Gibbons faces a special set of problems

By J. Patrick Coolican

Sunday, Jan. 21, 2007 | 7:20 a.m.

Standing on the corner of Tropicana Avenue and Maryland Parkway, you can look west and see the glass and the steel and the cranes - a limitless future of prosperity and glamour.

Walk a few feet, and on many days, you will meet kids going to the Nevada Partnership for Homeless Youth, where they seek shelter from a life of abandonment.

One place, two views. This is the current state of Nevada. Awash in the money of outsiders, and plagued by deepening social problems of our own. Giddy with growth, and alarmed about a health care system in crisis. Proud of a robust middle class, flummoxed by educational deficits that could leave us stuck in the past.

Nevada casino winnings were more than $1 billion in October alone, and yet Washoe County, in the throes of a rampant crank crisis, has just 38 beds for in-patient methamphetamine treatment.

As Gov. Jim Gibbons prepares to make his first State of the State address Monday before the new Legislature, he's confronted with some of the biggest problems the state has ever faced, as well as a tremendous well of resources he can tap to solve them.

"We need a leader," said Assemblywoman Sheila Leslie, D-Reno, who promises to be a leading player in the coming legislative session and has long been a champion of a more activist government in Nevada. "I'm eager to see what Jim Gibbons' vision for the state is. We need some big ideas to address these big problems. And it is up to the governor to step up."

"He's very capable, and he's very ambitious about enacting ideas that will make government more effective," said Robert Uithoven, who ran Gibbons' congressional office and his campaign.

The state's rapid growth and libertarianism have always invited persistent social problems, including crime, addiction, absent parents and substandard school and health systems.

As the state continues its rapid growth, however, and especially as Las Vegas becomes a major metropolitan area on the order of Phoenix, these problems threaten to overtake the state and bleed into the workforce that is so vital to continued economic abundance.

"There's a sense of crisis among people willing to see it," said Michael Green, a Nevada historian at the Community College of Southern Nevada.

A mediocre education system will prevent true economic diversification. Rising crime will scare away families and young urbanites. A troubled health care system will repel seniors, as well as health care professionals who will seek out more supportive work environments.

The facts are at times alarming, often placing Nevada in the company of some of the poorest states in the union, such as Louisiana and Mississippi, even as Nevada boasts economic growth, low unemployment and brimming tax coffers.

To wit:

For every 100 ninth graders in a Nevada high school, 50 will graduate by the time they are 18, 27 will go to college and just 12 will earn a bachelor's degree by the time they are 24. Those statistics lag well behind national averages, according to Postsecondary Education Opportunity, a national policy think tank.

These problems start early. Just 21 percent of fourth graders read at or above proficiency on the 2005 National Assessment of Student Progress test. The national average was 43 percent, according to a new report of The Education Trust, an education think tank.

The state's health care system is faring no better.

"Every day, every part of our medical system, it's virtually critical," said Lawrence Matheis, executive director of the Nevada State Medical Association.

To begin with, there aren't enough doctors or nurses. The state is currently 49th in the nation in the number of doctors per capita. "We've been 50th in the past," he deadpanned.

"It's no honor."

Although the university system's Health Sciences Center is designed to address the shortage by teaching and training more doctors to curtail the need to recruit them from out of state, it's years away from having its intended effect.

And the doctor and nurse shortage is just one of the many problems with health care in the state. Nevada ranks 41st in percentage of women who receive adequate prenatal care, a situation likely worsened by the high numbers of teen pregnancy - Nevada is consistently in the top five nationally.

At any given time, between one-fifth and one-quarter of the population is without health insurance, including 17 percent of the children, well above the national average of 11.7 percent; Nevada sits near the top of states with large numbers of uninsured.

Unfortunately, the uninsured still get sick, and they go to emergency rooms, taking up badly needed beds and driving up costs.

A 2006 UNLV report on Nevada's economic and social health offers more discouraging signs of near-crisis. The state leads the nation in methamphetamine use, which first lady Dawn Gibbons has promised to fight.

Nevada ranks 36th in per capita mental health spending, despite a suicide rate that is twice the national average, and fourth in the nation.

Nevada has the ninth highest violent crime rate in the country, and fifth highest murder rate.

More than 6 percent of the population are problem or "probable pathological" gamblers.

Besides these social ills, two other factors are a threat to the state's future: transportation and water. A task force of business leaders and politicians estimated last year that Nevada needs an additional $3.8 billion between 2008 and 2015 for roadway construction, even as traffic already disrupts the free flow of people and commerce.

A proposed pipeline to deliver water from White Pine County to Las Vegas has the entire state on guard for a fierce water conflict, with environmentalists concerned it could damage a fragile ecosystem, while pipeline advocates warn that without more water, Las Vegas - the state's economic engine - will have its growth capped.

As the Sun reported late last year, Lake Mead, where Southern Nevada gets much of its water, has seen a sharply falling water level in recent years, adding to long-term concerns about water shortages for a desert community with a seemingly unquenchable thirst.

Given this list of challenges, Gibbons might be forgiven if he finds the job less enjoyable than he had hoped.

For inspiration, though, he can look to fellow governors, both Republican and Democrat, who have kicked off 2007 with big, bold solutions, often borrowing the policy playbook from the other party.

Health care, in particular, has been an area of ambitious reform already this year, according to Laura Tobler, a policy analyst for the National Conference of State Legislatures. "2007 is the year for health care reform if you judge by governors' State of the State addresses."

On the heels of former Massachusetts Gov. Mitt Romney's move toward universal health insurance, other governors have followed with their own ideas.

Gov. Arnold Schwarzenegger, R-Calif., made his proposal earlier this month. Gov. Jodi Rell, R-Conn., is working with managed-care plans to offer low-cost plans to uninsured residents for $250 or less, through a single purchasing pool.

Indiana, Illinois, Iowa, New York, Missouri and other states - red and blue - are reforming their Medicaid systems, making health care more accessible and focusing on preventive health to hold down costs.

Strong state finances and a lack of action on the federal level have created "an environment for real activism," in states around the country, said John Thomasian, director of the Center for Best Practices, the think tank of the National Governors Association.

It's unknown what Gibbons will propose, although the agenda he laid out during the campaign was modest. His only overarching promise was that he wouldn't raise taxes. The state's $350 million budget surplus does give him room for some ambitious steps, at least in the short term.

Greg Ferraro, an outside adviser who is helping craft Gibbons' speech, declined to give details about Monday's address, although he said there would be themes consistent with the campaign.