Las Vegas Races to Expand Social Services Amid Growth Boom
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JIM LEHRER: Finally tonight, day four of our Big Picture visit to Nevada, one of the early political caucus states and site of tonight’s Democratic presidential candidates debate.
Judy Woodruff and Ray Suarez are talking to people in and around Las Vegas all week about the issues that matter to them in this election year.
JUDY WOODRUFF: It’s impossible to listen to Nevada voters, as we have all this week, without hearing the role that this state’s rapid growth plays in their political views. Nowhere is that connection clearer than in two areas, health care and education, both under extraordinary strain.
Ray Suarez has our report.
RAY SUAREZ: If you think Las Vegas’ reputation for excess lives only on the world famous strip, you need to go to school, to a brand new school, Rancho High, built to relieve overcrowding and a thousand kids over capacity on opening day. Twenty-two portable classrooms were quickly set up in the school’s parking lot.
The city’s explosive population growth means Clark County School District, which includes Las Vegas, is in a constant state of catch-up. In fact, the district builds a new school, on average, once a month.
In most places in the country, schools only occasionally rezone — that is, redraw their district boundaries — but here in Las Vegas, the school system is growing so fast that schools have to rezone every year, so a sixth-grader may have attended three different elementary schools since kindergarten.
Combine that growth with the fact that Nevada’s per pupil spending is in 50th place in the country, and you’ve got serious challenges.
For one, the district started this school year down 1,000 teachers. At Rancho High School, that means there’s only one teacher for every 50 students at the school.
More than four decades ago, Bob Chesto graduated from Rancho High. Today, he’s principal of the new Rancho, built right next to the old site.
BOB CHESTO, Principal, Rancho High School: There’s a critical shortage of highly qualified teachers. That means you’re an expert at what you do. There aren’t very many of those. We have a critical shortage, not only in Las Vegas, but in America.
And I don’t think it’s an emergency; I think it’s a catastrophe. I have 20 openings right now. It’s the end of October. So what have we done with those students for 60, 90 days so far? They’ve had long-term substitute teachers in there.
RAY SUAREZ: Clark County schools have recently shifted to majority Hispanic. And at Rancho High, 2,600 of the 3,600 students are Hispanic, the overwhelming majority of them foreign-born.
BOB CHESTO: Two thousand of the 2,600 have very limited English skills or no English skills at all. They’ve come in with an ability level, hundreds by the hundreds, pre-kindergarten, kindergarten ability. And we have four years to get them ready to pass the Nevada Proficiency Exams.
RAY SUAREZ: The population shift has put pressure on the district to find teachers who are qualified to teach English as a second language to what’s called ELLs, or English Language Learners. At the same time, the federal government has reduced the funding for ELL, and the student population is transient, with 1,000 new students predicted to enter Rancho High School in the middle of the school year and 1,000 other students expected to leave.
BOB CHESTO: I spent 20 years in the Army, and so I use militaristic analogies. I always feel like a high school is on the front lines, and we’re in combat, and we’re receiving fire and returning fire. And we’re running out of bullets, and we’re running out of guns, and we’re running out of food, and we’re running out of water. And supply lines had better advance.
No one wants to see their children not do well, myself included. I want them all. I expect them all to go to college, or to community college, or to advanced trade schools. I expect that to happen.
RAY SUAREZ: As is the case nationally, dropout rates are high among minority students. The district has been able to bring graduation rates up slightly; still, only 60 percent graduate. Walt Rulffes is the superintendent of Clark County schools.
WALT RULFFES, Superintendent, Clark County School District: We have a theme here, “Keep your eye on the cap,” and we try to keep everybody focused on helping students graduate, because across the country we have this, I think, a horrific issue of almost a third of our students who don’t graduate from high school. And without a high school diploma, a student hardly has a fighting chance for success. And so we’re focusing more and more on ways to keep students in school.
Using gaming to fund education
RAY SUAREZ: To ease the burden on school funding, Nevada's teachers union is asking voters to increase the amount the gambling industry contributes to school funding. The casino industry wants the government to look elsewhere for more taxes. Gambling already accounts for one-third of the money used to pay for education here.
Along with the schools, Nevada's overloaded health care services have been given a very tough assignment: 17 percent of Las Vegas residents don't have health insurance. Nevada ranks sixth-highest in the nation for the number of uninsured.
At the health center in north Las Vegas, nearly 70 percent of patients are uninsured. The majority of patients are immigrants.
Pediatrician Dr. Tamina Winn-McMillan says families without health care often wait before coming in for services, so they're sicker by the time she sees them.
DR. TAMINA WINN-MCMILLAN, Pediatrician: I think, for patients who are not insured, they have to be really sick for them to be brought in to be seen.
