SAHL: The Massachusetts gubernatorial race. Good evening. I'm R.D. Sahl and welcome to our viewers on NECN and our listeners on WBUR. This is our second debate of the 2006 Massachusetts gubernatorial campaign. Our forum tonight is co-sponsored by MassInc, the Boston Globe, WBUR, and NECN. The candidates this evening are the three Democrats appearing on the September 19th Massachusetts primary ballot. Let's meet them.
First, Chris Gabrieli of Boston, the 2002 Democratic nominee for lieutenant governor and a venture capitalist. Tom Reilly is the attorney general of the Commonwealth. He previously served as the Middlesex County district attorney. He lives in Watertown. Deval Patrick of Milton is a corporate lawyer. He was the assistant attorney general for civil rights in the Clinton administration.
Our program tonight is in three parts. In the first section, a panel of reporters will ask questions focusing on health and education. In the second section, the candidates and I will have a conversation not excluding but not limited to health and education. And we'll wrap up the hour with closing statements from the candidates themselves.
Let's meet our reporter panel this evening. We begin with Martha Bebinger of WBUR radio. Martha, nice to have you here. Robert Keough of Commonwealth magazine, Allison King from NECN, and Frank Phillips from the Boston Globe.
Now, in the first section, the ground rules. A reporter will ask a candidate a question. The candidate will have 60 seconds to respond. There's the opportunity for a follow-up question and a 30-second response, and then we'll invite the other two candidates for 30-second comments as well.
The questioning order was determined by draw. We begin with Martha Bebinger. Martha.
Q: My question for Mr. Gabrieli is, there is great concern about how to control the rising health care costs in this country. About a quarter of the money is spent on Americans in their last year of life. An example might be spending a half-million dollars on open heart surgery for an 85- or 90-year-old. Do you support setting limits on what kind of care we offer for what purposes?
GABRIELI: I don't support that. I do - the data is clear that we do spend a lot of money in the last year of life, in fact the last 30 and 60 days of life. Although, having looked very closely at this data, it's a bit complicated because sometimes people die unexpectedly and you know, you were trying to do something to help save them. So, you know, it's not that they were certain to go. I've been very involved in the hospice area. In fact, I helped - one of the things I'm proudest of was help expand and start a company that provides hospice services to people. I think America's beginning to learn the difference between, for individuals and for society, when it makes sense to fight disease and when it makes sense to accept fate. I had to deal with that as a family member in my father's case, and those were difficult decisions. I'm glad for the treatment we got for him. It gave him two more years of life than he would otherwise have had, and I think we also made the right choices near the end of his life.
So, I think it's very important to continue to leave that choice to between the patients and their families and physicians. The good physicians do a great job, I think, of coaching you, when to fight and when to recognize, you know, it's about comforting and dignity at the end.
Q: So if you were not going to try to control costs through rationing or limits, how would you?
GABRIELI: Well, it's a difficult problem across the country, clearly. One of the main ways, I think, to focus that I think everyone's going to embrace is to say, administrative costs. Roughly a quarter, or a third, depending on how you look at it, of the health care system, are something nobody wants to spend money on, administration. They want to spend it on drugs and treatments and physicians and nurses and so on, when they're needed. And prevention, for that matter. We could reduce the cost of administration, and I think this state could be a very active player on that, chiefly by getting automation into this. Thirty years ago - 20 years ago, I got started in my business career looking at how to use computers in medicine. We haven't come as far as we should have in automating things. It's still very paperwork-driven, and I think if we can take out some of that cost, we'll actually get better care, fewer errors, and lower costs. And that's something this state could be a leader on.
SAHL: Cost control? Health care (inaudible)?
REILLY: We have to make health care more affordable, and that's why I've offered a very detailed plan. It is better use of information technology, and administrative costs are at least one-third of the cost of health care. We have to do a better job at that, and we can. Better disease management. We know what the big drivers are, in asthma, in diabetes, in heart conditions. We have to identify and treat those earlier. Better prevention and less costly drugs. That's what my plan calls for. That's what we have to attack. That's the tough job. We've made progress in this state, but the tough job is making health care more affordable.
SAHL: Mr. Patrick.
PATRICK: Well, these are all important strategies, and I second the point that Chris made about the importance of using more technology to manage and maintain records. This is something the teaching hospitals do now. They can talk within their bubble, but they can't yet communicate with providers outside their bubble. I think there are smarter bulk purchasing strategies for prescription drugs, and there are steps we can take in terms of making uniform the codes and the forms used for reimbursements. These are ways to get at this 30 cents on every dollar that we spend on administrative costs and I think, frankly, all in, we spend what we need to spend, and maybe then some, in health care, enough to provide health care for everyone. Until we get at that administrative cost though, we're not going to be able to afford it in real ways.
SAHL: Very quickly. What about limiting the size of the network? In other words, what hospitals are available? What hospitals will be compensated for involvement? Very fast.
GABRIELI: Well, many health plans do have limitations and different payment structures. It's challenging in eastern Massachusetts. We have some dominant systems, like Partners, and people want the names that have the highest brand cache. Tufts, at one point, tried to exclude Partners from its network for cost, and it turned out most people wanted the right to go to Mass General Hospital when and if they wanted to. So I think it's a real issue.
SAHL: (inaudible) network?
REILLY: We have to make better use of our community colleges - uh, community hospitals. They provide tremendous services and medical aid and treatment. We need to make better use of those and better choices as to where - and our community health centers as well. That will lessen the cost of health care.
SAHL: Limit the network?
PATRICK: I think Tom is right on this point about the better use of the community hospitals and the community health services, and to do that not by limiting access to hospitals, but by creating more incentive, more attraction, to go to community providers for the service and the care we need.
SAHL: Let's move on. Bob Keough.
Q: Mr. Reilly, my question is about higher education. You have said that we need more math, science, and engineering graduates to grow our innovation economy. But how can we hope to produce these graduates when, at our state colleges, less than half of entering freshmen obtain their degrees within six years, and even at UMass-Amherst, the six year graduation rate is just 62%. What would you do to hold our public institutions of higher education accountable for results?
