Governor Arnold Schwarzenegger recently proposed leasing the California state lottery to a private company as a way to generate revenue for his health reform proposal. Since Governor Schwarzenegger’s health reform plan draws so heavily from the Massachusetts reform law, I’ve been wondering whether our state should also consider linking health reform to gambling, particularly since gambling is such a hot topic in Massachusetts right now. I’ll leave it to the lawmakers to decide whether to allow casino gambling here, but if they do, there might be ways to use casinos to support health reform. In fact, this linkage would be fitting, since we’d be effectively replacing one form of gambling—going without health coverage—with another.
There are all kinds of ways we could use casinos to support health reform. For example, casinos might be a wonderful new location to provide education and outreach about the new state’s new coverage options and responsibilities. Imagine an entire social marketing campaign conducted through slogans on poker chips and cocktail napkins: Health Insurance: We Bet You’ll Love It! Health Coverage: The Wonder of It All! Health Insurance, Oh Yeah! Feel Like a Winner: Get Insured! Bronze with Drug Coverage: The Biggest Little Policy in the World!
Casinos could set up systems to allow frequent customers to have their health insurance premiums automatically deducted every month by the casino cashier, thereby helping to avoid lapses in coverage and penalties for failure to comply with the individual mandate. They could even get connected to the Virtual Gateway and screen and sign up gamblers who qualify for Medicaid or Commonwealth Care.
Casinos might establish special tables, with better odds or other perks, that could be used only by gamblers who present evidence of adequate health coverage (Your Table is Ready—If You Have MCC). The slots with the biggest jackpots might be available only to people who swipe a valid insurance card (although HIPPA concerns would need to be addressed, along with clearly visible reassurances that: What Happens Here, Stays Here.) There’s even room for casinos to help in the battle to contain health care costs by promoting healthier behavior: tables that prohibit smoking or place limits on alcohol consumption, or the provision of preventive services like flu shots in one arm while people are playing the slots with the other, or vision screenings using the roulette wheel.
And of course, the state could specifically earmark some of the revenue it would get from casinos for subsidized coverage. As we continue to make progress on expanding coverage, financing challenges lie ahead. Since much of the money spent at casinos comes from people with lower incomes, it would only be fair if at least some of it were given back to them. And, considering the individual and public health problems that can result from casinos, gamblers could surely use the health coverage.
Nancy Turnbull
Harvard School of Public Health
You’ve kept a good poker face throughout this piece, Nancy!
Best line I have heard in a casino, “This place wasn’t built with our winnings.”
Ironic that the commonwealth will allow legal gambling in these casinos(but not online gambling because that doesn’t put money into the pockets of state lobbyists) but won’t allow the same citizens to gamble by not carrying health insurance. These 2 issues actually go hand in hand.
The true gamble becomes when one of the newly insured needs care that can’t be performed adequately within the narrow area network that was chosen for him by the plan. Even better, when the plan determines something not to be medically necessary because the procedure won’t bring the client back to 100%.
Why not offer a good old traditional 80/20 indemnity true insurance plan as opposed to managed care plans that dominate the flawed system here.
Nancy –
While you may offer this proposal with tongue firmly planted in cheek, some folks may, in fact, see it as a way to bridge the predicted universal health care funding gap.
After all, these vice taxes work real well, right? Lottery $$ goes to local aid for schools and such, and tobacco taxes are directed at smoking cessation programs, right? Well . . . sort of, or maybe once upon a time.
I’d be concerned if casino gambling got any (further) traction thanks to an expectation of a health care bailout. If the past is prologue, some casino tax income might be earmarked for health care for a year or so, but then would be seen as part of the general fund, available for the usual broad range of competing demands.
Finally, if patrons of casinos, like the lottery, are disproportionately lower-income, as you suggest, then these state-sanctioned forms of gambling would just serve to perpetuate — and expand — a regressive tax. Not something we want to promote, no matter how noble the goals of the programs we’d like to see funded.
