Look around. Everywhere, mixed signals. At lunch the other day, the Yard House in Town Square was packed, and it’s not a bargain joint. You wonder, this is a recession? Yet who doesn’t know someone out of work? Many are hurting, and most of those who aren’t fear they soon will be. Gov. Jim Gibbons goes on TV to tell us we’re screwed, and that all he can do about it is screw us some more, which is better than taxing business or mining. (He’s bravely willing to take the same 6 percent pay cut he’s demanding of state workers, but we can rest easier knowing he won’t have to worry about the wolf at the door, since his mansion is paid for.) The Democratic opposition counters with boilerplate about how working together we can blah blah blah. Meanwhile, you can get a fine room on the Strip at prices that Steve Wynn would have laughed at a year ago. No one knows when it’s going to improve, other than not very soon.

This is the time of year when everyone in charge of anything makes a state-of-the-blank address: presidents, governors, mayors, CEOs. A time of assessment, retrenchment, tough truths and a little hope-mongering. But because the air is so full of mixed messages, this year more than most we wanted to see the state of things for ourselves. So we sent writers to four quality-of-life zones of interest—education, tourism, the arts and health care—to get a front-lines feel for what’s at stake and how people feel about the future.

The state of education

By Ken Miller

Alana London is working her ass off. From the opening bell of her fourth-grade class at Brookman Elementary School, she’s tirelessly in motion, scanning her rapt young wards at all times for answers, questions or minor admonitions. There’s an even mix of students who look at her and smile, others who look at the ceiling and others who fidget with their water bottles, but no one escapes London’s attention. Participation is strongly encouraged, as is movement.

Within minutes of taking their seats, students are selected to come to the front to solve math problems on an overhead transparency. Soon after, students are told they have 30 seconds to find a math partner for an assignment in which they move about the classroom, finding math problems taped all over. When this is over, groups are told to grab an educational game, splay out on the floor and have at it for about 10 minutes. Some of the games use flash cards, some of which are returned slightly bent because of the students’, er, enthusiasm at wanting to see the answer.

Through all this, London, 25, displays a creativity and playfulness that always seem to rein in her students’ oft-wandering attention spans. Music is a huge part of their day. To get everyone’s attention, she begins the “Ooh eee ooh aah aah” chorus from “Witch Doctor.” If someone forgets to raise their hand, so begins a rendition of “There Is Nothing Like a Dame,” but substituting “hand” for “dame.” Math algorithms are explained oftentimes by a song that begins, “A simple strategy …” She’s got a nonaggressive response, musical or otherwise, for every situation. If attention really begins to flag, get ready for a little game of “Simon Says.” If she’s interrupted, she presses her two middle fingers to her thumb and sticks the pinky and index finger high, asking, “What does this mean, class? This means keep your mouth closed and your ears open.” When time is up on any given assignment, you’ll hear a call and response of “Macaroni and cheese …” “… Everybody freeze!”

A staid lesson plan this is definitely not. But it doesn’t stop at a chorus of “A peanut sat on a railroad track.” London has also used up every inch of wall space for accoutrements meant to stimulate imaginations. At the front of the room is a banner that reads, “Triumph is just a little ‘umph’ added to try!” Each student group is referred to by a geographical name, with that particular area hanging above each table. (“Way to go, South America!”) Everywhere you look, laminated boards advertise a different learning activity—“NFL Club—Never Finished Learning”; “Garden of Good Manners”; “Counting Sweet Treats”; “Books We’ve Read Together”; “Got Words?”; and on and on.

Nearly everything you see in London’s classroom—the signs, the board games, the books, the plastic containers used for the dry-erase markers, notebooks—was paid for out of her own pocket. London gets $7 per student a year for school supplies, which, in her case, means about 210 bucks. If you’ve been to an Office Max lately, you know how little that’s going to buy you. Every teacher received a $200 gift card on top of the normal allocation for the current year, but even so, “probably 20 percent of my income last year went into these supplies,” she explains. It helps financially that her husband also works, and that she does not yet have children, but even with the 4 percent pay raise teachers fought to get last year, London is doubtful she can keep up this level of spending. With the 10-12 hours a day she spends teaching, grading papers and providing free tutoring to her students, “it’s almost like making minimum wage.” And now she’s one of thousands of educators statewide facing Gov. Jim Gibbons’ 6 percent pay cut.