REILLY: Well, first of all, we do have to make our institutions, in all three levels - not just the university, but our community colleges and our state colleges - not just more affordable but more accountable. In terms of looking at math and science and where we need to go with public education and public higher education, we have to give more scholarship aid that will encourage people to go into those areas. I think the things that need to be done with public higher education - and by the way, it is becoming a major need in this state right now. For years, we have relied upon our private colleges and universities. They're too expensive for the average person. We have to give our state colleges and universities more stability in their funding. We have to hold them more accountable, in terms of management, purchasing, energy. Those things can be done to cut the costs, and we need more financial aid for those middle class families that are pretty much left out of the financial aid formula. So those are the things that need to be done to improve public higher education in this state.
Q: Yes, there's been a big push - particularly coming out of the state Senate - to appropriate more funding for the public higher education system, with the basic argument being that there has not been stability in that funding, and in fact that we haven't been investing enough in our higher education system. But, it turns out that in Massachusetts, we are 14th in the nation in spending on public higher education per student who actually attends public higher education. Does this system really just need more money, or do they need more accountability?
REILLY: It needs both. It needs more money and it needs more accountability. And this is where 16 straight years of Republican governors simply haven't gotten the job done, particularly in the last four years, cutting public education. And because they don't have stability in the funding, they make it up in fees. So, the cost of higher education has gone up. My goodness, $16,000, a little bit more than that, at the University of Massachusetts. That's a lot of money for just regular people. So we have to go at this in a very aggressive way, but you can't just throw money at a problem. They need more money. The size of the pie, they're all competing for it now, all three levels. We need to increase that, but we also need to increase accountability. So they go hand in hand, but there's no question about it. As middle class people rely upon the public education, higher education, system. You can't afford those private schools. I put three kids through private schools, I paid tuition for 20 years. I'm still paying.
SAHL: Mr. Patrick.
PATRICK: I would just add that we have - the reason to invest in public higher ed is both that, it is the way forward and the way up for kids of most working families. But also because it's the graduates of public higher ed who stay here in Massachusetts. Eighty, 85% of them stay right here. So if we're serious about investing in our future, we've got to be serious about investing there. One idea that I put out almost a year ago now was -also addressed an interest I have in stem cell research. When California started to come right at us on our stem cell research capabilities, one of the things they did was to pass a bond bill to raise public funds for stem cell research facilities. I'm very interested in something like that here as well, with the difference being, I would take those funds and invest them in public higher ed, to stimulate the development of their facilities and their faculties.
SAHL: Chris Gabrieli.
GABRIELI: I think the question was on science technology and (inaudible) address that, although I've got to say, I disagree a little bit with Mr. Patrick. The idea that we would take money that we want to get stem cell research prime with and only send it to public universities, that's a mistake. It should be merit-based, I think, clearly. And wherever the best research is, is where I would put my priority.
With regard to science and technology, it's a big problem. Not just of completion rates, Bob, but the fact that we have a declining number of students in the UMass system actually picking science and technology majors is a real indictment of what message we're sending to young people. I would like to see a real invigoration of science, technology, engineering at the high school level. In fact, I've proposed a state-wide system of sort of magnet schools, regional schools of excellence, so we'd have a Bronx High School of Science here in Massachusetts, a whole set of them, where the most promising kids would go on a strong track into science and technology, to where the careers of the future lie.
SAHL: Allison King.
Q: Mr. Patrick, ever since Massachusetts instituted the MCAS exam as a graduation requirement in 2001, the state dropout rate has steadily climbed. Critics of MCAS say this is no coincidence, that while raising standards, we're also encouraging many of the state's most vulnerable students to drop out. You support the MCAS graduation requirement. Do you believe the MCAS is helping the state's most troubled kids, who don't think they can ever pass MCAS, by in effect allowing them, some might say encouraging them, to drop out?
PATRICK: Well, first of all, the dropout rate is a serious problem. I don't think it's attributed entirely, or should be attributed entirely, to the MCAS. I do support the MCAS, and I support it as a graduation requirement. But I think we've had some experience now, enough with the MCAS, to begin to look at how it works and how it doesn't, what context, where it makes sense, and what context where it doesn't. Because if all we do is make our public education system, K through 12, about results on a standardized test, we are not educating the whole child. And it seems to me that ought to be the objective. The context where the MCAS works the best is one like I've seen, for example, at the Mason School in Roxbury, which is a public school. And their class sizes are small, the school day is long. There is enough time for kids to get the attention of the adults in those classrooms, and those adults are very, very strong professionals. In their context, their MCAS scores are off the charts, but the MCAS has receded in importance, because they have more time to pay attention to the whole child. It seems to me, the question is, how do we scale that model up so that that's the educational opportunity for every kid everywhere in the Commonwealth.
Q: You know, some recent numbers have come out showing that 91% of incoming seniors have already passed MCAS. If that's the case, should it be a tougher exam?
PATRICK: Well, I think it's time to think about raising the standards, if you will, or the difficulty of the MCAS. But as I say, I think if the best we do is think of the MCAS as a silver bullet, the one and sole
measure of a child's advancement, academically, socially and otherwise in public education, then we are missing something. We have got to be about the whole child, and raising the standards of the whole school and the expectations of that child in the school and in the home as well.
REILLY: Obviously we've made improvements in terms of the passing grade and the numbers passing - I was one of those kids when I was growing up and almost dropped out of school. I was very fortunate, and every single kid is important. Every single child is important. What we've done in this state is we have cut the remediation programs that were so helpful in 2003, with the graduation requirement came into effect. There's a lot of kids that need extra help. They need extra help after school. They need smaller class sizes. They need tutors. They need summer school. They need weekends. Let's focus on those kids, and give those kids the help that they need. Every single child is important and deserves a chance.
SAHL: Chris Gabrieli.
