Now that Super Bowl LVIII is upon us here in Las Vegas, it’s time to rehash an issue I’ve harped upon. In my view the country’s most popular sporting event and the country’s most popular entertainment town are a perfect fit for this shocking reason: Both offer shameful healthcare to their constituencies, and have for a long time.
Allow me to explain. Since much of this material is drawn from a post early last year, forgive me for sounding like a broken record. But maybe I’m just spoiled. Before becoming New To Las Vegas, I lived around places with terrific health care like Seattle, Los Angeles, Houston and New York.
With a violent, dangerous calling at the heart of its riches, the National Football League has seen its health problems well chronicled by the national media and medical studies. Inadequately protective equipment. Many players who age quicker and die younger. The degenerative disease chronic traumatic encephalopathy (CTE), caused by repetitive head injuries, found in 92% of autopsied player brains. Health insurance that runs out despite chronic injuries that can last or don’t manifest themselves for decades.
Ameliorating efforts by the NFL and the players union seem to have made little progress. Damar Hamlin, the Buffalo Bills safety who had a heart attack on national TV in January 2023 after making a tackle but recovered, is one lucky dude–for the time being, anyway–in that he didn’t die on the spot.
But at least players know what they’re getting into and are somewhat compensated (median salary for a half-year job: $860,000) for the added risk. Maybe not so much the average resident of Las Vegas (median salary for a full-year job: $64,000), which includes a lot of retirees. By almost every important health care metric, they live in a desert.
Most national studies rank Silver State health care among the bottom fifth of the 50 states. Here is a typical summary from the website 247wallstreet.com, which puts Nevada at No. 46 (No. 1 is best):
Nevada ranks among the states with the worst health care system in part due to low government spending on health care and hospitals as well as one of the highest uninsured rates in the U.S. Though the number of mental health providers and dentists per capita in Nevada are slightly lower than the national figure, the concentration of primary care doctors is significantly lower. There are 58.4 doctors per 100,000 state residents, the third lowest rate in the country, and compared to 75.8 doctors per 100,000 people nationwide. Nevada’s premature death rate, child mortality rate, and share of adults in poor or fair health are all above the U.S. averages. The share of adults with unmet mental health needs is the third highest, at 28.6%.
Another national study, from United Health Foundation, puts Nevada at No. 42 among the 50 states, where No. 1 is the best. In not a single major sub-metric of clinical care, an important component of the ranking, does Nevada make even the top 35%. The state comes in dead last in primary care providers per capita. There just aren’t enough docs around here.
Indeed, of the 32 teams in the NFL, only two are located in states with a worse overall health care rank from United Health Foundation. Hello, Louisiana (No. 50). How ya doing, Tennessee (No. 44)?
Last year, Becker’s Physician Leadership, a health care trade publication, put Nevada dead last in the country for its shortage of doctors.
In a study, the U.S. Center for Medicare and Medicaid Services gave Nevada the highest percentage of bottom-rated acute-care hospitals in the country: six out of 25. As it happens, all six are in Las Vegas, comprising nearly half the local acute-care hospitals. On a scale of 1 (bad) to 5 (best), no Las Vegas hospital ranked better than 3. The state’s two highly rated hospitals–one No. 4 and one No. 5–were both in the Reno area. The ratings aim to measure quality of care by looking at data on such factors as death rates, safety, re-admissions and effectiveness.
As you might image, Las Vegas hospital executives vigorously dispute these findings, which, of course, are not mentioned in the extensive media advertising efforts of the hospitals. One of the six, Sunrise Hospital and Medical Center, was co-founded by a mobster who helped develop the infamous casino skim to avoid paying federal taxes. More recently, Sunrise has been fighting charges it overbilled federal Medicare by nearly $20 million.
With nearly 75% of Nevada’s population, the Las Vegas area on average pretty much mirrors the dreadful state performance in health care. To cite but one statistic, primary care physicians per capita as calculated by countyhealthrankings.org, the national average is one such doctor for every 1,310 persons. In Nevada the number is one for every 1,710, or 31% worse than the country. In Clark County, with its large population and the home of the Las Vegas Valley, it’s even a little grimmer, one for every 1,760 (34% worse than the country).
In the United States, for better or worse, health care is the product of a combination of private and public sources. However, Nevada is a minimal government state with no state income tax and an extreme reluctance going back decades to spend much for the public good lest it hurt the business environment for the gambling industry. But you get what you pay for, and health care is no difference than, say, public education, where Nevada also ranks very low.
In office for barely a year, Republican Gov. Joe Lombardo has said he wanted to be the “education governor.” But he hasn’t declared he also wants to be the “health care governor.” He has even expressed skepticism about a public insurance option the Democratically controlled Legislature passed in 2021. Still, Lombardo has indicated support for better mental health treatment funding and higher reimbursements for Medicaid providers.
Clearly, Nevada has been trying on health care, even if not nearly enough. The state created a Patient Protection Commission to advocate for the cause. In 2017 UNLV opened a medical school aimed partly at increasing the number of local doctors. More recently, the school announced plans to try to convince 100 doctors to relocate from out of state to Las Vegas.
But it strikes me that medical professionals elsewhere are aware of these terrible statistics and are reluctant to relocate here. After all, they’re patients, too–as well as parents of school-age kids. I’ve actually had one doctor here complain to me that savings from no Nevada state income tax are more than canceled out by the perceived need to put the offspring in expensive private schools. (I’m not sure whether to laugh or cry about this. I grew up in New Jersey, which, thanks largely higher taxes, has excellent public schools. Indeed, I never spent a moment of my entire student life in anything but a public classroom, and that includes college and beyond.)
Health care measures are regularly introduced in the meet-every-other-year Nevada Legislature. One bill made it through last year might eventually set up a public vote to amend the state constitution to repeal the prohibition on commercial lotteries–a long-standing protectionist sop to the casino industry and maybe to sports betting now encouraged by the NFL–to help fund mental health care care for youths. But that will take years, and in the meantime the growing population outstrips the existing health care infrastructure.
Meanwhile, after the Big Game on Sunday in Las Vegas between two out-of-town teams, players, franchise officials and NFL pooh bahs like Commissioner Roger Goodell will return to the other states where they live with far better health care. Not so the residents of Las Vegas.
Anonymous, I would think.
Ask U.S. Senator Ric Scott about overbilling Medicare; he is the expert.