RAY SUAREZ: At Clark County's public hospital, University Medical Center, the costs for covering the uninsured became so acute, last year $60 million of county funds had to be pulled from the parks to cover hospital losses. Dr. Dale Carrison is director of the emergency room at University Medical Center.
DR. DALE CARRISON, Emergency Room Dir., University Medical Center: A lot of these people know they're sick, and they go, "Doc, I ran out of my medicines." And I go, "Well, why didn't you come in? We would fill your medicine. We'll take care of your medicine." "Well, I didn't have any money, and I didn't want to do this."
Especially in the group of the older people, because they don't want to -- they were just not raised -- they were raised in a different generation, so they don't want to come in and put a burden on you. They think, if they don't have the money to get their meds, then they'll just go without them. And, of course, when they go without their medications, they become more ill, and then come to our emergency department anyway.
RAY SUAREZ: Last month, the University Medical Center proposed offering a sliding scale for patients with limited income. The hope is that patients will try to pay if their bills are more manageable.
DR. DALE CARRISON: We're looking at a graded scale, so we can look at you as a person and say, "OK, he makes about $20,000 a year, $25,000 a year. OK, you don't have insurance. You need medical care."
OK, you should have to pay something for your medical care. But we, as the biller and the person that's doing this in the county system, need to look at you as an individual and say, "This guy makes this much money. Based on the percentage, he can afford to pay this much."
You make $40,000 a year, combined income in your family, you should pay a little more, you know. Â You make $100,000 and chose not to have insurance, then you need to pay the bill.
RAY SUAREZ: Getting some money from the uninsured will help, but if University wasn't a teaching hospital, able to shift some costs to the state, taking care of all these uncovered patients would be impossible.
On the other side of the health care spectrum, the 60,000 culinary union members, who make up a huge chunk of Nevada's workforce and get very good coverage. Brian Rubin, a waiter at Rao's in Caesars Palace, owns a small business, but continues to work at the restaurant, in part for the medical benefits.
BRIAN RUBIN, Waiter, Rao's Restaurant: Absolutely great, great benefits. It's a fantastic place to work. They give, you know, medical, dental, vision, all that good stuff.
RAY SUAREZ: Medical benefits, the uninsured, and government spending for education are just some of the complex issues facing Nevada voters as they consider presidential candidates in the new year.
Experts on Vegas public resources
JUDY WOODRUFF: To learn more about how Nevada voters see these issues and what they expect the next president to do about them, we came here to the campus of the University of Nevada, Las Vegas, Health Sciences Building, and brought together four people with deep interest in both health care and education.
Joining us here tonight in the nursing school's lab are, from left to right, Dr. Mary Guinan. She is dean of the School of Public Health at the University of Nevada, Las Vegas.
Rene Cantu, he is the vice president of multicultural affairs at Nevada State College. He is also chair of the Latin Chamber of Commerce's Education Committee.
Sandra Tiffany is a businesswoman and a former state senator. She served from 1992 to 2006.
And, as you just saw, Dr. Dale Carrison, professor and chair of emergency medicine at the University of Nevada School of Medicine and University Medical Center.
Thank you all for being here with us this evening.
I want to begin with health care. We just saw in that report the enormous challenges that are facing Las Vegas, southern Nevada. The issues you're facing here mirror the rest of the country. And so my question to you is: what needs to be done about it?
DR. MARY GUINAN, University of Nevada, Las Vegas: Well, I wish I knew what the solution was, but I think that we need to understand that health care and health is primarily a function of the state, not the federal government, and that states need to work for a state-based health care system that I think is universal, like has been done in Massachusetts, Hawaii, and other states.
The United States is huge, 300 million people. To have one universal health care system might be feasible in smaller places. I'm not sure it is here.
JUDY WOODRUFF: So you believe Nevada can handle this on its own without involvement by the federal government?
MARY GUINAN: Oh, no, I didn't say that. We need help, but we need to take some responsibility for ourselves to try and understand what solutions will work in Nevada. I don't believe all solutions are going to work the same in each state or even cities. So we have to try and understand what works here, and how will the powers that be and all of the operators work together to make it work?
JUDY WOODRUFF: Dr. Carrison, what do you see? You work in medicine everyday.
DR. DALE CARRISON, Emergency Room Dir., University Medical Center: Well, the federal government has a couple of problems. One is the inflexibility, and it's a political system that's trying to make medical solutions, which is difficult, because sometimes politicians look at things not as medical issues, but as political issues. And that doesn't solve the health care problem.
We have a huge problem with the insurances. We know that, right now, they're going to cut back 10 percent from Medicare, but yet we want universal health for children, so, you know, how do we balance this so it comes out and we do the best job of taking care of patients?
JUDY WOODRUFF: Sandra Tiffany is a former state senator, a consumer of health care. What do you think needs to be done? And do you think that the presidential candidates this year are talking about this issue in a way that it should be discussed?
