Gambling on healthcare

It is crucial that California pass a healthcare plan this year. Our state has a unique opportunity to lead a widening national discussion -- not to mention a chance at long last to provide healthcare for its 6.5 million uninsured.

Gov. Arnold Schwarzenegger’s decision this week to release his healthcare plan in bill form is a hopeful sign. While wonks in Sacramento must work out persisting disagreements over affordability and cost containment, evidence that negotiations on this vital reform are ongoing is welcome. Unfortunately, the proposed plans for financing California’s new health insurance system still fall short. Depending on funds from the lottery is no way to cure California’s healthcare ills.

To pull together additional money to subsidize coverage for middle-income Californians -- a laudable goal -- the governor has proposed using the lottery as a funding source. There is something perverse about encouraging Californians to engage in addictive behavior to pay for better health and counting on their financial irresponsibility to assure economic stability.

Those qualms aside, it simply isn’t clear that the lottery could deliver the promised billions. Because the financing for Schwarzenegger’s healthcare plan is destined for the ballot (to bypass a lack of support among Republicans), his bill doesn’t have to offer much detail. Estimates released earlier this week suggest that an annuity established from leasing the lottery to a professional management company could throw off $2 billion a year. But who knows if such projections would hold up? And would voters -- who would likely be barraged with 30-second spots from deep-pocketed gaming interests in addition to “Harry and Louise”-type ads from lobbies that have already lined up against healthcare reform -- go for it?

The governor’s plan acknowledges that funding to replace lottery revenues will have to be arranged at some later date. If healthcare is such a serious issue, the state should work to line up that funding now, and it should be honest about it. Advocates in all corners agree that we need a better understanding of what healthcare costs, and we must begin making decisions about medical spending with this knowledge in mind. Schwarzenegger loves to talk about “shared responsibility.” It’s hard to see how shifting costs to a lottery promotes that notion.