Paying for the Cost of Alcoholism with Alcohol

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The number being tossed around now in the high-ceilinged, wood-paneled chambers of the Finance Committee is a fee of 5.7 cents per ounce of ethanol, to be paid by the wholesalers who ship alcohol into San Francisco. “From what we’ve heard from small retail outlets about the tobacco fee,” says John Avalos, the supervisor who is proposing the legislation, “the paperwork and billing are very difficult. And so we want to apply the fee to those who are bringing it into the city, rather than those distributing it on the street level.”

Supervisor Sean Elsbernd objects. “This is about taxing — sorry, I mean charging a fee to — a large group of people to benefit a small group,” he says, with no small degree of sarcasm. The language is important: A fee can be passed by the Board of Supervisors; a tax needs to voted on by ballot initiative. Elsbernd is of the opinion that this is a tax. And so this meeting takes on a dinner theater-ish quality.

Avalos: It’s about taxing wholesalers.
Elsbernd: We know who is going to pay.

Meanwhile, Ross Mirkarimi brings up the issue of Healthy San Francisco, the citywide healthcare legislation that has proved wildly popular with residents and wildly unpopular with the businesses that were forced to either buy health insurance for employees, or pay into the Healthy San Francisco fund.

Ross Mirkarimi: And did the sky fall? When Healthy San Francisco passed?
City economist: I have not done a complete economic analysis of that legislation and so I wouldn’t want to speculate.

According to the report drawn up by the City Controller’s Office of Economic Analysis, the alcohol fee will be passed on down the line, from wholesaler to retailer to booze drinker. Those extra 5.7 cents, says the office, are likely to result in a decline of $1.9 million in spending in bars and restaurants, and $4.1 million at liquor and grocery stores.

This is a hard-drinking town. Out-of-towners make pilgrimage here, to neighborhoods like the Mission, in order to get tipsy. When I lived at the intersection of 18th and Guerrero, I used to fall asleep to the sound of the 1 a.m. bar exodus — the loud and drunk, shouting back and forth to each other about where they might have left the car. Today the Mission is home to many types of businesses, but it’s arguable that for years after the neighborhood’s industrial base departed, the bars that once served those factory workers — now transmuted into “dive bars” — kept the gears of the local economy turning.

“It is a risk,” says Jacob Moody, executive director of the Bayview Hunters Point Foundation for Community Improvement, “in a city where alcohol forms a social matrix of interactions both formal and informal, to ask if that comes with a social cost.” A study commissioned by the city [PDF] estimates that drinking cost the public health and fire departments about $18 million last year, including $1 million for the city’s Sobering Center, a buildng in Soma where drunks diverted from emergency rooms all over the city are sent to sober up. Over $4 million was in unreimbursed costs for the fire department, which provides most of the emergency medical transport for alcohol-related incidents to the hospital and Sobering Center. Over $7 million went to substance abuse treatment, and almost $600,000 for medical treatment of prisoners taken to the drunk tank.

In 2008, San Francisco passed Proposition T, which required the Department of Public Health to provide treatment on demand — substance abuse treatment for anyone who asks for it. Prop. T built off a prior resolution, passed by the Board of Supervisors in 1996, that urged the mayor and DPH to do the same. No funding was attached to either measure. San Francisco has, arguably, never had treatment on demand.

And so DPH, which has been hit by the double whammy of recession and an increasing number of uninsured sick people, is ecstatic at the notion that the holy grail of city funding might finally be at hand: the dedicated revenue stream. “Year after year, substance abuse services have been at the top of the chopping block,” says Laura Thomas, director of the Drug Policy Alliance, at the Budget and Finance Committee meeting. “But anyone with the problem of substance abuse should have access to treatment.” She lowers her voice, and adopts a confiding tone. “I promise that if this fee is passed, I will not lower my alcohol consumption. I will continue to drink in our fair city.”

Among the throng at the meeting: doctors, firemen, Teamsters, substance abuse counselors, substance abusers, bar owners, bartenders, winemakers. Arguments are made that the legislation will boost tourist revenues (more rehab meaning fewer drunks on the street, scaring tourists) and that it will lower them (alcohol would be more expensive). There is the fresh-faced teenager who seems to barely understand the legislation she has been prepped to talk about (“I am in favor of this legislation because it will bring, like, change?”), and the irate bar owner who shouts about how she already has to pay $200 to have her sidewalks steam-cleaned, and how this is the fee that will put her business under. Her customers, she adds, are not drunks.

“I use my tips as a bartender to pay for school,” says a petite UC Berkeley student with a freckled nose. “Less drinks means less tips and less money for school.”

“When I started at the ER at SF General in 1986,” Mitchell Katz, the director of DPH, tells the crowd, “they referred to us as ‘yellowbags’ because of the IV bags of mulitvitamins that we were always delivering to the chronically malnourished drunks. I would estimate that one-third of the patients in the ER today are there with problems caused by chronic alcholism: inebriation, withdrawal, the DTs, liver disease, gastrointestinal bleeding. There are human and financial costs to this.”

“By selling alcohol, am I causing the problem?” asks a suit-clad bartender from Bourbon and Branch. “The main profit margin at our bar is alcohol. This reminds me of the noble experiment — the 18th Amendment. And that did not end well.”

“Honestly,” says Preston Maxim, who teaches emergency medicine at SF General, about the alcoholic patients he treats there night after night, “most of them are like people you know already. They just can’t make it down the hallway without falling over.” He estimated that about 30 percent of emergency room admissions are the sort of drinkers who may go to the ER occasionally, or once in their lives, and 5 percent are there almost every evening.

“Nice people,” he said, “but you shouldn’t be here more than me.”

The only thing he’s seen help the last group is mandatory detox. The state of Massachusetts can force chronic alcoholics into the state prison hospital to dry them out. It doesn’t cure them, he said, just slows them down for awhile. But creating more than the 12 to 14 treatment detox beds currently available in San Francisco (Boston does have treatment on demand, with funding) would also help those who cycle through periodically because of personal misfortune, a fondness for drink, or an inability to stop. And perhaps in the end, that may be the hardest thing to grasp — that, whether this measure passes or not, it will be about ourselves, not strangers.