Could ObamaCare kill beer, wine and spirits?
August 20th, 2009
Dr. Obama
This country needs better health care. A requisite to successful and equitable administration of any publicly funded, universal coverage system is cost containment. A pillar of that is preventive care. That means getting the population to avoid doing things which will predispose them to chronic and, ultimately costly, conditions. It’s obvious that combating obesity and smoking should be at the top of the priority list.
What about alcohol consumption?
While moderate consumption of alcoholic beverages is associated with some health benefits, humans (in general) are not apt to practice restraint in most aspect of their lives. And lack of restraint carries consequences.
Chronic excessive alcohol consumption leads directly to disease of the liver (cirrhosis and cancer), pancreatic cancer, stomach and esophageal problems (from gastritis and reflux to malignancy), hypertension and heart disease as well as cognitive dysfunction, nutritional and metabolic dysfunction. The list really goes on and on. Indirectly, immoderate alcohol use puts one at risk of traumatic injury (vehicular and other) and sexually transmitted diseases. Of course, alcohol dependence, itself, is a problem with profound social impacts on the alcoholic and those around them.
Alcohol-related health problems are not at the pandemic levels in this country as obesity is. They are, however, real and their prevalence and incidence are significant. What’s more (and relevant to this discussion), alcohol-related illnesses are absolutely preventable. That means that impacting drinking attitudes and behavior in this country may be critical to the management of a public, universal, health coverage system.
There has been an undeniable shift in attitude towards alcohol all over the globe lately. Some commentators have gone so far as to call it “neoprohibitionism“. Those who follow such discussions have no doubt seen me take a relatively middle-of-the-road position in which I do not buy into conspiratorial thinking but also point out that there are public health reasons for the alcohol policies instated by local and national governments. At the same time, I do raise a skeptical eyebrow at the campaigns, most notably in France, which aim to equate ethanol with the most potent of carcinogens. I just don’t buy that hype.
While it may be impossible to legislate behavior and lifestyle, there is sufficient past precedent that consumption of alcoholic beverages could be put in the shadow of the same kind of stigma as tobacco use. Whether it is through government-funded educational programs or the efforts of groups like thetruth.com, public attitudes can be directed, swayed and manipulated.
So, returning to my question: could the institution of a universal health care system (however that ends up being structured) imperil the health of the beer, wine and spirits industry in this country? Would Wilson Daniels become the next Philip Morris?
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August 20th, 2009 at 10:11 am
In short, my answer to your rhetorical question is “no.” When Congress eventually acts to alter the rules for access to health care, it will not “kill” wine, beer, and spirits any more than it will stop people from overeating, smoking, having unprotected sex or driving badly. Our society has placed surcharges on some of these behaviors, such as excise taxes (so-called “sin” taxes) on alcohol and tobacco, and higher insurance premiums on bad drivers. It would not surprise me to see at some point passage of a mandate for individuals to carry health insurance, with insurance company bureaucrats pushing for higher premiums for risky behaviors, and being pushed back by government insurance boards. I expect sin taxes to increase, maybe disproportionately to alcoholic products most likly to be abused, and maybe be applied to fast foods and sodas.
August 20th, 2009 at 2:27 pm
John’s final sentence is exactly what I expect to see happen.
And Arthur, we have had this debate before: when someone comes up with an established break point that shows x consumption is harmful and x consumption is not, then the nation can have a discussion about alcohol. You said that moderate consumption has some health benefits–I believe that, too, but none of the tests that make that claim have ever really proven it.
Many wine drinkers are also higher income and health conscious people, living a lifestyle that might contribute greatly to the stats connected to their moderate alcohol consumption and their health.
It is no easy subject, as I know you know. But in my opinion, as long as society agrees to share the cost for everyone’s health care (which I doubt our greedy society ever will) I believe that restrictive and repressive laws need to be weighed more carefully against hard evidence.
We know that a drunk should not drive, but do we know exactly when someone is drunk? We know that excessive alcohol consumption can lead to health problems, but can we make a blanket statement concerning what constitutes excessive consumption for every person?
On the other hand, there’s a great degree of empirical evidence concerning weight and diabetes, smoking and a number of health problems, as well as certain types of diets and certain types of health problems connected to them.
Even with all the studies done concerning alcohol, I don’t think there’s anything definitive about them plus or minus, except for the obvious 24-hour alcoholic who likely will die of liver disease.
August 20th, 2009 at 6:12 pm
Rather than repressive and restrictive legislation how about something motivational. Regarding obesity, what if exercise was tax-deductible? As for wine, beer, and spirits. I’m not enough of an economist, but I say temporarily tax them if it helps fiscally, but don’t do it under the guise of helping our health. Besides, if you start making it too difficult for people to purchase these items you may find them resorting to an alternative even more risky to their health–who knew moonshine might make a comeback?
August 21st, 2009 at 3:18 pm
Increases in “sin” taxes come with conservative administrations just as often as liberal. Anyone remember Strom Thrumand? Even though there are just as many “do-gooders” in the liberal camp, generally the argument that these taxes are regressive, impacting the poor far more than the rich, carry the day. I think Obama is especially sensitive the the latter argument.
September 13th, 2009 at 7:52 pm
Very interesting debate I like to see what side has what to say and the only common thread is they both stretch the truth a bit