That is hardly the extent of the damage schools are expected to incur if Gibbons’ budget passes. He’s also proposing a $473 million cut to higher education, or an overall decrease of 36 percent. UNLV would have its budget cut 52 percent. And if Gibbons has his way, all state employees will have their health benefits reduced and receive no step increases this year. When you add it all up, the fiscal impact to each teacher’s wallet would go far beyond a 6 percent pay cut.

Schools are limited in asking parents for help, but more than a few moms and dads have been doing their part, even providing their children with hand soap. “Sometimes we run out of paper towels and soap in the bathrooms,” London says. “It’s almost too depressing to count up all the ways [we’re impacted].”

As London speaks, her students begin gently approaching her and grabbing onto her arms, beckoning her to pay attention to them once again. She goes to the front of the class and realizes that one of her students put a bit more time on the clock she had set for the math exercise. Getting a disappointed look on her face, she asks the class, “How do we define integrity?”

“What you do when no one’s looking,” the class responds in unison.

Wonder if Gibbons was ever taught that in the fourth grade?

The state of tourism

By T.R. Witcher

The Welcome to Las Vegas sign was hardly packed last Sunday, but it was doing a steady business; a queue of half a dozen or so waited politely to take their photo of the sign. One of these was New York lawyer Bobby Reither, who wore a Donovan McNabb jersey as he knelt before the sign and raised his fists toward the sky in what he described a moment later as “prayer and homage,” while his friends snapped photos. (Unfortunately for his Eagles, he prayed to the wrong gods.) Reither’s been coming to Vegas for years, and he’s contemplating moving here. (He’ll be back in July to take the state bar exam.) On this trip, though, Tao and Delmonico’s were on the agenda. Maybe the Maxim party and “hopefully a lot of sex.”

But this was the most subdued he’d seen Vegas, and the visitor volume numbers—which usually increase or stay flat—bear him out. According to the Nevada Tourism Commission, statewide in 2006 there were 54.5 million visitors; in 2007 there were 54.6 million. The commission projects 51.3 million for 2008.

Roughly two-thirds of those visitors come to Las Vegas, and at the local level, every indicator of visitor volume is down: gaming revenue (down 8.5 percent); airport passengers (down 6.4 percent); hotel occupancy levels (down 3.5 percent). Through last October, Clark County’s total visitor volume was down 3.2 percent to 32 million. “We’re obviously in a worldwide economic situation and a deep recession in this country, so tourism has felt the impact rather severely,” says Chris Chrystal, spokesperson for the tourism commission. “It’s something we have to weather and get through.”

It takes a lot for Vegas boosters to stray remotely from their message that Las Vegas is simply the greatest show on Earth, but everyone can feel that while Vegas is perhaps cruising along—32 million people is no small number—it’s far from gangbusters. Add to this the closing of venerable shows such as Mamma Mia! and Céline Dion’s ... A New Day and the lackluster response to the new Criss Angel show, and you have a Vegas that gives off the vibe of a middling party after the cool people have left.

The commission receives funding from the hotel-room tax, the same tax that funds the Las Vegas Convention and Visitors Authority. (The LVCVA gets five-eighths of 1 percent, the commission three-eighths of 1 percent.) In a good year, a normal year, that means about $22 million for the commission, but fewer visitors and budget cuts have dropped the commission’s budget to $16 million for fiscal year 2009; the governor’s budget for the upcoming biennium would strip it to $8.5 million.

A lot of what would be lost is the commission’s bread and butter, advertising, where it spends between $6 million and $7 million. “A lot of our advertising would have to stop,” says Chrystal. “That degree of opportunity will be lost in the marketplace.” She points to a $4.7 million ad campaign promoting Lake Tahoe ski resorts that generated $92 million in economic activity.

The cuts also mean the tourism commission is attending fewer trade shows and conventions where it can market itself to tour operators. And its contract with an advertising agency just ended and won’t be renewed.

