The sponsors’ initial promise was that Nevada’s dental school would cost the state nothing -- Medicaid funds that fund dental care for poor children would simply be channeled to the new school, covering its entire budget in exchange for the instructors’ willingness to perform the needed charity work “out the back door,” as it were. When that turned out to be illegal, a pair of new schemes was hatched. The state contracted with Sierra Health to handle the Medicaid contract -- paying that firm a percentage of the take for this legal “cover” -- and meantime the state bought out three private Southern Nevada dental practices, the intention being to take over those patient rosters, have dental school faculty tend to those patients’ dental needs, and use the resulting profits to fund the dental school.
But “The patients more or less found other service providers,” recalls state Sen. Bob Beers, R-Las Vegas, who replaced Sen. Rawson in Carson City. “It was buying the patients, essentially -- the locations of these practices were moved to the central dental facility. And it was a great plan if it wasn’t for the patients taking their teeth elsewhere. So that didn’t work, and last year we just gave them the $25 million.”
But UNLV president Carol Harter says only $4.5 million of the budget for the dental school -- which operates in downtown Las Vegas under her auspices -- comes from the state general fund.
“I imagine she’s not including the Medicaid funds,” Sen. Beers responds. “That’s an optional program, so we don’t get the same percentage federal match as we do on the mandatory programs, so a lot of that is state money, too.”
The bottom line? In the fiscal year ending June 30, 2004, the dental school collected only $2.35 million in registration fees. The rest of its $26 million budget comes from taxes of one form or another, no matter how they’re routed. That budget is slated to go up next year and every year thereafter, and that’s not even counting the $7.1 million in “one-shot enhancements” scheduled to go to the school from “surplus tax revenues” in the governor’s current, 2006 budget -- for audio-visual equipment, furniture, sterilization equipment, patient management systems, and “dispensing equipment and supplies.”
“So that’s how the governor plans to spend some of your excess windfall tax payments,” reports Sen. Beers.But does Nevada really need its own dental school, at all? The state had a perfectly good -- and far more frugal and flexible -- plan before 1999. Since 1959, the state has taken part in the Western Interstate Commission for Higher Education (WICHE) program, offering financial assistance to Nevada high school students who wished to attend out-of-state schools seeking professional education in fields not offered by Nevada’s state colleges. That program was expanded in 1997 when the Legislature adopted the state Health Care Access Program, which provides tuition funds in exchange for a two-year commitment that the student will serve underserved populations in Nevada.
To this day, Nevada still has 14 students attending out-of-state dental schools under the WICHE program, according to Sen. Beers.
In contrast, there’s no reason to believe most of the out-of-state students attending the new dental school at UNLV have any intention of setting up practice anywhere in Nevada -- let alone in isolated Northern Nevada mining camps or Indian reservations.
In fact, the Medicaid dollars now funding the dental school would be better used in neighborhood dental clinics in underserved communities, according to Assemblywoman Chris Giunchigliani, D-Las Vegas. And the other resources propping up the dental school would be better spent expanding the car repair training program at the Community College of Southern Nevada, which needs $10 million for a new facility, according to both Sen. Beers and state Sen. Sandra Tiffany.
The last line of defense for dental school defenders -- after all, it’s their job -- used to be the assertion that Nevada had “too few” dentists per capita.
But in 1999 (the same year the dental school was created) the Nevada Legislature enacted Senate Bill 133, reforming a system under which the passing score on the state’s dental examination seemed to fluctuate quite erratically (“depending on whose son was taking the exam that year,” according to one capital wag), under the guidance of a dental board dominated by dentists none too anxious to allow “excess” competition.
SB 133 replaced that arcane and protectionist system with a simple mandate that any dentist with five years’ experience practicing elsewhere and a clean record shall be granted a license to practice in Nevada.
“So suddenly we opened the floodgates, doubled the number of newly licensed dentists, and started building the dental school,” Sen. Beers explains “So there’s been a recent surge in licensees.”
Year 2000 data from the U.S. Census Bureau show Nevada now has 41.5 employed dentists per 100,000 population, significantly higher than the national average of 32 dentists per 100,000 people.
Unable to continue claiming Nevada has “too few” dentists, Nevada Dental Association Executive Director Maury Astley is now reduced to bemoaning “a dentist distribution problem.”
“This dental allocation issue basically describes their (new dentists’) attempts to locate their practices near the people who use their services,” in places like Henderson’s Green Valley, “rather than in Gabbs,” Beers says.
And there’s nothing an in-state dental school does to prevent this, which isn’t done better by the HCAP program, funding out-of-state tuitions for Nevada students. The Nevada dental school is a $26 million boondoggle, which will only develop a louder self-interested constituency, beating the drum for more monument-building, the longer it’s allowed to metastasize.
Shut it down, now.