The proposal that there should be a minimum 40p/ unit price for alcohol, announced last week, has been broadly welcomed.  Not universally, but broadly.  There has been some dissent – but, by and large, it doesn’t seem to have been particularly vocal.

From a ethicist’s perspective, the objection that we might expect to hear articulated most has to do with paternalism: if the move is designed to coerce people into a certain kind of behaviour, and the motivation for this is a concern with people’s own good, then that might be presented as undue interference.  However, the response to this is simply to deny that paternalism of this sort is always a bad thing.  “Respect for autonomy” has become something of a dogma among many people working in bioethicists, but it’s not beyond question – and it’s certainly not enough simply to stamp your foot and say, “Yes, but AUTONOMY” to defeat a proposal.  At the very least, the idea that governments should not intervene to prevent self-harming behaviour needs argumentative backing.  (I know that this is a particular bugbear of Angus Dawson and a number of other people working in public health ethics.  I don’t agree with the suggestion in some quarters that the “rules” of PHE are different from the “rules” of the rest of bioethics, such that autonomy is not as important in PHE as it is in those other areas – I think that ethics is ethics is ethics; but this simply means that unquestioning deference to autonomy and liberty is philosophically bogus right across the board.)

But, actually, the minimum-pricing policy doesn’t have to be defended on public health grounds.  It could also be defended on the grounds that not having a minimum price is simply ignoring the true cost of alcohol.  That cost would be counted in terms of strain on the NHS, lost work days, public order, and so on.  Alcohol consumption – at least in large quantities – generates all kinds of externality that the price at the till simply doesn’t reflect.  It’s therefore legitimate – the argument would go – for the government to intervene and set a minimum unit price as a way to correct this failure in the market.  Arguing in this way would mean that we don’t have to engage in endless debates about liberty and paternalism – we’d simply be able to say that people can do what they want, as long as they pay the “true” cost.  It’s hard to insist that that’s an infringement of anyone’s rights.

The problem is that minimal pricing is regressive: it means the price of the cheapest booze will rise, while the price of the stuff that’s already more expensive will not; and this means that the impact will be felt by those most likely to buy the cheaper alcohol – the poorest – and not by those more likely to buy more expensive alcohol – the better off.  (Eric Joyce, for example, has claimed that the price rise is directed at the poorest.  That isn’t true – but it is the poorest who’ll bear the brunt of the rise.)

Should we worry about this?  Probably not too much.  Many things are priced, if not regressively, then at least non-progressively, but without that being a problem.  For example, near my office in Manchester there’s a garage that sells Jaguars, Maseratis, Ferraris and suchlike.  These things are, obviously, unaffordable to most people.  (I’m assuming that there’s passing trade from the higher levels of the non-academic staff, consultants from the medical school, and so on, tee hee.)  But that’s not a problem, because though there’s a right not to be prevented from buying a car like this, there’s no actual right to buy.

Alcohol, as far as I can see, might be like this.  It’s not a basic good – notwithstanding what a rather perplexing recent ruling in Lithuania might imply (and – gee whizz – I suspect that that might have had more to do with union-busting than any genuine belief that brewing is an essential service, though I’d love to read the ruling – preferably in English, my Lithuanian being a little rusty…).  There’s therefore little in the way of a positive moral right to access it.  At the same time, the social cost of alcohol is demographically blind: a wrecked liver is a wrecked liver, and I’m not convinced that the propensity to smash bus-stops is particularly strongly associated with any one class.  On this basis, everyone paying the same price is not self-evidently unjust.

There is a small caveat, which is that, though the social cost is class-insenstitive, it doesn’t follow that it’s constant.  To see why, imagine the difference between two drinkers, Smith and Jones.  Smith buys a crate of cheap strong cider in order to get drunk.  Jones buys a crate of the same cider because he’s invited some friends around for a barbecue, would like to be able to offer them a drink, but can’t afford to buy the more expensive stuff.  In Smith’s case, it’s likely that the social cost will be higher: he’s more likely to become ill, to injure himself, to get into a fight, and all the rest of it.  Jones and his friends, by contrast, will consume a couple of units each, and so their risks will not be significantly elevated all else being equal – and so the social cost will not be elevated either.  So there does seem to be at least a slight disparity of treatment.

Is this enough to matter?  I doubt it.  Cheers!