SANDRA TIFFANY, Former Nevada State Senator: All political people are talking -- especially election year -- are talking about health care, whether it's the state legislature or whether it's the federal government. We all do; it's a big issue.
But I think for me, from my point of view, accessibility, affordability, and portability, and those are the things that the legislature looks at.
Is the federal government involved? Sure, because of Medicare and Medicaid and CHAMPUS, they provide a great deal of health care coverage.
JUDY WOODRUFF: CHAMPUS being...
SANDRA TIFFANY: That's the military.
JUDY WOODRUFF: The military coverage.
SANDRA TIFFANY: And in Nevada, I think we're doing -- I think in Las Vegas, for the growth that we're experiencing, I think we're not doing a bad job.
JUDY WOODRUFF: So everybody else agreeing Nevada's doing pretty well?
DR. DALE CARRISON: I disagree, I'm sorry.
MARY GUINAN: I disagree. We have one of the highest uninsured in the nation. Even our Medicaid coverage, for example, Medicaid only covers part of our poor population. And each state develops eligibility criteria from Medicaid, and ours is one of the least generous in the country. We're in the lower 25 percent of that.
Expectations of a 2008 candidate
JUDY WOODRUFF: To bring this back to the presidential candidates, because you have this caucus coming up in Nevada in January, what do you look to these individuals who want to be president to be doing and saying about this?
SANDRA TIFFANY: I think the defining -- between the Republicans and the Democrats is whether you want a single-payer and you want a government-based health care system or whether you want the free market to continue and to improve, but to have the free market. I see it very clear cut, Democrat versus Republican.
DR. DALE CARRISON: I don't see it as clear cut as Tiffany does at all, because I do see -- absolutely, if that's what we're going to look at.
But my problem is, I haven't heard a candidate yet that has addressed the system. They're addressing pieces of the system. They're addressing, "Well, this is a problem. We'll fix this. This is a problem. We'll fix that." Well, it's like our tax code. They fixed it so many times it's impossible to deal with, and that's what's happening to health care.
Why is it that people make profit on health care? Why do shareholders get dividends on health care when we can't afford health care? You've got third-party payers out there that do nothing but shuffle papers. They don't contribute to health care in any single manner.
JUDY WOODRUFF: You're talking about the insurance companies?
DR. DALE CARRISON: They make billions of dollars.
JUDY WOODRUFF: Are you talking about the insurance companies?
DR. DALE CARRISON: I'm talking about third-party-payer insurance companies. I'm talking about insurance companies that answer to their stockholders to make more money. And when your interest in health care is to make more money, then you don't care about the patients.
JUDY WOODRUFF: So what do you look to these candidates to be saying, to be saying that they will do once elected?
RENE CANTU, Nevada State College: I think we're looking for bold solutions to the health care problem. And I think, you know, there has to be a hybrid, not something, not either or not as pure as Sandra's talking about, where it's a single-payer or the free market. I think there can be a hybrid.
JUDY WOODRUFF: Presidential candidates, what should they -- are they saying what you want to hear them saying?
DR. DALE CARRISON: No, I think the presidential candidates are saying what they think we want to hear. I don't think anybody's been bold and come out and had an idea. There's no original ideas in any of the rhetoric that we've seen so far in any of the debates. They're too interested in attacking each other; they're too interested in trying to be all things to all people.
JUDY WOODRUFF: In both parties, are you saying?
DR. DALE CARRISON: I think in both parties. Somebody needs to stand up and stand up for an issue and put a solution forward, instead of all these little bits of parts of things.
JUDY WOODRUFF: Well, some of them have put health care plans forward, haven't they, Dr. Guinan?
MARY GUINAN: Yes, they have, but most of them, I think, accept the idea that health care should be rationed. I don't believe that. I think all people are entitled to health care, and we have to find a system to give it to them.
But we don't have one. And all of the plans that are being proposed, at least as I read them, are patching things together, just as Dr. Carrison said, and they're really not handling saying, "Listen, it's wrong to ration health care."
DR. DALE CARRISON: I agree with Mary. It should be accessible. But you know what? People should all have to pay for their health care. If you don't pay for something, you don't respect it. And every time we give stuff away, you get a whole subset of people that just want everything for nothing.
SANDRA TIFFANY: And I think you're going to see that debate -- again, I'm going to say Republican versus Democrat. You're going to see the Democrat presidential candidates say, "Open market, come one, everyone, you get served, we'll give you everything you need, anytime that you want it, from prescription drugs to unlimited surgery, live as long as you want," to the Republicans saying, "Now, wait a minute. Let's look at this free market system."
RENE CANTU: You know, part of the problem is this absolute lack of communication between political parties. We're in this state of polarization where we're not talking about solutions to problems in a pragmatic sense. We are taking political stances to galvanize political bases, and conduct war, and we're getting nowhere.
