The latest attempt from the booze wowsers

We do love this latest attempt at justifying minimum alcohol prices:

Minimum alcohol pricing of 45 pence per unit would be 50 times more effective in targetting harmful drinking than current policies which only ban the selling of alcohol as a loss leader, research suggests.

Really?

Researchers at the University of Sheffield compared the effects of the two policies on public health using a mathematical model alongside General Lifestyle Survey data to estimate changes in alcohol consumption, spending, and related health harms among adults.

What did that model look at?

In their findings, published by bmj.com, they estimated that below cost selling would increase the price of just 0.7 per cent of alcohol units sold in England, whereas a minimum unit pricing of 45p would increase the price of 23.2 per cent of units sold.

They estimated that below cost selling would reduce harmful drinkers’ mean annual consumption by just 0.08 per cent – or around three units per year. By contrast, a 45 pence minimum unit price would reduce consumption by 3.7 per cent or 137 units a year – a 45 times greater effect.

So they plugged the price change into their estimate of the elasticity of demand and found that….wait for it, wait for it….higher prices reduce demand and or consumption?

Gosh, do we really need a team of highly trained and expensive alcohol researchers to tell us that?

Unfortunately this latest paper fails to tell us the three things we’d actually like to know about minimum alcohol pricing.

This first being should we be attempting to reduce consumption in the first place? Current levels of booze taxation more than cover the public costs of boozing. There are, indeed, substantial private costs remaining: but those are being carried by the people doing the boozing which is just where they should be. Is there actually a reason or justification left for public policy action in this case?

The second is whether that rise in prices actually reduces harmful drinking, or just deters the occasional tippler from a small pleasure. There is, after all, fairly convincing evidence that the addict will always feed their addiction while the diletante is more amenable to price signals.

And thirdly, even if the above can be answered in a manner that leads to our wanting to increase the price, why on earth would anyone want to have minimum pricing? Not only is it illegal under EU law but it puts the extra cash into the hands of the retailers and manufacturers. Rather than into the Treasury as would be the case if prices were raised through higher taxation.  Minimum alcohol pricing just doesn’t make sense.

On Ed Miliband’s new tax on tobacco profits

Ed Miliband has decided that there should be higher taxes on the profits of cigarette companies. The argument being that smoking costs the NHS money and that thus some cash should come from the one activity to cover the other. However, that activity of smoking already more than covers the public costs associated with it. As is helpfully pointed out here:

Estimates for the amount spent on tobacco in the UK in 2011 range from £15.3bn to £18.3bn. The cost of smoking to the NHS is put at between £2.7bn and £5.2bn.

The Treasury earned £9.5bn in revenue from tobacco duties in the financial year 2011-12.

When even The Guardian is pointing out the mathematical difficulties with a Labour Party leader’s promises then it would be fair to say that it’s not really going to fly, wouldn’t it?

And that is rather the point about smoking. The activity is already sufficiently taxed that it pays for all of the public costs associated with it and more (and that’s to ignore the fact that shorter lifespans as a result save the NHS money). There are substantial private costs of course: but public taxation isn’t the correct way to deal with such private costs either.

How did we end up being ruled by the ignorant?

It always comes as something of a shock to us to see public policy being decided upon the basis of information that simply isn’t true. We expect a bit of political argy bargy, of course we do, for different people weight different outcomes, err, differently. Equity and efficiency, inequality and economic freedom, we might agree or disagree on those weights that different people place upon them but can still regard such opinions (for opinions they are and no more than that) as being valid. But that’s very different from our being told pure porkies, having supposed facts deployed, facts which just are not a reflection of reality. As the Original Tax Dodger in Chief himself pointed out, comment is free but facts are sacred.

And so it is that we come back to a favourite subject of ours, the relationship between the prevalence of obesity and the costs of it to the NHS.

Mr Stevens, who took up post last April, said: ‘Obesity is the new smoking, and it represents a slow-motion car crash in terms of avoidable illness and rising health care costs.

‘If as a nation we keep piling on the pounds around the waistline, we’ll be piling on the pounds in terms of future taxes needed just to keep the NHS afloat.’

The problem with this is that it simply is not true. Obesity does not cost the NHS money: on balance it saves it. This is something we’ve been pointing out for a number of years now. The source is here and the finding is:

Obesity is a major cause of morbidity and mortality and is associated with high medical expenditures. It has been suggested that obesity prevention could result in cost savings. The objective of this study was to estimate the annual and lifetime medical costs attributable to obesity, to compare those to similar costs attributable to smoking, and to discuss the implications for prevention.
….
Although effective obesity prevention leads to a decrease in costs of obesity-related diseases, this decrease is offset by cost increases due to diseases unrelated to obesity in life-years gained. Obesity prevention may be an important and cost-effective way of improving public health, but it is not a cure for increasing health expenditures.

When someone’s arteries explode at the age of 60 from that 15 cheeseburger a day habit then the NHS doesn’t have to pay for another 25 years’ worth of hip replacements. This saves the system money as a result of the shorter lifespan.

This is well known: and yet we have the CEO of the NHS telling us the opposite. And further, he’s demanding public action that he should know will make his financial problems worse, not better.

All of which leaves us with that essential question: how did we end up being ruled by the ignorant?

Why sign up generics manufacturers for a drug you’ve only just got patent and approval for?

