If Poker Is a Public Health Issue, What Isn't?

In a front-page story published yesterday, The New York Times notes that the Justice Department's recent reversal concerning the reach of the Wire Act may encourage states to legalize online poker and other forms of Internet gambling. While the Times suggests the payoff for state treasuries will be modest, it also notes that legalization will help protect consumers:

Supporters of online gambling say the current estimates may undercount how many people would play poker online. Many of the forecasts are based on how many people have played on illegal Web sites in the past. But placing bets on illegal Web sites requires a leap of faith — that the electronic cards are shuffled fairly, that other players cannot see your hand and that the Web site will pay you if you win. Legal, well-regulated Web sites, supporters say, would attract more players.

In fact, the proposal to legalize online poker in Iowa is more about protecting consumers than about raising money, said State Senator Jeff Danielson, a Democrat from the Cedar Falls area who is drafting a bill. "We are not doing this to expand our state budget," he said. "Our purpose is to make sure every Iowan who wants to play poker has a fair game, has protections, and, if they win, is able to retain those earning in a fair and safe way."

So far, so good. But the Times immediately adds that "Iowa has studied the potential impact of online poker on public health." In what sense is poker a "public health" issue? The 2011 study to which the Times refers, "Internet Poker: A Public Health Perspective," explains:

Numerous studies have shown associations between problem gambling and a variety of adverse consequences or comorbid conditions including substance use and abuse, emotional and mental health problems, physical health problems, relationship difficulties, criminal behavior, financial problems, and loss of productivity… As with many other conditions, the adverse consequences associated with problem gambling behaviors affect not only the gambler but also the gamblers' social groups such as family, friends, coworkers, and community members. In a recent survey, 22% of adult Iowans said they have been negatively affected by the gambling behavior of a family member, friend, or someone else they know.

See? Heavy gambling, itself a "condition," may lead to health problems, and its consequences may affect other people. Hence poker is a public health issue. This sort of slippery reasoning is troubling, notwithstanding the fact that the Iowa report is a pretty evenhanded discussion of how legalization might affect gambling patterns. A concept of "public health" that is broad enough to encompass poker is broad enough to encompass anything. The phrase becomes synonymous with "public welfare" or "the common good," an empty vessel big enough to accommodate all manner of meddling. But while it is generally understood that different people have different concepts of public welfare or the common good, based on value judgments as well as facts, "public health" lends a quasi-medical, pseudoscientific patina to moralistic and paternalistic policies, making them seem like the products of empirical investigation and expert knowledge, not to be questioned by laymen. Add to that illusion of objectivity the assumption that "public health" threats require a government response (an assumption that stems from the field's roots in fighting communicable diseases), and you have a pretty potent recipe for tyranny.

For more on this theme, see my 2007 Reason essay "An Epidemic of Meddling," which cites gambling as an example of public health's wide reach. The idea that poker is analogous to malaria seemed novel in 1999, when the addiction specialists David Korn and Howard Shaffer published "Gambling and the Health of the Public" in the Journal of Gambling Studies. Now it is taken for granted, at least in The New York Times.