GABRIELI: I do support the MCAS test. I do think it's important that when it was offered and put in place, it has a range. Not just passing and failing, but needs improvement, which is what passing is. Proficient and advanced. And I think the whole goal from the beginning was to have a test that first of all meant that kids in the communities where almost everyone's passing early, they have goals to get to proficient and advanced. It's really an important set of goals. Passing is allegedly just an eighth grade level of success. Many kids who go to college who have passed the MCAS go into remediation because they're not actually ready for college. So, we need to continue to work hard to help every kid get over that passing grade, but we also need to say, passing alone is not enough. And I think it's a real concern I have that many communities, people think, if my kids pass, they're fine. They're not. They need to reach proficiency, even advanced levels, if they're going to have the skills needed to compete in the 21st century.
SAHL: Let me just make sure that we got an answer to Allison's follow-up. Raise the MCAS bar. Deval Patrick, you think we ought to study it?
PATRICK: No, I think we should do it, but I'm saying that that is not enough to assure consistent excellence (inaudible) -
SAHL: OK. Tom Reilly?
REILLY: We have to go about this the right way, and I think we are shooting for proficiency in the MCAS-
SAHL: Up the bar?
REILLY: We should shoot for 240 as a passing score, but we have to bear in mind that some of these kids are just passing at 220. That's where remediation and specialized programs for these kids, so we don't leave these kids behind.
SAHL: Up the bar?
GABRIELI: No, not now. There's too many kids who are just barely passing. We don't know enough yet how to help kids at the bottom of the achievement gap get up there. I do say, as I think, we've got to target every kid for higher. It would be a mistake right now, and I know that's something that's being discussed. And I do not believe we should move the bar above 220 right now.
SAHL: All right. Thank you. Frank.
Q: Mr. Gabrieli, under the new health care bill, most companies that provide no health insurance have to pay a $295 assessment per employee each year. You have said that the assessment is, quote, not enough. That figure, $295, was a critical part of the negotiations that led to the passage of the bill, mainly because a reluctant Massachusetts business community agreed to that figure, and in turn, agreed to support the legislation, breaking the logjam. If not $295, what do you think the assessment should be?
GABRIELI: You know, look, I salute everyone who's involved in trying to get this state to be different than the rest of the nation and the federal government to get on the health care plan. So I think it was progress that we did this, and the next governor's going to have a lot of work to make that bill succeed. But I do - I've looked at the math carefully, and I'm not sure the numbers really add up. When you look at a plan that they say will cost $3500, and that would be lower than many plans today cost for an individual, and you say the employer's going to contribute $295 for that person, the rest of that $3500's going to have to come from some mix of government and the individual, and we're talking about working poor people. There's no proposal been put forward how that's really going to be afforded. So first of all, I'm just skeptical on the numbers.
Second of all, I don't think $295 is the right number for, for example, the same size, one size fits all, for a larger, healthy employer and a smaller, struggling employer. I think there's some real differences among employers, and I think - one of the things I worry about, Frank, is if you're an employer who's on the edge on being able to afford coverage today, and the state government tells you, actually, $295 is your fair share. The rest, the government, slash, the individual should pick up. I think you're going to see some employers drop health care insurance. I'm really concerned about that. So, I do feel there are employers who can and should afford significantly more than $295, and I think we've got to get this right, otherwise the math won't add up and, like a previous attempt at universal health care, this'll never get off the ground. So I want to make that happen.
Q: Well, if you're elected governor, are you going to reopen negotiations with the business community? They went along with this compromise. Are you going to go back to them and say, now we're going to have to up this assessment?
GABRIELI: Well, right now they're out there supposedly calculating what's going to be affordable. So let's see what they come back with. Obviously that's the first step. But I am skeptical whether they're going to come back with plans that somebody making $25,000, $30,000, $35,000, $40,000 is going to be able to afford their piece without creating a huge and rapidly growing expense on government. And yes, I think if you're a midsize or large employer and you're healthy financially, I do think you probably could contribute more than $295, and probably the balanced load among everybody, employers, individuals, and government, I think we're going to need everyone to pull fully at that table. And I will be absolutely willing to step up to whatever has to be stepped up to to make it really work.
SAHL: What's the number?
REILLY: The job of the next governor is to make that work, and that's why experience is so important. I've had that experience with Harvard Pilgrim, struggling hospitals, dealing with the large pharmaceutical companies. That's why at the end of the day, we have to make health care more affordable, and that's why I've offered a very detailed plan. The - you can't be just going into this saying, I'm going to raise the assessment at this point. The job is to try to make it work, and work within the confines of the law, and the details are going to be very important here as to how this is done, and that's why experience and a background in health care is absolutely vital for the next governor of this state.
SAHL: Deval Patrick.
PATRICK: I think it's right that we have to live with the assessment that's in the legislation right now. It's not just a legislative balance. It's also an economic balance that has been worked through. I have some of Chris's concerns, I share some of Chris's concerns about what happens if enough small businesses make, frankly, a rational economic judgment to stop providing the health care they do right now for their employees, and instead pay the $295 assessment. If enough employees do that, it's a whole new ballgame. But there's a lot of work here to work through these details, and I'm committed to it as governor.
SAHL: Martha Bebinger.
Q: Mr. Reilly, there's been a heated debate on Beacon Hill for a number of years now about whether the state should set limits on the number of patients assigned to each nurse. Right now, the nurse's union is pressing for that legislation, because they say it would improve the quality of care for patients. The hospitals say it's unworkable and the expense is not worth the results. When you weigh in on that, what would you do? Should the state be regulating the number of nurses that each patient -
REILLY: First of all, making sure this adequate staffing is absolutely vital. Whether the state should be mandating that through legislation is something I question. Public health can set standards and staffing standards, and I think that's the appropriate role for government. But at the end of the day, what's missing here is we don't have enough nurses, and that means particularly our public higher education, our community colleges, have to be aligned with the workforce needs. If we need more nurses, then they're going to have to turn them out. And there are some encouraging things that are happening. Northern Essex Community College is now undertaking and planning a new program that will address the need for nurses. So we need more alignment throughout our economy with the workforce needs, and that's how I would address it. I have problems with the legislature mandating particular staffing levels that public health can set reasonable staffing levels, and I think that's the best way to do it, through regulation.