Of course, Las Vegas—and by extension the rest of the state—remains an attractive destination. “When you have a crisis like this, that’s the time to go full steam ahead to the extent that you can to market the state.”

And there’s some good news. There were “piles of people” at Tahoe over the holidays. The convention business remains strong—shows are booked years in advance, and the convention center is about at its usual healthy capacity of 70 percent. Still, says UNLV professor Curtis Love, the main challenge is that fewer people are opting to attend trade shows. “All that goes directly into heads and beds.”

LVCVA’s new campaign, “Vegas Bound,” tries to encourage people to “take a break” in Vegas—a sort of passing nod to the fact that people across the country are having their lunch handed to them. The campaign features the starry-eyed, once-in-a-lifetime trip to Vegas taken by a bunch of hard-working folks from tiny Cranfills Gap, Texas. The $2.5 million campaign has already earned $4 million in “earned media” revenue—a calculation of the amount of coverage the story has gotten. This week marks the launch of the campaign’s website.

And beneath all the numbers, the Vegas tourism machine continues to grind away. The office of Maverick Helicopters, which gives tours of the Grand Canyon, was virtually empty, as was a tour bus pulling into the lot. But business is apparently good. I was told that eight flights had recently left. Maverick’s vice president of sales and marketing, John Buch, told me later that the company added nine choppers to its fleet last year—bringing the total to 32—and two airplanes to keep up with extra demand in Vegas (and in Phoenix) for trips to the Grand Canyon. “If we have another ’08,” he said, “then that will be a good year.”

The state of the arts

By Richard Abowitz

Sitting in her antiques shop, the Funk House, local arts promoter and First Friday co-founder Cindy Funkhouser sees this as a precarious year for arts in Vegas: “In Vegas we are still in our infancy as far as art. We are more vulnerable, not as established as a lot of cities. Not just New York and Los Angeles, but places like Houston, Dallas, Kansas City or Omaha, Nebraska. Importance has been put on art in those cities for a long time.” Her prescription for Vegas in 2009 is a modest increase in the dramatic growth the Vegas arts scene experienced over the past five years. “I would like to see more galleries and more people buying art. At First Fridays we still are seeing a really good audience. But the key thing is to see more galleries and studios coming in.”

But Funkhouser, who also operates the Fallout Gallery with her husband, is uniquely aware of the specific challenges art faces in Vegas in 2009. “The economy is the No. 1 threat impacting everything. My husband and I own the Fallout Gallery. And we both have several jobs, and if they are impacted it affects what we can do at the Fallout Gallery.” Sadly, she does not see the plummeting cost of real estate making space more affordable to artists and galleries. “Obviously rentals and real estate are less expensive. But when that has happened in other cities those economies have been fairly stable, and it was just those neighborhoods that had low property values. Here it is the whole economy. People don’t have the ability to come in. I hope the arts district is still going to grow in 2009. But I always do.”

To her, the biggest downer for the arts scene happened in 2008 with Libby Lumpkin leaving the Las Vegas Art Museum. “I don’t know if it was something avoidable. I really think the city should be giving them land and build them a museum. They will continue, of course, without her. They have been around for a while. But that departure was a tremendous opportunity lost.”

Far more openly optimistic about the future of Vegas arts is Myron Martin, president of the Smith Center for the Performing Arts, which aspires to eventually house the local ballet and orchestra. Of course, it has to be built first, and Martin’s goal for 2009 is to break ground. To build anything in this economy could seem a daunting challenge, yet Martin is as confident as a person can be who is not yet ready to place a date on a groundbreaking. In fact, his enthusiasm is only dimmed when the language of accounting and law appear as alternatives to specific dates that loom in the planning. Martin notes, for example: “We are in the most turbulent economy I’ve seen in my lifetime, and it has an effect on everything, including the most important building to be built in Nevada in our lifetimes, and that is the Smith Center. We have raised something like 85 percent of the money we need to build it. The last little bit is the most difficult to raise during these turbulent times. But for the Smith Center things are going great. Our designs are on time. We are doing the last interior stone material selection next week. We are right on schedule with our plans to be able to release them in their entirety at the end of the first quarter of this year. Then we can start the process of building this thing. We are in really good shape.”

