He spent decades dedicated to putting a dent in Nevada's healthcare workforce shortage.

John Packham is our guest this week on Nevada Week In Person.

♪♪ Support for Nevada Week In Person is provided by Senator William H. Hernstadt.

-Welcome to Nevada Week In Person.

I'm Amber Renee Dixon.

And when it comes to public health in Nevada, he's one of the experts.

He's the coauthor of more than 100 statewide research reports focusing on the state's most pressing healthcare challenges and solutions.

An Oklahoma native whose work in Sweden changed the direction of his career, John Packham, Associate Dean of the Office of Statewide Initiatives at the University of Nevada, Reno School of Medicine, thank you for joining Nevada Week In Person.

(John Packham) Thank you for having me.

-How did you end up in Nevada in the first place?

-Well, it was a long journey.

After I completed my postdoc in public health in Sweden, looking for a new place to land, I thought I'd be in Nevada for a couple of years and then move on to the next academic position, but ended up staying here.

It's now been almost 30 years, and I plan on retiring in Nevada.

I love it.

-Oh, and you want to leave Nevada better than you found it?

-That's the game plan, and I think we're doing that.

Our office, in addition to health workforce research, we do a lot of outreach to rural and underserved communities of the state.

And I was originally trained as an academic sociologist, but unlike academic sociology, I get my hands dirty every day.

And it's whether we're undertaking research to inform policy or making a difference in the economic viability of a rural hospital or clinic, it's rewarding, and I would say rewarding on a daily basis.

-When I've spoken with you on the phone a few times, you have been in rural parts of Nevada.

What is it like when you, when you leave, I guess, the big city of Reno and you're going out into these areas, and does anything change?

-Well, one of the things I love about visiting and working with rural hospitals and communities, primarily rural hospitals, is it grounds you.

You can think about issues, you can research issues, you can try to deal with them from your desk in Reno, but until you've actually been in those facilities in the communities to see what they're struggling with, what's working, what's not working, and what our office might do to address some of those concerns, it's very rewarding.

Our office, on an annual basis, visits every rural hospital in the state.

It's about two weeks and 2,500 miles later before we're back to Reno.

But I would say, to kind of borrow a cliche, if you've seen one rural hospital, you've seen one rural hospital.

So they have very different needs.

They have some common struggles, but they have very different needs and challenges that, again, we try to assist them with.

I like to think I'm making a difference in healthcare, and rural healthcare in particular, but they end up doing the heavy lifting.

We try to assist.

-What is top of mind for you right now when it comes to healthcare in rural areas in Nevada?

I know Winnemucca, for example, is something that's on your radar.

-Right.

I think that what I always try to think about in terms of what we can do to assist, it's (a) getting a good understanding of the issues they're facing, what they are.

In some places, it's workforce.

It's usually workforce in every place we visit, but it's also economic challenges.

Every rural hospital in the state has a patient population or patient profile that's about 50 to 80% Medicare- and Medicaid-supported individuals.

That's the type of insurance coverage they had.

All things being equal, those tend to pay a little less--in some cases, a lot less--than commercial or private plans.

And so helping them serve the populations that define their communities--aging populations, a lot of retirees, and so forth--requires that we be nimble in terms of how we can help them and what we help them with.

In some hospitals, they're struggling with nursing shortages and using very expensive traveling nurses and so forth.

The next hospital, it'll be billing and coding clerks or an administrative physician or two, like that.

And again, we try to tailor the programs that we are fortunate to administer to those varying needs.

-So when you hear about potential cuts to Medicaid on a personal level, what do you think of when you have interacted with so many people that depend on that?

-My first reaction is, why in the hell are we doing this, for starters; but more to your point, people are going to suffer.

It's not complicated.

When the Medicaid program was established in the mid-60s, it was there was a recognition that low-income and poor people are priced out of healthcare.

And that was in the '60s when things were much better and much less expensive than they are today.

And those, those issues haven't changed.

We still have low-income individuals, most of whom work, it should be pointed out, and either don't get insurance through their employer like I do.

I feel quite fortunate through the university to have pretty decent health insurance, and it's not a cost burden to me, including out-of-pocket expenses.

For low-income individuals that rely mightily on Medicaid, they're going to suffer.

And I'm hoping that there will be pushback, not only from the beneficiaries, but also the hospitals, clinics, and physicians that provide care to those, those individuals.

-I want to go back to Sweden.

What did you do there, and how did it impact you?

-Yeah.

If you ever get a chance to spend a year in Sweden and get paid for it, seize that opportunity because I was fortunate, once I completed my dissertation in Sociology at Hopkins, to do some part-time work at the School of Public Health there.