Q: So on the issue, though, of quality in health care, what should the state's role be? What should the state be doing to make sure that the quality of care is improving?
REILLY: In terms of overall, I think there are quality control measures all the way through this system as part of my health care plan. You need to focus on quality, performance standards. Government is the largest purchaser of health care. Attaching performance standards and quality standards to things like Medicaid reimbursements and all the way through is a role that government should play and a governor should play. A governor has to drive this kind of change, addressing quality, and I would drive it through public health with administrative standards and goals and objectives, and expect those to be met.
SAHL: Mandated nurse/patient ratios. Deval Patrick.
PATRICK: Very skeptical about this, although I will tell you that in talking with both folks from the hospital association and the nurses, the compromise that they worked out sounded like it had appropriate flexibility. I think this is one of these things where, it doesn't really allow it - lend itself to legislation. It's something that you want to expect will be done well by successful managers in hospitals.
I will say, though, that measures of quality should be uniform in different providers, and as they are reviewed by different companies, so that we're not having - different insurance companies, so that we're not having just new, additional burdens to the whole administrative expense of having different measures of what quality outcomes are in different settings.
SAHL: Chris Gabrieli.
GABRIELI: You know, the data's pretty clear that nurse, staffing ratios to correlate to outcomes. They correlate even to fatalities. They certainly relate to errors in medications, to length of stay. There's some real benefits to lower staff ratios, including certainly what patients have experienced, but also objectively on the data. I think the compromise that was hammered out was a good compromise. It puts it in the department of public health to set the exact ranges, a ceiling, as well as a target so that the ceiling would be significantly higher than the target. I think it's a good piece of legislation. The details matter here, but I think it should be supported, and so I do.
SAHL: Bob Keough.
Q: Mr. Patrick, you have said that you support charter schools, which have proved to be very attractive to parents, especially in cities where the quality of district schools is problematic. But you have also said you would support the founding of more charter schools only if the funding system, which was substantially overhauled just two years ago, were changed so that it didn't drain money from district schools. And you have said that charter schools should be more accountable to local districts, when the whole idea of charter schools was to make them independent. Isn't this tantamount to saying you oppose charter schools?
PATRICK: No. I think there's a place for charter schools. I think we ought to be clear, though, there's some very successful and very helpful charters, and some not so successful and not very helpful charters, in the same way there are district schools that are fabulous and district schools that are failing and that need improvement. I think the issue with charters is - for me, the most compelling argument for charters is that they would serve as a laboratory for innovation that then could be imported into the district schools, and so I'm very interested that they be accountable for that kind of contribution, if that is what was motivating the particular charter. I also think that the funding mechanism, particularly in smaller towns and communities, creates an unnecessary tension among teachers and faculty and families about how you support public education in the district schools and public education in charters. I have not, frankly, worked out what that funding mechanism ought to be. I just know that right now, where you have a system which drains money from the district schools in favor of the charters, is not serving the overall interest of communities, especially in a smaller community.
Q: Charter schools have been especially popular in Boston, so much so that they've reached the cap on the number of schools that are allowed in any city or town. Would you support lifting that cap for Boston?
PATRICK: Not yet, because I'm interested, as I say, in a better funding mechanism, and I'm interested in a better accountability in terms of how those innovations are transported. Now, there's a cap for Commonwealth charters, there are not very many Horace Mann charters, and they're nowhere near the number of pilot schools, which is an experiment I have seen also work quite well in Boston and elsewhere, and I'd like to see more of that.
SAHL: Charter schools. Anybody?
REILLY: Yesterday I was in Malden meeting with a group of folks, and there was a young mother there. She's a public school teacher, two children. One of them is going to the - young children. One of them going to the public schools, doing well. The other going to a charter school, doing well. Parents deserve choice, and to have some choices when things aren't going well. I support charter schools, and particularly if we get into a situation, as we've seen in this state, where there are underperforming schools and the problems have been addressed and they haven't been straightened out, then we will have to consider increasing the cap to change that situation. It's all about the children, and it's all about giving them the very best chance at an education, and charter schools are part of that.
SAHL: Chris Gabrieli.
GABRIELI: I think Tom's right. Choice is good for parents, and certainly most parents want to send their kids to the school they think's best for them. And I certainly agree with Deval that innovation was the idea behind charter schools. However, I don't think the burden of spreading innovation from charter schools to district schools ought to be put on the charter schools. I think that's an extraordinary idea. I worked on doing just that. Eighty percent of charter schools have a longer day for their kids. They're one of the role models we've used in informing the work we've done, the very hard work, to get district schools to change. And I'm proud that seven districts in this state will be the first in this country to take standard schools and turn them into longer day schools. But I've got to tell you, that innovation challenge of changing district schools to a thing like that, where teachers are paid more, it's voluntary, but it's good for the kids, is really hard work. And the next governor of Massachusetts had better be willing to step up to the hard challenges of driving innovation in standard district schools, standing up to whoever has to be stood up to to make that happen, if they want to see education change.
SAHL: Let's try and pick up the pace a little bit. Allison King.
Q: Mr. Gabrieli, there are a number of studies that show that universal early childhood education programs have very important long-term educational benefits. This is children age 3 to 5. The legislature has taken initial steps that would move this forward, estimated price tag about a billion dollars a year when it's fully phased in. You have been a major proponent of after-school programs, including expanding the school day and the school year. The legislature is also considering that, also very expensive. If you were governor, only able to fund one of these two initiatives, early childhood or after school, which one would it be and why?
GABRIELI: Well, I mean, I think that's a false choice, and I think they both have merit. There's a real argument for early ed kids who don't arrive at kindergarten ready to learn, are already behind the eight ball, and you can argue that we waste a lot of money trying to get them caught up and they fall farther and farther behind. So, absolutely early education's crucial and it's why most parents with the means get their kids going age 3 and 4.
