MARYLANDERS VOTED last week to expand gambling in the state — specifically with the expectation that a new casino and resort would rise on the banks of the Potomac River in Prince George’s County. In fact, the casino may be the less consequential of two major new facilities in Prince George’s triggered by the gambling referendum. The other is a new hospital.

During the months-long fight over the gambling referendum, no one talked much about the connection between the casino and the hospital. But earlier this year, the president of the Maryland Senate, Thomas V. Mike Miller Jr. (D-Calvert), made it no secret. Without the tens of millions of dollars in new tax revenue generated annually by expanded gambling, Mr. Miller said, state funding for the new hospital was a non-starter.

The implicit threat in Mr. Miller’s remark, and the implicit promise, was lost on no one. By Mr. Miller’s lights, the state’s share of the new hospital’s construction — one-third of a price tag that may exceed $600 million — should now be assured.

The other two-thirds is to come from the county itself, which would simply apply the annual subsidy it already provides to the struggling Prince George’s Hospital Center in Cheverly, which the new hospital would replace, and from the University of Maryland Medical System. The system runs a statewide network of academic hospitals and would operate the new hospital as well.

The quality of health care in Prince George’s, Maryland’s second-largest jurisdiction, is a scandal. Doctors are in short supply, and rates of obesity, heart disease, diabetes, asthma, HIV and heart disease are higher than in neighboring counties. Prince George’s Hospital Center loses money, due to its less-than-stellar reputation and its limited menu of specialized services. Each year, 25,000 Prince George’s patients are admitted to hospitals in the District; others go to Baltimore.

The exodus of paying patients leaves the existing hospital with an overabundance of patients who are uninsured or on Medicaid. If a new hospital — one with better management and facilities and a more complete array of specialized services — could recapture just a portion of those “lost” patients, it would mean jobs and tax revenue for Prince George’s, as well as a financially viable facility that would not need state and local subsidies to survive.

Above all, the absence of a first-rate hospital in Prince George’s is a failure of political leadership. County and state officials were on the verge of a breakthrough to secure a new facility in 2007, only to see the deal collapse amid distrust among the county’s elected leaders.

Now, under the abler leadership of County Executive Rushern L. Baker III (D) and the current county council, the outlook is better. County officials hope to break ground on a new hospital in 2014. Gov. Martin O’Malley (D) has pledged his (and the state’s) support for the project; Mr. Miller should also be on board.