise tax per pack: $.24  $.39 State excise taxes 41 states raise tax rate by > $.25 (11 states increase by more than $1.00)

8. Excise Tax Revenues Federal $billions State $billions Total $billions Cigarettes7.514.021.5 Alcohol8.95.214.1

9. Tobacco as an inspiration Cig taxes are now fair game for states and cities Justified as public-health measure No carryover to alcohol taxes. Why?  Size of problem?  Strength of evidence on efficacy?  “Lessons” of Prohibition?

10. The wrong lesson The “Great Experiment” This ‘dreadful example’ is now so firmly established that it has become a maxim of popular culture, a paradigm of bad social policy, and a ritual invocation of opponents of a variety of sumptuary laws Aaron and Musto 1981

11. Prohibition & Drinking 1911-14 Local bans 1918-19 Wartime limits 1921-22 Volstead 1927-30 Volstead Ethanol gals. 1.690.970.731.14 Cirrhosis mortality rate 13.99.38.08.2

12. Prohibition’s differential impact by class and location Alcohol-related mortality drops sharply for working class Martha Bensley Bruère’s survey of social workers (National Federation of Settlements)

13. Good evidence on alcohol control and outcomes “Indeed, the forty-eight states will constitute a social science laboratory in which different ideas and methods can be tested, and the exchange of experience will be infinitely valuable for the future.” {Fosdick & Scott 1933: 150}

14. 30 years of research: Higher taxes save lives Reduce alcohol sales and binge drinking Reduce highway fatalities (stronger effect for youths) Reduce rate of STD transmission (stronger effect for adolescents) Reduce youth suicide rates (under age 24) Reduce cirrhosis mortality rate Reduce robbery and rape

15. How high for excise tax rates? Public health standard: higher is better Historical standard $1.68 federal tax on fifth of 80-proof spirits, 1951 $13.50equivalent today $ 2.16actual tax today Fairness standard Excise tax is “user fee” or “insurance premium” for public costs

16. Who pays the excise tax? Distribution of drinking Source: 2001-2 NESARC Number of Drinks Consumed in the Past Month by Decile

17. (Almost) everyone comes out ahead Suppose we raise federal alcohol tax by 10 cents per drink. Average is ~600 drinks/year  $60 Suppose revenues are returned to public on per capita basis About 93% of public would profit directly Also there would be additional widely shared benefits (auto insurance rates)

18. Should liquor be taxed higher than beer? Current federal tax: Liquor: 21 cents/ounce of ethanol Beer: 10 cents/ounce History standard: Yes Fairness: Probably not – beer is the drink of younger men

19. Unintended consequences of raising taxes? Substitution to other substances? NO (Marijuana and tobacco are more likely to be complements) Re-Creation of a black market? NO (Not a serious problem, even in 1950s) Decline in healthy drinking? DOUBTFUL (Middle aged folks break even) Economic burden? NO (No job loss on balance.)

20. F. Conclusion  Alcohol is our leading “drug” problem  The full policy portfolio should be utilized  Evidence has accumulated over the last 25 years on efficacy of alcohol taxes  Higher prices will encourage “voluntary self-control” and raise our overall standard of living