Longer school day, to match what the rest of the world is doing, to give kids more chances to learn in the 21st century, not an agrarian society, also crucial. So, the question, I think, it all comes down to, if you have finite resources, what do you do? And I think the answer's what we try to do on extended learning time, which is don't give money to every district and hope for the best. Don't make a universal top-down mandate. Find the districts that want to work on these things. All the districts working on extending the day chose to volunteer to do that. Pick the ones that have the capability of really doing innovation, because I think some districts are not proving that they really have the ability to use more resources well, and get them going on both sides, on the early education and on extended learning time. Focus it on the districts where the kids are doing poorest and where the districts show the greatest competency to incorporate it, and then measure it. That's really key. Because we've got to see, as we implement these on a broader basis, do they provide the gains that we expect? On extended learning even, even though I'm a big proponent, if those gains aren't there, I don't think the state should continue to expand it. Only the things that really work to raise achievement should be expanded.
Q: So if you could choose one or the other, which one would it be?
GABRIELI: I wouldn't choose one or the other. I think there's enough resources to do both of them - I know - on a measured amount in the districts that need it the most, and see - many -
Q: But everyone's going to want early childhood education.
GABRIELI: You know what, I've got to tell you, you would think everyone would want extended learning time, too, when the state was funding it -
SAHL: Deval Patrick.
GABRIELI: -- and too many districts stepped forward, and many of them didn't make it to the finish line because they couldn't get it through with parents, unions and other issues. So, unfortunately, big change is hard, and I don't think you'd find every district stepping forward.
PATRICK: I mean, it's a fair question, but Chris's point is right. I've found this out on the campaign trail. In fact, there's not universal acceptance of the idea of universal early education. That is a part of my education plan, because I do think a more comprehensive approach that starts before kindergarten and goes right up through public higher ed is important. But I think it is important, and Chris has a point here, about phasing these things in, particularly in communities that are under stress and need them, poor communities or underperforming schools, and thinking about how we get to this over time, not all at once.
SAHL: And quickly, Tom Reilly.
REILLY: Put your money where it will get the most benefit, and different districts have different needs. So I agree with Chris and Deval on this.
Q: Mr. Reilly, you've said the biotechnology industry in Massachusetts, with its 30,000 employees and 280 firms, is an essential part of the state's economic future. And they say they need a business-friendly environment to thrive. But you have also been a strong advocate for legalizing the importation of prescription drugs from Canada, as a way of countering the rising drug prices here. The biotech firms see these imports as a serious threat to their economic well-being. How do you reconcile your push for imported Canadian drugs and the very strong position that the biotech firms have taken against them?
REILLY: Frank, I see the people that are caught in the middle here, many of them seniors forced to make impossible choices - you talk about Allison's question - between paying for medicine and paying for heat and having enough food on the table. That's why I was the first attorney general in this country to call for the safe reimportation of medicine from Canada. I continue to do that, and if I'm governor, we will set up a program to help those seniors and just ordinary people here and regular people in Massachusetts make those types of choices. I don't believe - and I obviously know the importance of biotechnology in this state, but we can no longer - we can't subsidize the rest of the world and countries like Canada when our people are hurting right here. And actually, it'd be a good question, because I know where I am on the safe reimportation, and I'm not sure I know where Deval is or Chris is on this question, but I strongly support it. If I'm governor, I'm going to push it.
Q: So is the biotech industry crying wolf on this issue?
REILLY: What I believe is that we can not afford it, and that we have to find - I've taken on -
Q: Can we afford to hurt the industry though, with all the jobs and the future that it holds?
REILLY: There are individuals that are caught in the middle of this, that are frankly more important to me. And I believe that the biotech industry has to change, but our trade policies have to change, and we have to put pressure on George W. Bush and the Republican administration to force some change and have medicine that people desperately need more affordable.
Q: Reimportation of drugs. Deval Patrick.
PATRICK: I think I would agree with Tom on this, although I'd say it's a band-aid. It's not a long-term solution, and my interest is in bringing the biotech firms to the table to help figure out what a long-term solution is. One of the points that you hear from biotech today in Massachusetts is the availability of free drugs for folks who can not afford prescription drugs. What can we then leverage from that activity, those initiatives that the biotech firms are pursuing as a quid pro quo for making a more welcome and successful business environment for them? Those are the kind of questions I want to pursue.
Q: Chris Gabrieli.
GABRIELI: I'm fine on attempts to reimport drugs. I've spent my career in that industry. I don't think it's going to hurt, because what'll happen right away - if there was ever any significant amount of drugs coming from Canada, that supply will get cut off. So it's a bit of a political gimmick, because the pharmaceutical companies are never going to let all of America get Canada's prices. They'll jack up Canada's prices. Tom's right to say, it's a crazy world in which we live, in which we pay in the U.S. far more for a drug than people right across the border with a pretty comparable cost of living do. But, the solution isn't going to be, we're ever really going to get Canadian prices in scale, because at scale the pharmaceutical companies will change prices. So, I do think the biotech industry is really important. They should focus, as the companies I think I've been involved in have, on innovative drugs that are going to hold patents and are going to be well-rewarded, not on me toos and jacking up prices through marketing.
SAHL: Martha, our final question in this round.
Q: Mr. Patrick -
Q: The state's new health care law is projected to run a deficit in the third year, even under optimistic scenarios. That's your second budget year. Where would you go for more money?
PATRICK: Well, I think, as I said, the efficiencies that we have to bring out of the system, where we spend 30 cents on every dollar administering the system, is where we have to go for more money. And I think some of the strategies there that can help are greater use of technology to manage and maintain records, smarter bulk purchasing strategies for prescription drugs. And I also think uniform codes and forms for reimbursement. You know, I lost my mother a year ago, and she had insurance, having retired from the post office. She had a combination of uterine cancer and hepatitis, so each one made the other hard to treat. Her primary care physician said it's urgent that you get the referrals to specialists. Six weeks later we get those urgent referrals. You go in, it's a minor miracle if the patient record is there when she's there. And behind the reception desk is a whole team of people, good people, just moving all the paper around. You can see the 30 cents on every dollar that we spend, and it seems to me we've got to get those efficiencies if we're going to afford, genuinely, universal health care. And universal is - it seems to me, has got to be the ultimate destination.
