First page of Joe Lombardo’s health care bill

It was sometime in the middle of the last century when Norman Biltz, a Reno tycoon and land baron also known as the “Duke of Nevada” for his considerable statewide political influence, talked about the proper way to conduct economic development in Nevada. “Nevada must be kept small,” he was quoted as saying in The Green Felt Jungle, the seminal 1963 book by Ed Reid and Ovid Demaris about corrupt influences in Las Vegas. “Let industry go elsewhere. Large industrial payrolls bring in large families, which cost more money in taxes for public services.” In other words, stick to gambling and hospitality.

The Silver State is small no more. Since then, Nevada’s population has jumped 11-fold (and that of the Las Vegas area, 18-fold) such that 19 other states are now less populous. But Biltz’s philosophy of minimal government and minimal public spending has persisted to this day. It is a major reason why Nevada sits at or near the very bottom of national rankings when it comes to key quality-of-life metrics touching on health care. Every day the state dearly pays the price.

So to me, New To Las Vegas, it was terribly interesting when Governor Joe Lombardo last week finally unveiled a bill for the Legislature to consider that would try to deal with a plethora of serious health care issues. A conservative Republican like Biltz, Lombardo is no big spender (except maybe, as an ex-Clark County sheriff, on law enforcement). So most of the proposals are of the free-market variety, removing barriers and regulation.

Still, it’s a start.

I’ve written before in this space about the dreadful medical situation here. Since then, I have encountered real estate professionals who tell me of elderly or retired clients selling their Las Vegas homes and moving to other states in search of better health care. That’s on top of folks I’ve been told about who feel they have to travel to Los Angeles or even Salt Lake City for medical specialists.

Here’s how grim the picture is here. National study after national study dings Las Vegas, Clark County and Nevada on a variety of medical metrics. For instance, to cite just one statistic, nationally there is one primary care physician for ever 1,310 residents. But the ratio in Clark County is 38% worse, one for every 1,830 residents (a higher number is worse), roughly the state number, too. This is huge.

Clearly, population is expanding at a rate higher than that of new doctors. What do the physicians know?

Other studies show poor rankings on such issues as mental health care, infant care and percentage of uninsured persons. A 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. Las Vegas hospital executives don’t mention this in their extensive media advertising.

Lombardo’s 100-page legislation, officially Senate Bill 495, is also called the Nevada Healthcare Act. It would create an Office of Mental Health to focus on that issue. It calls for increased funding for medical residency programs, where doctors study after their diplomas but before they hang out a shingle. National studies show many doctors stay in the same area after their residencies. There’s a $25 million-a-year fund to address workforce shortages, especially in rural areas. The bill calls for public-private partnerships, competitive grants and new infrastructure under the jurisdiction of a yet-to-be-formed Nevada Health Authority.

Other provisions would bar health insurers from requiring prior authorization for covered emergency services,and generally speed up the approval process. The bill also would prohibit non-compete clauses when a health care provider leaves a practice. This alone could be a big deal in expanding the medical workforce. I personally had to find one new specialist who left a big practice and then was forced to leave the state for employment after the practice invoked his non-compete to stop him from working around Las Vegas.

Lombardo’s bill would also streamlined licensing and credentialing for doctors, dental hygienists and assistants. But not, it seems, nurses. A different bill proposed by the Nevada Patient Protection Commission that would have allowed nurses holding a license in 41 other states that are part of the Nurse Licensure Compact the automatic right to practice in Nevada died without a hearing–and without an explanation. Despite a huge nursing shortage in the state, it is thought organized labor in Nevada was trying through Democratic legislators, who control both houses, to protect jobs. This is hardly in the public interest.

One sad aspect of the bill is that much of the stuff in Lombardo’s bill is standard operating procedure in other states that don’t think taxes are automatically a Communist plot. Nevada’s lack of a state income tax isn’t helping–except to lure retirees who then find to their alarm unmet medical needs. Lombardo’s bill clearly states it “contains unfunded mandate,” meaning a funding source–like taxpayer money–will have to be found.

Another problem: The legislature, which meets in regular session only every other year, adjourns on June 2, so there isn’t much time to consider this lengthy, complicated legislation bristling with 150-word-long sentences. (There is the possibility that Lombardo could call a special session for that singular purpose.) A governor’s race looms next year, at which Lombardo will stand for re-election. You just know that both parties already are trying to gauge who will be blamed if this goes down. Here’s hoping they find some common ground.

Which brings me back to Norman Biltz, the tycoon who didn’t want to spend government money in Nevada on things that might help families (and, for what it’s worth, whose wife was an aunt of Jackie Kennedy). On the day before Independence Day 1973, he died at age 71. Two days later, the Nevada State Journal reported Biltz, in ill health, had shot himself at his Reno home in an “apparent suicide.” Perhaps he could have benefited from a better health care system.