What do you think?
Rate this book
Paying the Tab: The Costs and Benefits of Alcohol Control
What drug provides Americans with the greatest pleasure and the greatest pain? The answer, hands down, is alcohol. The pain comes not only from drunk driving and lost lives but also addiction, family strife, crime, violence, poor health, and squandered human potential. Young and old, drinkers and abstainers alike, all are affected. Every American is paying for alcohol abuse.
Paying the Tab , the first comprehensive analysis of this complex policy issue, calls for broadening our approach to curbing destructive drinking. Over the last few decades, efforts to reduce the societal costs--curbing youth drinking and cracking down on drunk driving--have been somewhat effective, but woefully incomplete. In fact, American policymakers have ignored the influence of the supply side of the equation. Beer and liquor are far cheaper and more readily available today than in the 1950s and 1960s.
Philip Cook's well-researched and engaging account chronicles the history of our attempts to "legislate morality," the overlooked lessons from Prohibition, and the rise of Alcoholics Anonymous. He provides a thorough account of the scientific evidence that has accumulated over the last twenty-five years of economic and public-health research, which demonstrates that higher alcohol excise taxes and other supply restrictions are effective and underutilized policy tools that can cut abuse while preserving the pleasures of moderate consumption. Paying the Tab makes a powerful case for a policy course correction. Alcohol is too cheap, and it's costing all of us.
Paying the Tab , the first comprehensive analysis of this complex policy issue, calls for broadening our approach to curbing destructive drinking. Over the last few decades, efforts to reduce the societal costs--curbing youth drinking and cracking down on drunk driving--have been somewhat effective, but woefully incomplete. In fact, American policymakers have ignored the influence of the supply side of the equation. Beer and liquor are far cheaper and more readily available today than in the 1950s and 1960s.
Philip Cook's well-researched and engaging account chronicles the history of our attempts to "legislate morality," the overlooked lessons from Prohibition, and the rise of Alcoholics Anonymous. He provides a thorough account of the scientific evidence that has accumulated over the last twenty-five years of economic and public-health research, which demonstrates that higher alcohol excise taxes and other supply restrictions are effective and underutilized policy tools that can cut abuse while preserving the pleasures of moderate consumption. Paying the Tab makes a powerful case for a policy course correction. Alcohol is too cheap, and it's costing all of us.
- GenresNonfictionDrugs
280 pages, Hardcover
First published January 1, 2007
7 people are currently reading
129 people want to read
About the author
Philip J. Cook
20 books6 followersPhilip Jackson Cook is the ITT/Terry Sanford Professor of Public Policy at the Sanford School of Public Policy at Duke University in the United States. He also holds faculty appointments in Duke's departments of sociology, and economics.
Ratings & Reviews
Friends & Following
Create a free account to discover what your friends think of this book!
Community Reviews
Displaying 1 - 8 of 8 reviews
July 2, 2017
“Alcohol abuse remains our leading ‘drug’ problem,” writes Philip J. Cook. But our presidents never identify alcohol as the drug that causes the most harm to society. Americans support using taxes and other regulations to curb smoking, but there is an aversion to using such policies to curb alcohol abuse. Cook attributes that aversion to the aftereffects of Prohibition.
A professor of public policy and economics at Duke University, Cook is a veteran in researching and writing about alcohol and public policy. His book surveys decades of research in explaining how much excess drinking costs society, and which policies work and which don’t to curb the harm.
The cost to society, aka the “bar tab,” is “much larger than it needs to be or should be.” One reason is that the cost of alcoholic beverages has declined in constant dollars since the 1950s. That’s because the federal excise tax on alcohol in the 1950s, in inflation adjusted dollars, was more than six times as high as it is today. The excise tax is based upon volume, not value, and the tax has been raised only once since 1951.
The research is clear that a higher “user fee” would save lives while imposing most of the cost on the ten percent of drinkers who consume the most alcohol. There is no question that price increases for cigarettes reduce sales and underage smoking. That happens even though almost all smokers are dependent, compared to perhaps one in ten drinkers. Prices matter with alcohol as well. When prices are cut in half at a happy hour, both casual and heavy drinkers quaff twice as much.
The alcohol industry is aware that higher taxes reduce sales, which is why the industry lobbies so tenaciously against tax hikes. The research shows that young people are particularly price sensitive. “Contrary to conventional wisdom, prices even matter for chronic heavy drinkers...The evidence supporting the public health benefits of increased alcohol taxes is every bit as strong as for cigarette taxes.”
Former Surgeon General C. Everett Koop recognized that the social costs of alcohol abuse far exceed the declining value of the excise taxes. Consequently, he “strongly recommended” a nickel a drink increase in the alcohol user fee. The evidence suggests that a nickel a drink increase would reduce consumption by 12 percent, motor vehicle deaths by 7 percent, suicides by 6 percent and the cirrhosis death rate by 32 percent.