Q: It's a stretch to think you can accomplish that, I think, in two years. Where would you go for more money immediately?
PATRICK: Well, I'm hoping that I can accomplish it in two years, and I'm certainly going to be working real hard to do so. I think if there are shortfalls and we have to look to how we steward the surplus that we have in the budget right now so we're prepared for that, and we're continuing to grow the economy so that that money is there when we need it.
SAHL: Quickly, where's the money?
REILLY: Martha, my neighbor came over to see me the other night, and he's got two young sons, and one of them sprained his ankle, little league baseball game. And he said, Tom, and he showed me a piece of paper, what do I do with this? And he had a bill for an emergency room visit of over $1100 for something that was not a major thing. And it was an endless back and forth between the hospital and the insurance company, who was going to pay? I'm going right after those administrative costs and I'm going to force the change that is necessary. That's what governors do, they lead, force the change. Better use of information technology, go at the cost of health care. That's the only way we're going to be able to do this to make it more affordable for everyone.
SAHL: Chris Gabrieli.
GABRIELI: I'm a big fan of innovation and change. Martha, your question's just right. One of the recent things I've said, we should have five year projections. As governor, I will present those on the budget, as not to kid ourselves that a program we can afford in year one isn't going to be a problem in years three and five, number one. Second, that's why I've said, I don't think the numbers add up. It's fine to sit here today with a plan where there isn't even estimates what people are going to pay and say, this is a great plan. The reality is, when you've got only a fifteenth of it being proposed to be paid by the employer, and the rest of it by working poor folks and the government, we are probably going to have a real problem unless we're more honest about who's going to pay what over what period of time. And I think, promising what you can deliver, not what you can't, is what we need in a governor.
SAHL: All right. That concludes the first part of our program. Our thanks this evening to Martha Bebinger from WBUR, Robert Keough from Commonwealth magazine, Allison King from NECN, and Frank Phillips from the Boston Globe. We'll be back with more with the Democratic candidates for governor of Massachusetts in just a moment.
SAHL: Welcome back to the second part of our forum with the Democratic candidates for governor. In this section, we're going to open it up a bit, give it a bit more room to breathe. I have questions, and we'll just see what happens. I want to ask all three of you to engage tonight in a way that you have not engaged so far in this campaign. One of you has to emerge as the victor in this primary campaign.
SAHL: At least that's the way I read the rules.
PATRICK: That's the idea.
SAHL: You all talk about why you are the best qualified candidate. I want you to tell us tonight why these other opponents are not. And you can volunteer to start, or I'll pick somebody. Policy, position, or experience.
REILLY: First of all, it comes down to experience. That's a big factor. Massachusetts is going in the wrong direction. We've lost population, we've lost jobs. Steadily declining standard of living for our people. We need to change. But you need to have the experience to change. I have that experience.
SAHL: Now, you're the man because you've been there a long time.
REILLY: And I have a vision for Massachusetts. I have a vision for - proven record of getting things done. You can't make up Harvard Pilgrim. One million members in danger of losing their health insurance -
SAHL: Tom Reilly, you're not answering the question. You're telling me about you. I want you to tell me about your opponents and why they should not be governor. They don't have the experience?
REILLY: The lack of experience, particularly at this level. The lack of a proven record of being a -
SAHL: At this level? You were an assistant attorney general. Deval Patrick.
PATRICK: You know, I think - I appreciate your question. These are fine men, but I think that -
SAHL: We know that. Tell us why they shouldn't be governor.
PATRICK: Well, I think that the state is ready for something other than the same old, same old. And I have a range of life and leadership experience different from either of these two candidates. I've had leadership experience in government at the highest levels, in the Clinton administration, as you've said. Also in business. I've managed now thousands of people and hundreds of millions of dollars across multiple
continents. I have experienced leading in community groups and not-for-profits. I understand how those worlds work and how sometimes the best solutions come from partnerships between government and those different worlds, and no one else in this race, Democrat or Republican, has that range of leadership experience.
SAHL: Chris Gabrieli, you've met a payroll, right?
GABRIELI: Sure have. R.D., look. You're asking us to cast the gauntlet down against each other, and we certainly are doing that in this race. But I want to cast my gauntlet down against Mitt Romney and Kerry Healey. These are people who have had a chance to get results. I want that job because I would get results, as I have all my career. And I have -
SAHL: But you have to beat these two candidates to get there first.
GABRIELI: I understand that, and I think the voters are going to make their decision on who they think can get results. I don't think it's about, in the end, any of the other arguments. I think they want to see, do you understand that kind of accountability? When you talk about education, have you done anything about education?
SAHL: Is there a policy position where your opponents are just flat-out wrong, in your view?
REILLY: Tax rollback to 5.0. That's a big difference.
PATRICK: That is a difference.
REILLY: That's a big difference.
SAHL: Where are they wrong?
PATRICK: Well, my view is that we ought to postpone the rollback to 5% because we have so many unmet needs, and if we want to grow the economy we're going to have to invest in cities and towns and in our infrastructure, because that's how businesses make their decisions. And we can't do that at the same time we afford today a rollback to 5%.
SAHL: Where are they off-base, Chris Gabrieli?
GABRIELI: I think you should lay out to voters exactly how you're going to get to 5.0. I think it's fiscally irresponsible, just like they've been doing in Washington, to say we can do it today. That's why even Romney doesn't say we can do it in one step. I also think, to say that we'll get there someday, we hope, maybe is not credible enough to people who voted for it and who are squeezed in the middle class class. There is a very clear way to do it. It's what I've been involved in since 1998, to propose doing it based on economic triggers. It's what the legislature's at, but they ought to accelerate it significantly because they can. That's why they're talking about things like, as soon as we get to 2002 local aid levels, having it start to trickle in -
SAHL: Chris -
GABRIELI: You've got to be honest about how you're going to do it. Election year promises can't be filled -
SAHL: Yes or no.