So, does that mean the remaining 15 percent or so needs to be raised in 2009 before ground is broken on the building? Sort of and maybe. Martin explains his plans to break ground in 2009, though not to commit to a date, this way: “Not all of it [the money] has to be there. But you need to understand where it is coming from. We have 42 donors who have pledged $1 million or more, most over five years. None of them have defaulted so far. Some are in their third or fourth year. And we expect in the next few months as we add names to the founders’ roster many of them will choose to donate over five years. So you don’t need cash in the bank, just to know where it is coming from. I am very confident we will break ground in 2009.” After the groundbreaking the plan is to take 32 months of construction followed by two months of tuning before the building opens.

In addition to the Las Vegas Philharmonic and the Nevada Ballet Theatre, Martin hopes to house a children’s theater and to be a home for touring Broadway shows and other theater events. Martin sees this as essential to the future not just of the Vegas arts community but also of the city: “There is a host of cultural attractions that do not come to Las Vegas at all. This is about community and redevelopment and making Las Vegas a better place to live. Our audiences in Las Vegas are ever increasingly sophisticated. We need to keep up. People thinking of moving a business here and looking to recruit executives and their families to Las Vegas expect an arts center, because they are used to having an arts center where they came from. A performing arts center in other cities has a proven track record in helping with redevelopment and helping attract knowledge workers.”

Back at the Funk House, Funkhouser is instructing someone on her much-lower threshold of donations for First Friday. “Even $100 is a huge help. Some people don’t like to ask for donations, but I don’t mind. We need it.” Asked about what the Smith Center’s benefit to the city will bring, she notes: “It might help. But it is years off, and so we won’t see that for quite some time.”

The state of health care

By Stacy J. Willis

Last week, 30-year-old Lamica Jones broke out in boils all over her torso. Although she has health insurance through her job as a teacher at a private school, she has never developed a relationship with a primary-care doctor. “I need one, but you go in and they don’t care, they’re just trying to get you out of there to push more patients through,” she says.

So on Thursday, after also suffering a fever, she went to UMC’s emergency room. “I felt like crap. And it was a terrible experience,” she says, sitting outside the ER three hours later, waiting for a ride home. “[An aide] gave me a nasty blanket with dried crusty shit on it, I had medications leaking on me, there was dried blood on the floor ... I had to get up out of my bed to go get help. I just don’t understand why it’s like this.”

She was prescribed antibiotics and told to come back in a few days for a follow-up, she says. A UMC rep says sanitary conditions are a priority, but as Jones sits outside the nearly full ER, she presents a tiny but not uncommon take on the Southern Nevada health-care picture: a little desperate, a lot dissatisfied and completely at a loss for a simple solution.

“The No. 1 problem with health care is access,” says Nancy Menzel, president of Nevada Public Health Association and an associate professor of nursing at UNLV.

“We have many low-income people here. Access for the uninsured, underinsured or Medicaid patient is not good,” Menzel says. “But it’s all connected. Access and quality. We just don’t invest enough in health care.”

A year ago, Nevada made national medical news when multiple endoscopy clinics were found to be using unsafe procedures that exposed thousands to hepatitis C in an attempt to save money. Since then, local health-care headlines have ranged from questions about the survival rate at UMC’s kidney-transplant program to the closure of the UMC oncology unit to a lawsuit over an English man’s death following gall-bladder surgery at UMC.

A 2006 survey by the economic research nonprofit Public Policy Institute of New York State ranked Nevada 50th among states in health-care spending per capita, saying the state spent $472 per capita for Medicaid—less than half the national average of $1,015 per person—on care for the indigent.

And a 2007 study by Health Affairs, a medical journal, ranked Nevada among the bottom five states in combined Medicaid, Medicare and personal health-care spending.

Further, the United Health Foundation ranked Nevada No. 42 overall in the 2007 America’s Health Rankings, which ranks states on factors such as insurance coverage, immunization rates and infectious-disease control.

