You Bet Your Life

America is crazy about gambling. Once you had to gamble illegally with a bookie, or go to Atlantic City or Las Vegas; now 45 states – plus the District of Columbia, Puerto Rico, and the U.S. Virgin Islands – have state lotteries. Since the Supreme Court struck down PASPA, the federal ban on sports betting, 38 states – plus the D.C. and Puerto Rico – offer legal sports betting. I didn’t think we could get any crazier, until I saw last week that arcade chain Dave & Busters was going to allow betting on some of its games.

Honestly, healthcare may be the only industry upon which you can’t bet, and I’m beginning to think that’s too bad.

It may come to this. Credit: Bin Image Creator

Dave & Busters are working with Lucra Sports, a “white-label gamification” technology company. “We’re thrilled to work with Lucra to bring this exciting new gaming platform to our customers,” said Simon Murray, SVP of Entertainment and Attractions at Dave and Buster’s. “This new partnership gives our loyalty members real-time, unrivaled gaming experiences, and reinforces our commitment to continuing to elevate our customer experience through innovative, cutting-edge technology.”

“Friendly competition really is a big fuel for our economy, whether you’re playing golf on Sunday with your buddies, or you’re going to play pickleball or video games or even cornhole at a tailgate. There’s so many ways that you can compete with friends and family, and I think gamifying that and digitizing all this offline stuff that’s happening is a massive opportunity,” Lucra CEO Dylan Robbins told CNN.

Credit: Brodie Brazil

The companies are careful not to describe what they’re doing as gambling; they avoid terms like “bet” or “wager.” Michael Madding, Lucra’s chief operating officer, told The New York Times that the focus was on “skills-based” games, such as Skee-Ball or shooting baskets: i.e., “recreational activities for which the outcome is largely or entirely dependent on the knowledge, ability, strength, speed, endurance, intelligence of the participants and is subject to the control of those participants.”

This falls into a category I had never heard of: “social betting.” With social betting, there is no third party setting the odds, and more head-to-head competition with people you know. You’re not betting against the house; you’re challenging your friends. It is estimated by gaming research firm Eilers & Krejcik to be a $6b market, and its proponents argue that it is not subject to licenses & regulations that other gambling does.

Not everyone agrees. Marc Edelman, a law professor and the director of sports ethics at Baruch College in New York, told NYT:

If two people are competing against one another in Skee-Ball, presuming that there is nothing unusual done in the Skee-Ball game and physical skill is actually going to determine the winner, there is no problem. If I am taking a bet on whether someone else will win a Skee-Ball game, or whether someone else will achieve a particular score in Skee-Ball, if I myself am not engaged in a physical competition, that very likely would be seen as gambling.

Brett Abarbanel, executive director of the University of Nevada, Las Vegas, International Gaming Institute, went further, telling CNBC: “regardless of the legal classification of the activity as ‘not gambling’ vs. ‘gambling,’ this is an activity in which participants are risking something of value on an outcome that is uncertain. Therefore, there should be consumer protection measures in place for players, particularly when the target audience is skewed toward younger participants.”

Both Illinois and Ohio gambling authorities have already expressed concerns; Illinois State Rep. Daniel Didech, chairman of the Illinois House Gaming Committee,, told CNBC: “It is inappropriate for family-friendly arcades to facilitate unregulated gambling on their premises. These businesses simply do not have the ability to oversee gambling activity in a safe and responsible manner.”

There are also numerous “social sportsbooks,” including Flitt, PrizePicks, and Underdog Fantasy, that are blurring the line between online sports gambling and social betting, between fantasy leagues and plain old gambling. And they do it with users as young as 13 and with little or no state oversight. Keith Whyte, executive director of the National Council on Problem Gambling, told The Washington Post: “What a lot of these social gaming — social casinos, social sportsbooks — have found is that the regulators ... either don’t feel like they have the jurisdiction or the time or energy to go after every single app that springs up.” 

Whether we like it or not, people are going to bet. “People will place a bet on ‘Will we have rainfall?’, or ‘How much snow will a certain place get?’, or ‘What will be the first day of snowfall?’” sports policy expert John Holden, JD/PhD, associate professor at Oklahoma State University, told Fox 5 NY last year.

So why shouldn’t they bet on health care?

Let’s face it: we all already bet on health care. We bet that the doctor we pick is well trained, competent, and of the highest ethical standards. We bet that the hospital we go to won’t kill us or make us worse. We bet that the prescriptions we take do far more good for us than they harm us. We bet on all these things, spending trillions of dollars, even though we know the odds are against us: in aggregate, Americans are getting sicker and dying younger.  That’s those other people, we tell ourselves; my doctor/hospital is the “best.”

What makes healthcare different from other areas that one might bet on is the paucity of data. I always remember a colleague told me years ago: “I can know more about the performance of every MLB player than I can about any physician.” And that was before legal sports betting.

If we were to bet on health care – either our own (social betting) or others’ (online gambling) – there’d be more data. We’d insist on it. We’d analyze it. We’d use it. It’d get better and more detailed over time. And, I daresay, healthcare would become better for it.

Personally, I don’t like to gamble. I don’t buy lottery tickets. I don’t go to casinos. I don’t even bet on the Super Bowl or March Madness. So I’m tired of gambling so much on healthcare without knowing more about the risks/rewards, without the data I need and should have. If betting is the only way to ensure the data, then I say: let's roll the dice.

Maybe Lucra could develop a gamification platform for us to bet with our doctors and hospitals.