You’ve got to be kidding!
I am ashamed for the author of this post and for the first commentor.
Are you so removed, in your Harvard Ivory Towers, from the reality of peoples’ life and death struggles for healthcare that you do not realize the condescension and cruelty of your remarks? Are you deaf to the testimonies that the mandate law is hurting real people across Massachusetts?
What a coincidence that a nurse colleague just shared the below story with me…
Uniquely American; Poker for Patrick
When Patrick got cancer, he had to drop out of school. When Patrick dropped out of school his insurance company dropped him. His health care became dependent on tin cans in gas stations and poker tournaments in basements. [He likely couldn't afford the Connector's YAP plan or quickly hit the ceiling for "lifetime coverage" - what irony]
Unfortunately, Patrick is not alone. People all across America depend on… [fill in the blank, credit card payments for healthcare that result in bankruptcy] and other depraved activity for their health care — because they can’t depend on their elected officials.
Check out this preview of a scene that didn’t make it into the SiCKO movie about this uniquely American phenomenon (scroll down for pictures of Patrick and his Mom and link to YouTube video):
http://www.michaelmoore.com/sicko/index.html
This article is hilarious. Glad to see that social satire is still alive and kicking.
Mary,
no one is laughing at my home and haven’t laughed since the mean mandate took affect.
To Mary Read (and Nancy Turnbull): Social satire has its place and it is not here. Perhaps the two of you, and Paul Levy, can set up a “salon” to engage in that activity since you appear to find it so gratifying.
And to Martha Bebeinger and WBUR leadership: I think you know what needs to be said to you…
Glad you all weren’t around blogging in Jonathan Swift’s time. Maybe you can write some indignant self-righteous comments at: http://art-bin.com/art/omodest.html. They’d be posthumous but, what the hell, it’s never too late to lack a sense of humor. Maybe if you didn’t take yourselves so seriously, more people would listen to your often very thoughtful comments.
Ann, skim this thread again. (I was only kidding)
http://www.wbur.org/weblogs/commonhealth/?p=167#comments
“And to Martha Bebeinger and WBUR leadership: I think you know what needs to be said to you…”
Yes, indeed. I’m not sure what Ann has in mind, but here is what I think needs to be said: “Thank you for setting up this site and giving people a chance to trade opinions for all to see.”
This is a response for Peter S.
Your post is very insulting.This blog is for the “uninsured” are you uninsured or are you trying to get free advertisement for your magazine?Are you uninsured? Are you wealthy enough to buy insurance without causing a hardship to your family?Do you have to produce all your financial records to people you don’t know? Do you know if they will loose your financial records?Are you being penalized financially for not being insured?This sir makes me loose my sense of humor!
With regards to the red captioned postcard the we all received a few weeks ago:
“Urgent Message to Massachusetts Tax Filers- ACT NOW TO AVOID TAX PENALTIES”
Is this a joke, too? If the fees and penalties are not a tax, why does it distintly say “TAX PENALTIES”?
Is it a TAX or is it not? I see no humor here.
In response to Ann E. Malone – Thank you for your thoughtful comment on the condescending “humor” of Ms. Turnballs and Paul Levy. You have more class in your smallest finger than either of them could ever hope for.
I believe Paul Levy is a doctor but I could be wrong. Sounds to me like he doesn’t care about people and, thus, has no regard for the oath he took: “First do no harm” which means more than just physical or medical harm.
Those two clowns ought to review their history book: Let them eat cake was a real loser and so is this mandated health insurance law.
By the way, this so-called Health Care Reform Act of 2006 needs a name change because it has nothing to do with care and most certainly does not meet the definition of reform which is “to make changes for improvement in order to remove abuse and injustices.”
And Commonwealth Care and Commonwealth Choice can both be filed under Commonwealth Extortion. Let’s call a spade by it’s name. Oh, I made a funny: spade/casino.
I am new to your blog and I do like to read it!