And then that parlayed into a opportunity I couldn't refuse to spend a year in Sweden working on a social workplace and kind of social determinants project on stress in Sweden.

And so I learned a lot.

Again, it's, to this day, changed my thinking on a lot of things that we grapple with here in the country, whether it's health insurance coverage or the appropriate allocation of resources to healthcare and so forth.

It was just a great experience.

-I believe you told me on the phone that there were wealthy people in Sweden who said, What are you doing over there?

What was that in relation to?

-Okay.

So I'd been there like two or three weeks, and one of my first experiences when my boss said, We're going to go out to dinner with this guy.

Well, I didn't know he lived in a castle.

We literally had dinner with a man and his family who lived in a castle.

And one of the conversations that I had with him is he said, How do you all tolerate the number of uninsured that you have in your country?

I said, That is a wonderful question.

And the conversation evolved in a way in which he said, Wealthy individuals like myself, we don't like the taxes.

We have to pay upwards of 50 to 60% for an individual in his situation-- -Wow!

- --but we can see what those taxes result in.

And so universal healthcare from the day you're born to the day you die; inexpensive, if not free, childcare; free K to 12, college, and so forth.

And kind of what you see is that they're quite good.

They have more than a safety net.

It's almost a social insurance model.

It's been criticized as being a nanny state, and I would just say, nonsense.

If you, if you can imagine your ability to navigate life and not worry about health insurance coverage, what it's going to take to get you to college, and so forth, you can see the benefit of that type of system.

When I first moved there, I also learned that Sweden does something, something that is remarkable.

And at the time, it was about 500 paid days of leave for a couple when you had a child.

-Wow.

-And you could, you could divide it up in any way you wanted.

Mom could have 400 days.

Dad could have 100 of those days.

You could mix it up in any way.

But in thinking about what that is accomplishing, it is basically allowing new parents and couples to spend that first year or two with their child.

In the United States, a person has a child and it's in daycare in three months and mom's forced to go back to work because you got to pay for the daycare, among other things, and so forth.

And so just a thousand little items like that that are quite intriguing, and we're-- the legislature's struggling with a paid leave bill.

Actually, I think there's a couple this particular session, and those are minuscule to what-- compared to what a country like Sweden can offer their population.

-You're going to make me cry.

When you do talk about, well, Medicaid, for example, the biggest argument for cutting it would be there's too much waste, fraud, and abuse.

Did that exist in Sweden?

Was that a complaint?

-I think that that exists in every society where you might gain a social program or a health insurance program and so forth.

But one of the things that is remarkable about Sweden is the lack of administrative burden when, for example, a hospital is dealing with one health plan, as is the case in Sweden.

If you look at UMC or Renown or Sunrise or any of the big hospitals, they have entire floors dedicated to administrative folks processing claims, and that complexity (a) is expensive, but I think it almost invites some fraud and abuse, because everybody is trying to game the system in a certain way.

Not the hospital so much, but it's-- we're overly complex.

And I learned that from Sweden.

-Let's come back to Nevada.

And a big gain for the state will be when that standalone children's hospital opens in 2030 here in Las Vegas.

Did you ever see the day that that happened?

I mean, it hasn't happened yet, but you've been here, what, almost 30 years-- -Almost 30 years.

- --working in this area?

-And I know there's, there's some, a little politics and controversy with that, but I think what I would always stress in thinking about that there's plenty of need.

And whether it's, you know, a children's hospital, as is the case within the confines of UMC, or a new standalone facility that's being proposed and over the next five or six years, there's plenty of need, okay?

And so I always try to remind folks that while competition is good and competition is fierce in Las Vegas, as I've learned over the years, there's plenty of need.

There's plenty of business to go around.

I think there's also some advantages of having that standalone facility.

It makes you eligible for certain federal funding streams, including graduate medical education that can be provided or take place in a children's hospital that's not available to those that aren't freestanding.

-That's certainly something that Nevada needs.

So I understand you are winding down your career?

-Yeah, well, a little bit.

I don't ever want to step out of the game.

I just want to travel more and play more golf.

So if I can work that out with the university, I'll continue that.

But I turn 65.

I'll be a Medicare recipient in about four months.

So I'm, I'm looking at that on the horizon.

-Will you be playing more golf, where?

-In the winter I'll play down here in Clark County.

The golf courses in Reno, one more reason that I plan on staying and retiring there is the golf courses are great.

I played last weekend.

-And you also hike?

-Oh, yeah.

Yeah.

-John Packham, thank you so much for joining Nevada Week In Person.

-Thank you.

♪♪