Another reason for the big bar tab is that public policy is used to address only one source of harm from excess drinking, namely DUI. As a result, DUI has declined markedly since the early 1980s. But the alcohol problem is not limited to the highways, and other harms get neglected. Among those are suicide, the transmission of STDs, and fetal alcohol spectrum disorder. One more is from violence that occurs in barroom brawls, date rape, domestic battery and murder. Drinking is involved in at least two out of five injury deaths.
When it comes to tobacco, the public recognizes that availability matters. Consequently, cigarette vending machines were eliminated, and tobacco ads were taken off the air. The public is doubtful, however, that such regulations would work with alcohol. Cook’s review of the research finds that availability does matter: “A ten percent increase in per capita drinking is associated with a 5 percent increase in homicide and suicide, a 9 or 10 percent increase in accidents, and a 15 percent increase in cirrhosis deaths.”
The reformers who abolished Prohibition, such as John D. Rockefeller, Jr., advocated a variety of controls on drinking to prevent abuse. He recommended state monopolies for distribution and retail sales in order to eliminate the private profit motive, and with it the motive to stimulate sales and increase intemperance. Seventeen states did adopt a monopoly system of wholesale distribution for liquor though some included wine as well.
The Illinois Liquor Control Act of 1934, which is still on the books, reflects that Rockefeller attitude by explicitly advocating moderation: “This Act shall be liberally construed, to the end that the health, safety, and welfare of the People of the State of Illinois shall be protected and temperance in the consumption of alcoholic liquors shall be fostered and promoted by sound and careful control and regulation of the manufacture, sale, and distribution of alcoholic liquors.”
Interesting facts:
• The whiskey tax was the first internal revenue measure imposed by the first Congress in 1791. It was advocated by Alexander Hamilton, who contended the liquor tax would produce adequate revenue as well as encourage moderation.
• The whiskey tax was replaced as the main source of federal revenue when the Sixteenth Amendment passed in 1916 authorizing the income tax. Thus the Sixteenth Amendment made possible the 18th Amendment for Prohibition.
• Though Prohibition was a political failure, it nevertheless resulted in a substantial reduction in consumption, particularly of beer.
• After the repeal of Prohibition, bootleggers continued to supply 45 million gallons per year until enforcement was ramped up and deflated the black market within four years.
• If the top ten percent who drink the most could reduce their consumption to that of the next highest drinking decile, then alcohol sales would drop by 60 percent.
• Opponents of raising the alcohol user fee call it a regressive tax, even though the heaviest drinkers would pay most of it, while teetotalers wouldn’t be affected, and light drinkers would hardly notice. Besides, alcohol is not a necessity, like food or electricity, and people of modest means could avoid paying more by reducing how much they drink.
• When it comes to the age-21 laws, the allure of forbidden fruit exists. But research shows that those laws have the overall effect of reducing the likelihood minors will drink and abuse alcohol.
“Alcohol is the source of great enjoyment and also great harm.” Cook makes a persuasive case that the social costs can be significantly reduced without infringing on the enjoyment, by employing effective public policies to reduce the harm. ###
A professor of public policy and economics at Duke University, Cook is a veteran in researching and writing about alcohol and public policy. His book surveys decades of research in explaining how much excess drinking costs society, and which policies work and which don’t to curb the harm.
The cost to society, aka the “bar tab,” is “much larger than it needs to be or should be.” One reason is that the cost of alcoholic beverages has declined in constant dollars since the 1950s. That’s because the federal excise tax on alcohol in the 1950s, in inflation adjusted dollars, was more than six times as high as it is today. The excise tax is based upon volume, not value, and the tax has been raised only once since 1951.
The research is clear that a higher “user fee” would save lives while imposing most of the cost on the ten percent of drinkers who consume the most alcohol. There is no question that price increases for cigarettes reduce sales and underage smoking. That happens even though almost all smokers are dependent, compared to perhaps one in ten drinkers. Prices matter with alcohol as well. When prices are cut in half at a happy hour, both casual and heavy drinkers quaff twice as much.
The alcohol industry is aware that higher taxes reduce sales, which is why the industry lobbies so tenaciously against tax hikes. The research shows that young people are particularly price sensitive. “Contrary to conventional wisdom, prices even matter for chronic heavy drinkers...The evidence supporting the public health benefits of increased alcohol taxes is every bit as strong as for cigarette taxes.”
Former Surgeon General C. Everett Koop recognized that the social costs of alcohol abuse far exceed the declining value of the excise taxes. Consequently, he “strongly recommended” a nickel a drink increase in the alcohol user fee. The evidence suggests that a nickel a drink increase would reduce consumption by 12 percent, motor vehicle deaths by 7 percent, suicides by 6 percent and the cirrhosis death rate by 32 percent.
Another reason for the big bar tab is that public policy is used to address only one source of harm from excess drinking, namely DUI. As a result, DUI has declined markedly since the early 1980s. But the alcohol problem is not limited to the highways, and other harms get neglected. Among those are suicide, the transmission of STDs, and fetal alcohol spectrum disorder. One more is from violence that occurs in barroom brawls, date rape, domestic battery and murder. Drinking is involved in at least two out of five injury deaths.