More importantly, why would you sign up generics manufacturers to make a drug that you can charge $84,000 a course of treatment for? Which is exactly what Gilead, the makers of Sovaldi, the $84,000 a course treatment for Hepatitis C have just done:

Multinational American drug maker Gilead Sciences was set to join hands with at least five Indian generic pharmaceutical companies and allow them to manufacture and sell cheaper versions of its new hepatitis C medicines – sofosbuvir and ledipasvir – in 90 countries, four people in the know told Business Standard.

Clearly, someone is being either terribly clever here or terribly stupid. So which is it?

It is, of course, being clever. NICE has approved Sovaldi for use in the UK, the FDA has in the US. Gilead has some short number of years (usually, about ten) to squeeze that drug for the billion dollars or so it cost to develop. So, obviously, they’re going to charge what the market will bear. $84,000 looks like a lot, is a lot, but it’s about the same price as other current treatments and is markedly more effective. So, that’s the price they set.

But to then go and licence to generics manufacturers to sell in 90 odd countries looks most odd: won’t this undercut sales? No, no, it won’t: for the generics manufacturers only get the rights to sell in countries where there’s no way at all that anyone would pay $84,000 for a course of treatment. For yes, there are poor countries out there and poor countries, rightly, don’t try to spend that sort of money on treating one patient. They can save tens, hundreds, thousands of lives by spending the same amount on, say, a vaccination campaign.

Thus, at full market price there would be no sales: at generics prices there will be some and thus some revenue to Gilead.

But that then leads to, well, isn’t it unfair on us? We’ve got to stump up $84,000 a treatment and poor people pay a groat a pill. True, but why is this unfair? Aren’t we rich people supposed to be tendering to the ill and sick of the world?

Further, this isn’t particularly to do with the way that the patent system works. Imagine that all health care research was done by the state instead. It would still be us rich world people paying for all of that research from our taxes, wouldn’t it? On the simple grounds that poor people don’t have incomes to pay tax upon to fund medical research. So whatever the structure is the end result will be the same. We rich people will pay to get the drugs designed and through the approval process. The poor will then get them. Whether we pay in advance in taxation or later through the price of the patented drug doesn’t make much difference, does it?

And yes, for all that the NHS is The Wonder of the World and all the rest, we in the UK are indeed rich world people and that’s why we’re being charged this arm and a leg for this drug. And, given that we pay for the NHS through taxation it really makes absolutely no damn difference at all, what the patent or research structure is?

Dear Dr. Sarah Wollaston MP

I write this open letter to you in the hope that you have been grievously misquoted by the Daily Mail. For it would be painful to have to believe that a sitting MP, and a qualified doctor to boot, could be quite so ill-informed about food, prices and obesity. It is thus my hope that your words have been manipulated by the newspaper rather than that you actually believe any of this tosh.

For example, you are quoted as saying that:

‘There is a huge amount of personal responsibility. But it is now so serious we need to state to step in and take some measures.

‘The choice is you either do nothing and carry on saying it’s all down to personal choice and you continue to pick up a huge bill through the NHS.

‘We have to take out junk food calories and help to get people moving and more active.’

The problem there is that obesity does not cost the NHS anything at all. Indeed, the price to the NHS of obesity is negative. The reason being that the NHS is a system of lifetime health care and those who are obese die earlier. Yes it is true that they incur healthcare costs while alive and fat: but these are more than outweighed by the savings to the NHS when they are dead and buried and not requiring those longer years of health care.

This means that there are substantial private costs to people of being lardbuckets, entirely true, but it is not true to then say that there are public costs to their being so, as you well know.

‘One of the reasons why the most disadvantaged people are running into difficulties is partly because the healthy food is more expensive.

‘If you are struggling on a budget, you are much more likely to pick food on special offers. But all of the special offers tend to be on crisps, sweets and junk food.

That is also not true. Rice, beans, onions and tomatoes may not be a very interesting diet but it is still both healthier and vastly cheaper than any form of junk food calorie for calorie, whatever the BOGOF or discount that is being offered. This is something that we both know and so for the Mail to be quoting you as it did is obviously something you’ll want to correct.

And finally the paper seems to be making a good attempt at making you look like an idiot:

She warned voluntary agreements with big chains had not worked and regulation was now needed to force stores to offer discounts on fruit and vegetables.

This is price fixing and price fixing does not work. By definition price fixing does not work: clearly a Tory MP is well aware of this fact for the following obvious reason. If we fix prices below the market clearing price then we will have fewer suppliers willing to produce at that price. We will also have more people desiring to consume that good or service at that price: the result is instant shortages of those goods and or services. We need only to look at the provision of toilet paper in Venezuela, well reported recently, to see that. Similarly, if we fix prices above the market clearing price then we find that consumers desire to purchase less of these goods and services while producers will be squeezing every extra unit out they can. Leading, as the European Union showed us when they did it, to vast gluts in the form of butter mountains and wine lakes.

Price fixing thus leads to either dearth or glut unless we fix those prices at the market clearing price itself. In itself that has a problem for as you well know we don’t in fact have any other mechanism than the market itself to work out what that market clearing price is. But even if we did, again as is obvious to both of us, what’s the damn point of fixing prices where they would be anyway?

Quite clearly you’ll want to make sure that the Daily Mail corrects this terrible misrepresentation of what any sane or sensible person could possibly believe on this subject. My suggestion is that you start by calling 020 7938 6000 and ask for a certain Mr. Paul Dacre. He should be able to sort out matters for you.

Yours etc

Tim Worstall