Big issues are all about people: Health Care

Ed Koch and Marshall Allen

Sunday, Nov. 5, 2006 | 8:06 a.m.

Nevada candidates suggest several ways to address the myriad problems of the health care crisis - including the uninsured, a shortage of doctors and nurses, and the high cost of drugs and treatment.

Health care is too big a morass to be "taken all at once," said Democratic candidate for governor Dina Titus. "You have to do pieces of it."

"I would do this for sure: an audit of Medicaid to make sure we are not paying for empty beds or for people with other resources like private insurance."

Dr. Ikram Khan, a Las Vegas medical consultant, is concerned that about one of every five adults in Nevada is without health insurance.

"That is a huge issue that directly impacts the cost of health care for everybody," Khan said, noting that many of the uninsured are working people who make too much to qualify for state Medicaid coverage but not enough to afford private insurance premiums.

And while Southern Nevada's medical industry has over the years grown significantly to make it possible to get almost any procedure performed by skilled doctors, it is difficult for patients to find enough of those qualified health care professionals.

A recent report by the American Academy of Family Physicians showed Nevada has a dire need - the most severe in the country - to increase its number of primary-care doctors.

Tony Clark, executive director of the Nevada Board of Medical Examiners, said the number of physicians has not kept up with the state's huge population increases.

"We're licensing up to 500 or more new doctors each year, but we're not keeping up," Clark said.

Not enough local med grads

The local medical schools do not produce enough graduates to keep pace with the population, so the state needs to increase its number of residency programs, Clark said.

Studies have shown that about 80 percent of doctors practice near the place where they completed their residency, he said.

Jack Carter, Democratic contender for Republican John Ensign's U.S. Senate seat, said: "Doctors got squeezed a couple years ago when malpractice companies pulled out and premiums went through the roof. We need to figure out how to get competition in medical malpractice insurance."

The doctor shortage is exacerbated by consistently decreasing reimbursement rates paid by insurance companies, Medicare and Medicaid, the government's insurance programs.

Anthem Blue Cross and Blue Shield recently dropped its reimbursement rates by up to 18 percent for most procedures. Brooke Wong, executive director of the Nevada Academy of Family Physicians, said lowered reimbursements are putting doctors out of business.

"Reimbursement rates are so low they (family doctors) can't afford to see their patients," she said.

Federal legislation has offered some "Band-aids to help the doctors on reimbursements," said Rep. Jon Porter, R-Nev., who is seeking re-election to his District 3 Congressional seat. "We're helping each (legislative) session a little bit, but we haven't finished the battle."

Incentives for health care providers

Porter wrote legislation earlier this year that would require insurance carriers to maintain electronic health records for all participants. That would allow essential information such as drug allergies and medical histories to be quickly accessed. The bill provides incentives for health care providers that create compatible electronic systems.

"We need to make sure that technologies are in place to reduce costs, accidents and mistakes," Porter said.

Nevada faces a chronic shortage in registered nurses in all regions and in a variety of settings, according to the Nevada Hospital Association. There are about 15,000 nurses in the state, and the number of nurses is growing, but again, not at the rate of the population.

The nursing shortage can result in diverting patients to other facilities or shutting down sections of hospitals, Khan said, calling the shortage a crisis. He said the state needs to address the problem by training more nurses locally and improving compensation.

Republican gubernatorial candidate Jim Gibbons championed a pilot program in Northern Nevada that allowed nurses to get certified in 18 months instead of two years. He would like to make that a statewide program.

"We do have to address the nursing shortage in Nevada - it will take funding," Gibbons said. "I'm willing to work with the Legislature on that."

Increase nursing programs in system

Titus said plans are afoot to greatly increase the size of nursing programs within the university system. She said, however, a lot of people go into nursing but drop out when they are overloaded with patients and feel they can no longer make a difference.

Carter said universal health insurance might be a solution to reducing overhead. He also is focusing on preventive medicine as a solution.

"Nobody makes money from preventive medicine," Carter, son of former president Jimmy Carter, said. "We need to create incentives for preventive medicine. If there was an insurance company out there that got paid more if you (patients) didn't smoke, I guarantee they would have good programs to get you to quit smoking."

Ensign said there are several areas of improvement that can lead to lower health care costs. One, he said, is with medical liability reform, and another is small business health plans, in which companies can join forces to create more buying power to get good insurance rates for workers.

Also, Ensign said, a push toward standardized electronic health records and electronic prescriptions could lead to what some experts have estimated as a 35 to 40 percent savings in health care costs.

Reimportation of Canada drugs

Gibbons says he supports reimportation of drugs from Canada : "We want to make sure we have affordable prescription drugs, but we've also got to ensure the safety of that medicine."

Some candidates are focusing on providing health care for youths.

"The place to start with health care is with children," said Tessa Hafen, Democratic contender for Porter's congressional seat. "I would start by making sure all children under the age of 18 have access to a doctor."

She points to asthma as an example of how prevention is the right path. If someone gets an inhaler for $12 a month, they can avoid expensive trips to the emergency room, she said.

Titus supports the so-called HIPPA waivers to provide more flexibility to use federal matching dollars to help provide insurance for more people. Nevada has used such waivers to cover pregnant women and children, she said.

Titus and Hafen also say they support tax credits for small businesses that offer health insurance to their employees. Hafen supports allowing small businesses to pool together to purchase health care for their employees.