“Let’s put it this way,” says 80-year-old Fran Brady while waiting in UMC’s crowded emergency room for an uninsured friend to be treated. “If I ever become seriously ill or need surgery, I will fly to California.”

That’s been a common refrain for years, even as the state’s population has soared and the lifestyle in Southern Nevada has become one sought by people from all over the world. In retrospect, it seems that local regulators might have addressed health-care challenges in the good times while resources were more available, say health-care advocates.

But now, as the economy sinks, Nevada’s problems may worsen. As more people become unemployed, their chances of affording coverage—and finding health care—become even slimmer.

In September, the state addressed its economic problems by cutting Medicaid reimbursements to Nevada hospitals by 5 percent. As a result, UMC closed its outpatient oncology, dialysis, mammography and prenatal-services units, among other programs. As the area’s lone not-for-profit hospital, UMC has long been the main place for the indigent to seek care—the “safety net,” says spokesman Rick Plummer—and the closing of the outpatient oncology unit means some Nevadans simply will not receive care for cancer.

“It’s caused people to hit the panic button a little,” he says. “And now the governor has proposed cutting Medicaid another 5 percent ... UMC is going to have to make some tough decisions [about what other programs may be lost if such a measure passes].

“People have the misconception that health care is free at UMC,” Plummer adds. “It is not. Health care is not free. We had $160 million in uncompensated care last year, and that’s a staggering number.”

And, he says, “The state cannot continually cut [Medicaid] reimbursements without cutting access.”

Access is the beginning of the problem. Indeed, a Families USA study this year found that between 2000 and 2006, more than 1,600 adults 25-64 years old died in Nevada because they did not have health insurance. “But there’s a domino effect,” Plummer says. “If you cut off the funding, you limit the care, it affects quality.”

Doctors are squashed between the forces of high malpractice-insurance rates and HMO mandates to treat a minimum number of patients per day, while fewer state and county dollars are making it into health care, which means fewer federal matching dollars make it into the system—all of which adds up to problems with both access and quality.

“We have an undersupply of physicians,” Menzel says. “You see health-care providers who are under stress and have to increase caseloads to 25 patients per day. And we are 49th in the country in nurses per capita. And we just woefully underspend on public health.”

Nancy Whitman, president of Nevada Health Care Reform Project, worries that UMC’s decision to close programs in cost-cutting efforts may be followed by other medical providers. “I believe other hospitals will follow suit and eliminate programs because they’re not cost-effective to keep in this climate with more uninsured patients. They can’t afford to have a line of business that’s not profitable,” says Whitman, whose group is starting a grassroots lobbying effort on behalf of health-care quality and accessibility in the state.

The Nevada Health Care Reform Project is putting together a campaign called “Health Care Wanted in Nevada” with buttons, a website, fliers and a presence in Carson City for the legislative session.

“Instead of saying, ‘What can we do about this specialty or that, prenatal or oncology?’ we need to say, ‘What can we do about health care, period?’” says Whitman. “We need to get Nevadans together and realize that if we don’t have health care, we have nothing ... And we will drive people out of state. And that makes the economic problems worse.

“My goal is to raise consumer awareness,” Whitman adds. “We hear parents speak up about education all of the time, but you don’t hear consumers speak up about health care, saying, ‘We need to do something.’”

Another on-the-ground program is in the works by Dr. Florence Jameson and an organization called Volunteers in Medicine, Southern Nevada, which she started last summer. Jameson, an OB-GYN at Sunrise Hospital, says she made the effort to get health-care providers to provide services pro bono after considering that more than 400,000 Southern Nevadans have no insurance. The group is now 250 strong, including 70 physicians and 30 nurses who will donate time. But the group is still in the process of raising $3 million to refurbish a clinic.

Other grassroots efforts are in place—on Thursday, a mobile health clinic for children was scheduled to visit some local elementary schools to provide basic well-checks and immunizations. It was paid for by Las Vegas Rotary Clubs.

In a health-care climate that involves volunteer physicians, rotary-club donations and shuttered programs at the county hospital, staying healthy may be the safest way to approach health care for consumers right now, Menzel says.

“The answer is to look more at prevention so that people are not put into this vortex of a health system,” Menzel says.