JUDY WOODRUFF: And on that point, let's move to education. Are the candidates -- we described earlier what challenges Nevada is facing with regard to education, 50 children in a public school classroom. Does the federal government have a role in this issue? And are the presidential candidates saying what they should? Or is this something that the state and the city should work out?
SANDRA TIFFANY: I don't think federal government belongs in public education system. Your parents do, and your family does, and your teacher does, and your principal does. I do not believe the federal government belongs in public education.
RENE CANTU: We're sitting here, you know, at the top of all the bad lists and at the bottom of all the good lists, in terms of high school graduation, college going rate, college graduation rate, education funding.
It's a holistic issue. It really is from pre-K through graduate school. We have to look at it holistically. I don't think that there's necessarily a large federal role. There is a federal role, but, really, it's a state commitment to funding a way of life that we'd like to have and...
DR. DALE CARRISON: I want a plan. I want a plan that's realistic and that's attainable. But everybody talks about it. And everybody's polarized, as Rene said. And you hear Washington, nobody's interested in solving any of the problems anymore. They'd rather fight back and forth between Republican and Democrat, which solves nothing.
Extending the debate on immigration
RENE CANTU: One of our biggest challenges in Nevada is educating a very diverse population. You know, you just heard on that report that the largest population is Hispanic. And the education system is not doing a good enough job in educating Hispanics. That's going to affect the future.
And so issues like immigration tie into education and health care. So a lot of what I look at and a lot of my friends and colleagues look at is, what are their positions on immigration? You know, they're on the wrong side of history if they oppose finding a solution for the 12 million people who are in this country that we depend on everyday.
JUDY WOODRUFF: And just quickly, what's the right solution for immigration?
RENE CANTU: I would say rational, comprehensive immigration reform. The DREAM Act is absolutely essential. And I'll tell you, from a Hispanic standpoint, people have long memories. The Cubans remember the missile crisis and Kennedy. You know, what's going on today with immigration reform is going to be remembered 20 or 40 years down the line when the population is more empowered.
JUDY WOODRUFF: So those who are in the country today, path to citizenship?
RENE CANTU: Yes, border security, path to citizenship.
JUDY WOODRUFF: Path to citizenship for those who are in the country?
SANDRA TIFFANY: Absolutely not. Illegal immigration is one of the four top issues that I think that the presidential candidates need to address.
JUDY WOODRUFF: And so what would you...
SANDRA TIFFANY: And so my position is close the borders. That's the most important thing. And if you are illegal and you are caught doing a criminal act, you should go back. What we're saying is they've got to be here legally. We've got to have a green card, and we probably need to look at reforming that system.
DR. DALE CARRISON: These people are saying, "Send them all back." That's a joke. We don't have enough people to close the border, much less go find 12 million people and send them back. They make our economy. Who are we going to send back?
JUDY WOODRUFF: So to sum up, the-- you're saying it's key to solve the immigration issue, in order to address these other issues of education and health care?
RENE CANTU: When we look at presidential candidates, that is a bellwether issue.
JUDY WOODRUFF: I want to raise one other thing, and that is, Tuesday of this week, President Bush vetoed an appropriations bill, the so-called Labor-HHS appropriations, that included funding for health care, for medical research, for education, among other things. The president accused the Democrats of spending, I think, it was $10 billion more than what he wanted. The Democrats, in turn, say the president wants to spend $200 billion additional for the war in Iraq.
When you hear these debates going on in Washington, what do you think? What do you make of it?
SANDRA TIFFANY: It's Washington rhetoric again. It's political fighting. It's a presidential election session right now.
JUDY WOODRUFF: What do you think when you hear these debates in Washington, Dr. Guinan?
MARY GUINAN: Well I do think that it's a lot of rhetoric during the election cycle. And I don't think they get down to serious problem-solving, which is what nobody's doing.
How do we solve the problems? That's what I feel public health is. Public health, people say, "Oh, Nevada is the worst in this, the worst in that." So what are we going to do about it? We are supposed to be finding the solutions.
I'm tired of everyone saying, "We're the worst and the best and on the top of the bad list." I think we have to find solutions and to bring people together to find the solutions and not wait for the federal government to put a solution on us.
JUDY WOODRUFF: All right, we're going to -- on that note, I want to say thank you very much, Dr. Mary Guinan, Rene Cantu, thank you very much, Sandra Tiffany, and Dr. Carrison. Thank you all very much for being with us. Appreciate it.
JIM LEHRER: And thank you, Judy, again.
On our Web site, you can view a slide show of Nevada residents explaining what's important to them in the 2008 presidential election. Just go find us at PBS.org.
On Friday, we'll have excerpts from tonight's Democratic presidential candidate debate in Las Vegas, plus a conversation with six voters who watched it along with Judy.