34 United States The Economist January 29th 2022
the spoils look likely to be captured by just
a few winners.
The Supreme Court annulled the feder
al prohibition on sports gambling in 2018.
States raced to write the practice into law,
eager for new tax revenue. Today, 30 states
and the District of Columbia have such
laws, with three more set to join them. But
California is the best prize: analysts project
over $3bn in annual revenue there. The Na
tive American tribes and the card rooms
are desperate to lure young sports gam
blers, lest they are poached by the gam
bling sites. For all players, this is a big pot.
The only measure that has qualified for
the ballot so far is one backed by Califor
nia’s Native American tribes. Gambling is a
critical source of tax revenue for them, as
well as the basis of their power in state pol
itics. The measure would give them a near
monopoly on inperson sports gambling,
extending their dominance of the industry.
But it is another provision, allowing priv
ate citizens to sue casinos and opening the
prospect of crippling damages and injunc
tions, that card rooms fear most. The card
rooms suspect their longtime tribal rivals
aim to drive them into bankruptcy.
A smaller group of tribes has sponsored
another measure that would allow them to
offer sports gambling online. Although the
tribes may need the technical expertise of
the online operators, they could name
their price to wouldbe partners. Frederick
Boehmke of the University of Iowa reckons
both tribal measures are a gamble that Cal
ifornian voters’ past sympathy for Native
American interests will once again trans
late into support at the polls.
Yet the tribes are not the only ones hop
ing to keep the market for themselves.
Large onlinegambling websites, includ
ing DraftKings and Betmgm, have gone all
in on a third measure. It would allow
sports wagers to be run only by the web
sites and the tribes. This would require
nontribal online operators to pay licens
ing fees of $100m. Conveniently, only the
measure’s sponsors could afford these
sums. Nine months before the election
they have already committed more than
$100m to the effort, just under half the to
tal amount Uber, Lyft and others spent on a
ballot fight in 2020, the most expensive in
California’s history.
The small cities that host card rooms
are betting on a fourth measure. Becca Gi
den of Eilers & Krejcik Gaming, a research
firm, reckons this is the most liberal of the
bunch, opening both online and inperson
sports gambling to card rooms, the tribes,
racetracks and professional sports leagues;
online operators would need to find a
partner among one of these. But the cities’
principal aim is to stymie the tribes. For
Keith Sharp, general counsel of the Gar
dens Casino, the opportunity of sports
gambling is less important than the threat
ofthemeasurethathasalreadyqualified
fortheballot:“Ifit weren’tthere,wewould
juststandonthesidelines.”
Forthetribesandcitiesthatdependon
tax receipts from gambling, the stakes
couldnotbehigher.VictorFarfan,a life
longresidentofHawaiianGardensanda
citycouncilmember,rememberswhatthe
townwaslikebeforethecasinoarrivedin
1997,andhowfarit hascomesince.“When
I wasgrowingup,itwasatoughneigh
bourhoodplagued bygangviolence,” he
says.“Iftheballotgoesagainstus,itcould
putHawaiianGardensbacktenyears.”n
Houseofcards
Autopsiesandcovid-19
The politics
of death
I
n flu seasonspast, JamesGill never
worried about how the death certificates
his office produced might be received by
grieving families. As Connecticut’s chief
medical examiner, he oversees investiga
tions for about twothirds of all deaths in
the state, and his work is not usually the
stuff of controversy. Covid19 changed
that. Relatives sometimes question wheth
er covid was the cause of their loved one’s
demise; some want the virus removed
from the death certificate. Dr Gill, a civil
servant, is insulated from such pressure.
That is not so in many parts of America.
Death investigation in America falls in
to two broad categories. Medicalexaminer
systems are run by unelected technocrats,
physicians who probe deaths and draft cer
tificates. Coroner systems are led by elect
ed officials, who may or may not be medi
cal doctors. Both are supported by forensic
pathologists, specialists in autopsies.
About 60% of Americans live under
medicalexaminer systems, according to
Jeffrey Jentzen, a professor at the Universi
ty of Michigan and author of a history of
death investigation. Coroners dominated
during the early years of the republic, but
were prone to corruption. Undertakers,
lawenforcement officials and insurance
agents all stood to gain by taking on a sec
ond job as a coroner. Issuing death certifi
cates provided many potential avenues for
profit, from determining insurance
payouts to covering up evidence of a crime.
A push to replace coroners with medi
cal examiners gained traction in the early
20th century, before losing momentum.
Coroners attract little attention—about
80% ran unopposed in the latest electoral
cycle. But polarisation has created more
competition. When Bobbi Jo O’Neal ran for
coroner in South Carolina’s Charleston
County in 2020, after two decades as a
nurse conducting death investigations,
she faced a less qualified opponent. Yet as a
Republican in an increasingly liberal area,
she barely scraped through.
Covid19 has put death investigators
under pressure. With no national supervi
sion, and often minimal guidelines from
states, they were left to their own devices.
Carl Schmidt, medical examiner for Wayne
County in Michigan, says his office decid
ed that if they did not see symptoms of
acute respiratory distress, coupled with an
inflammatory response signalling a viral
infection, the death would not be attribut
ed to covid19. Others were less meticu
lous. Dr Schmidt recalls one coroner giving
a presentation arguing that conducting co
vid19 autopsies was unnecessary. The va
ried quality of autopsies is one reason why
measuring excess deaths gives a better
overall gauge of covid’s toll.
But it is the politicisation of the pan
demic that has most exposed the weak
nesses of coroners in America. Coroners
reliant on voters who are sceptical about
covid have not been as scrupulous as their
medicalexaminer peers. One coroner in
Missouri candidly told the press that he
strikes covid19 from the death certificates
at the request of the family of the deceased.
Despite increased demand for their servic
es, coroners have struggled to secure extra
resources. Dr Schmidt observes that “some
autopsies are done in a garage with a single
light bulb, like a Quentin Tarantino movie.”
Excess deaths may be a superior tool for
a broad covid count, but death certificates
from autopsies provide critical informa
tion for understanding the virus. Ameri
ca’s ability to provide reliable ones will re
main patchy and poorly resourced. Coro
ners were “already overwhelmedwith the
opioid epidemic”, recalls DrGill,“and the
cavalry wasn’t coming then.”n
FARMINGTON, CONNECTICUT
America’s elected coroners are too
often a public-health liability