REILLY: OK, least of all is being open and forthright on it. You're either going to do it or you're not going to do it. If you're not going to do it now, we're never going to do it. I'm in favor of rolling it back, and where are you? Is it yes or no?
GABRIELI: Yeah, Tom, I'm exactly where I say, Mass Taxpayers Foundation and other responsible people who don't, in an election year, say - Tom, Mitt Romney and Kerry Healey said four years ago they were four it. They haven't made a bit of progress on it because the legislature won't go along with a fiscally irresponsible proposal. A responsible proposal says, as the economy continues to expand, as we can afford it, we can get their fast, we can go faster -
REILLY: We have the money right now.
GABRIELI: I think we should show people -
REILLY: We have the money right now.
GABRIELI: Well, you know, I looked on your Website, Tom, and I looked to find the $500 million you keep talking about that we have extra next year, and I've got to say, I couldn't find it. Because I'd love to be convinced we could do it. I -
REILLY: That's all you have to do, is look at the revenue projections for next year. It's there. It is there.
GABRIELI: It's not on your Website, because I (inaudible) -
PATRICK: I disagree that if we don't do it now, we'll never do it. What we have to get here is sustainable economic growth. The way we will get that economic growth is by investing in ourselves, because that's the judgment businesses will make. They want to be in communities that function, where the infrastructure is intact, where the schools are decent. So if we don't invest in ourselves, we can not expect that economic growth. And without that economic growth, we can not afford a 5% income tax rate.
SAHL: The constitutional convention meets in a little less than two weeks here. Among the items on the agenda, the definition of marriage amendment. Some suggestion that it may be kept from a vote by parliamentary procedure. Should the legislature vote on this amendment, yes or no?
PATRICK: You know, I will tell you. I think the SJC got it right, and we ought to move on.
SAHL: You've said that. Should the legislature vote on (inaudible)?
PATRICK: I wish they wouldn't. I'm not in the legislature, but I wish they wouldn't. I think we have had enough of this debate. I've been married for 22 years in a straight marriage. There is nothing about gay marriage that threatens my marriage. The basic question here is whether people come before their government as equals. The SJC has said, yes, that was the right outcome. Let's move on.
REILLY: I'm opposed to the constitutional amendment, but yes, I think -
SAHL: You've said that.
REILLY: The legislators should vote, should vote on this. I would vote against it if I was a legislator, but they should vote on this.
SAHL: And Chris Gabrieli.
GABRIELI: I'm against the constitutional amendment. I would - the next governor - I think the important question is, is the next governor someone you can trust to work hard to defeat that amendment? I would. I've been a supporter of equal marriage for years, held the first fundraiser in my house of anyone who's straight. So I believe very strongly that we should get to equal marriage rights, and I would make sure that, if it goes to a vote, voters in Massachusetts reach to the best of themselves and continue with something that has been good for our state.
SAHL: If being the conditional word here. Is it fair to use parliamentary procedure to keep this from going to a vote? Anyone?
PATRICK: Look, you're asking a question of a would-be chief executive about how he would behave if we were in the legislature. I'm going to let the legislature run the legislature -
SAHL: But there's a system of tension and checks and balances in that system as well, right?
PATRICK: Well, there is. And to that point, and to that point - and it's a good one - the SJC has a role in the system of checks and balances as well. They made a judgment about the interpretation of our Constitution that was in favor of expanding equal rights. That is something I've been working on for most of my professional life. It should have ended there, and frankly, I think it was an unhelpful and unnecessary thing to advance the argument this way by certifying the ballot amendment.
SAHL: Why did you certify the ballot amendment?
REILLY: First of all, I had a constitutional responsibility to serve that ballot initiative -
SAHL: But there are advocates here who say that you ignored the Constitution, because this is (inaudible) -
REILLY: Then I followed the same policy for over 20 years followed by attorneys general, and I certified, and I did my job. First of all, I'm opposed to the constitutional amendment. I'm very confident that most people in this state agree with me, and if it ever comes to a vote, I will continue to oppose that, and I believe it will be defeated whenever - if that happens, I believe it will be defeated, and it should be defeated.
SAHL: Repeal the 1913 marriage amendment?
GABRIELI: You mean the law?
SAHL: Yes, the marriage law.
GABRIELI: Yes, I would do that, but let me just say, R.D. -
SAHL: Repeal? I'll come back to you. Repeal the 1913 law?
REILLY: I think we should respect the rights of other states to make their own decision on this issue. We've shown them the way to get it done. It's working very well in Massachusetts, so I think we should respect other states' laws and their right to make their own decisions.
SAHL: Repeal the law?
PATRICK: Repeal it, yes. It has very suspect origins to begin with.
SAHL: Understood. Go back, Chris Gabrieli.
GABRIELI: I just want to say, you're asking us about what the legislature should do. Let's talk about what the governor should do. We have one. Sometimes it's forgotten for obvious reasons, because he's not in state much. We have a governor who's out there right now pushing the gay marriage amendment issue, just as we have a president doing that. Why? It's an election year. It's what the Republicans have been up to for a while now, is divisive social issues at a time when their record on fiscal discipline, their record on job creation, their record on making this a more affordable state, their record on improving education for kids, is poor. So, I hope this year's election is run on the record of this administration. Kerry Healey will say, elect me to give me another four years. I think that record's poor. I think we can get much better results. And I expect a lot of other divisive social issues to be floated by them in an attempt to distract people from what's really at stake, which is a lot.
PATRICK: If I may, R.D., I think Chris makes a very, very important point here about how this and other divisive issues are used for divisive reasons and for political reasons, and we have to see it that way. There are anxieties that people are feeling all over the Commonwealth, frankly all over the country, about getting - and if they have one, keeping - a good job, and educating families, and health care. And that is what we ought to be focused on, not on these issues that pull us apart.