When it comes to tobacco, the public recognizes that availability matters. Consequently, cigarette vending machines were eliminated, and tobacco ads were taken off the air. The public is doubtful, however, that such regulations would work with alcohol. Cook’s review of the research finds that availability does matter: “A ten percent increase in per capita drinking is associated with a 5 percent increase in homicide and suicide, a 9 or 10 percent increase in accidents, and a 15 percent increase in cirrhosis deaths.”
The reformers who abolished Prohibition, such as John D. Rockefeller, Jr., advocated a variety of controls on drinking to prevent abuse. He recommended state monopolies for distribution and retail sales in order to eliminate the private profit motive, and with it the motive to stimulate sales and increase intemperance. Seventeen states did adopt a monopoly system of wholesale distribution for liquor though some included wine as well.
The Illinois Liquor Control Act of 1934, which is still on the books, reflects that Rockefeller attitude by explicitly advocating moderation: “This Act shall be liberally construed, to the end that the health, safety, and welfare of the People of the State of Illinois shall be protected and temperance in the consumption of alcoholic liquors shall be fostered and promoted by sound and careful control and regulation of the manufacture, sale, and distribution of alcoholic liquors.”
Interesting facts:
• The whiskey tax was the first internal revenue measure imposed by the first Congress in 1791. It was advocated by Alexander Hamilton, who contended the liquor tax would produce adequate revenue as well as encourage moderation.
• The whiskey tax was replaced as the main source of federal revenue when the Sixteenth Amendment passed in 1916 authorizing the income tax. Thus the Sixteenth Amendment made possible the 18th Amendment for Prohibition.
• Though Prohibition was a political failure, it nevertheless resulted in a substantial reduction in consumption, particularly of beer.
• After the repeal of Prohibition, bootleggers continued to supply 45 million gallons per year until enforcement was ramped up and deflated the black market within four years.
• If the top ten percent who drink the most could reduce their consumption to that of the next highest drinking decile, then alcohol sales would drop by 60 percent.
• Opponents of raising the alcohol user fee call it a regressive tax, even though the heaviest drinkers would pay most of it, while teetotalers wouldn’t be affected, and light drinkers would hardly notice. Besides, alcohol is not a necessity, like food or electricity, and people of modest means could avoid paying more by reducing how much they drink.
• When it comes to the age-21 laws, the allure of forbidden fruit exists. But research shows that those laws have the overall effect of reducing the likelihood minors will drink and abuse alcohol.
“Alcohol is the source of great enjoyment and also great harm.” Cook makes a persuasive case that the social costs can be significantly reduced without infringing on the enjoyment, by employing effective public policies to reduce the harm. ###
March 15, 2021
Really excellent treatment of alcohol control policies from taxes to minimum age laws. Rigorous without falling into the common trap of “letting the data speak for itself”. Cook presents a compelling case that alcohol is too plentiful and cheap in American society and that the dedication of resources to youth drinking and excessive drinking is not as efficient at policies which would generally reduce average consumption. While being clear of his support for higher excise taxes, he takes a balanced approach.
His arguments as applied to alcohol are something to consider for marijuana legalization (what would a general loosening do for those at the right tail of the distribution who use the drug heavily), especially with the evidence presented that alcohol and other drugs, including marijuana, are complements and not substitutes. Given the current policy path and how states have begun to decriminalize or legalize marijuana, I’m sure we will start to get a picture of the impact.
His arguments as applied to alcohol are something to consider for marijuana legalization (what would a general loosening do for those at the right tail of the distribution who use the drug heavily), especially with the evidence presented that alcohol and other drugs, including marijuana, are complements and not substitutes. Given the current policy path and how states have begun to decriminalize or legalize marijuana, I’m sure we will start to get a picture of the impact.
January 27, 2019
Amazing how malleable we are; this is a nice example of behavioral economics applied and thoughtfully analyzed in the contexts of costs. Small increases can still make a meaningful difference in behavior, and I appreciate his attempts to quantify the benefits of social drinking as well (though viewing the human impact of sociability purely in terms of financial gain/professional productivity is a dismally capitalist view in my book).
September 30, 2019
Very informative book about the history of alcohol in the USA, taking a close look at taxation, controls, and effects of drinking.
February 5, 2022
Excellent book covering a topic that doesn’t receive much attention.
Some of the findings were quite surprising. However, I didn’t find anything to be factually inaccurate.
Some of the findings were quite surprising. However, I didn’t find anything to be factually inaccurate.
October 10, 2012
Excellent analysis of alcohol control social policy methods, weighing the pros and cons of different approaches with evaluation of evidence from major scientific studies. Clearly presented and, for a complex topic such as this one, readable and balanced discussion.
November 1, 2007
alcohol policy from the public health point of view. better written and more sensitive to liberty and health questions than i expected. but nothin' new or special.
Want to read
January 7, 2009As seen on Freakonomics.
Displaying 1 - 8 of 8 reviews