SAHL: Let me move on. Should the Supreme Court of the United States overturn Roe v. Wade? The abortion debate will come back to the states. In fact, it arguably already has in some measure, in South Dakota for example. Should that happen, and this issue return to state government, as governor, would you favor, or what restrictions if any would you favor on access to abortion through the term of a pregnancy?
GABRIELI: I'm pro-choice. I think the laws as they stand in Massachusetts are just about right. I certainly think abortions would be better if they were rarer, but they should be safe. They should be legal. I think this state has got it right, and I'm confident Massachusetts would continue to lead on that issue. So I think, happily, I don't think that will be an issue in Massachusetts.
REILLY: I'm pro-choice as well, and I agree with Chris on this. I hope that doesn't happen, with the United States Supreme Court and overturning Roe versus Wade. I think the court has gotten it right, and I hope we don't go back to that time.
PATRICK: I'm pro-choice as well, and I think the law in Massachusetts is, as Chris says, and as Tom has said, just about right where it is right now.
SAHL: Any of you ever hired an undocumented worker?
PATRICK: Gosh, I don't think so.
GABRIELI: Certainly not to my knowledge.
SAHL: OK. What should the role of the governor of the state be in enforcing immigration rules and regulations?
GABRIELI: Well, that is a place where I've obviously disagreed some with my opponents, really chiefly on the issue that I think it's important to draw sharp distinctions between legal and illegal immigrants. I think legal immigrants are a key part of this society. My parents are legal immigrants, and I remain pro-legal immigration. There's a lot more we can do, making English as a second language available, for example, not waiting a year or two in line for that.
SAHL: Should the State Police be enforcing immigration?
GABRIELI: No, that was a gimmick of Romney's in an election year to say 40 state troopers are going to do who knows what. I think what is important is to recognize that there's clear, documented evidence that, for example, state contracts are allowed to go to people, employers, who do abuse and exploit illegal immigrants. That 15-year-old shown in a picture getting $6 an hour in a dangerous place in the building. And I do think there's no excuse for the fact that we continue to give state contracts to employers who clearly abuse that, not to the help of those people, and absolutely taking work away from middle class Massachusetts residents trying to hang in the middle class, and I think we should get on enforcement against those culprits.
SAHL: So bring the hammer down on state contractors.
PATRICK: I think that's right. I think that this is an issue which really requires a better partnership between state and federal government, and the appropriate leadership at the federal level, in terms of both the correctness of the rules for legal immigration and enforcement of the rules against illegal immigration, so that the balance struck by the McCain-Kennedy bill, the proposal which gives more resources for border control, but also a path to citizenship for families that are here and contributing, seems to me to be right.
SAHL: Closings in one minute. Go ahead, Tom Reilly.
REILLY: We should enforce the laws against those companies that are violating our labor laws and wage laws, which is exactly what I'm doing. I believe the job of a governor is to lead, to take a step back, fight for tougher security and tighter security on our borders, but also recognize the economic reality of what we're faced here. I, too, favor a bipartisan approach by Senator McCain and Senator Kennedy as well. I believe that's the way to go. This requires a national solution.
SAHL: Well, the hour has flown by, thanks to you for your answers and questions this evening. We have allowed a minute for closing statements from each of you. Tom Reilly, we'll start with you.
REILLY: Massachusetts is a lot like I was when I was 18 years old. I was struggling then, a great deal of tragedy in my family's life, and lost interest in school. My grades, they were absolutely terrible. I barely graduated from high school. And there were those that said I didn't belong in college, and wasn't good enough to go to college. But there were others that believed in me, and they cared about me, and they saw potential in me. And fortunately, I had the opportunity. I worked my way through AIC in Springfield, and Boston College Law School, and that's given me the wonderful opportunities that I've had to live up to my potential. I see the same potential in Massachusetts right now. We are a great state, enormous assets, colleges and universities and hospitals. But our greatest assets are you, our people. Their drive, their determination, their skill. We need a governor right now who believes in Massachusetts, who cares about you, who will work very hard to make things better in your life. I've done it as the district attorney of Middlesex County, I've done it as attorney general of this great state. I'll be a governor who's on your side.
SAHL: Deval Patrick.
PATRICK: R.D., thank you, and thanks to the sponsors as well for bringing us together. I'm glad to be here, and I'm glad and proud to be running to serve as your governor. I grew up in a neighborhood where every child was under the jurisdiction of every single adult on the block, where if you messed up down the street in front of Ms. Jones's, she would straighten you out as if you were hers. And what we learned in that neighborhood, on the south side of Chicago, a poor and broken neighborhood, was that the adults had a stake in us, and they expected us as kids to understand we had a stake in each other. I've been here in Massachusetts for most of the last 36 years, since coming here at age 14 to go to school. And it was education, frankly both on the south side of Chicago and here in Massachusetts and in Milton Academy and in college and law school, education that transformed my life, where there were teachers engaged and caring about not just what we were going to do from a career point of view, but what we were going to become from a character point of view. And when I look around and I see all these challenges facing us here in Massachusetts, working families, entrepreneurs, there seems to be nothing beyond our capacity to care about and solve, because that is the kind of investment that Massachusetts people and institutions made in me. And I want to return that favor. Thank you.
SAHL: Chris Gabrieli.
GABRIELI: Massachusetts is stuck. We've got Republican governor, Governor Romney and Lieutenant Governor Healey, who have not gotten the results people expect or want from state government. We have population leaving our state. We're 46th in job creation. It's time to elect a governor who wants to serve full-term, more than one term, wants to get results, has a track record of getting results. Big promises are nice to put out, especially in election years, some of which could never be fulfilled. What people want is someone who has a personal ethic, a personal commitment, a personal track record, of taking on issues and getting to results. If it's education, as we've been discussing today, not just being for better education, doing something about it. I think thousands of kids in after-school programs across this state, being the first state in the nation to move beyond 180-day, six hour schedule to something bigger, a project I've led that's actually coming to fruition in our state, and I wasn't even in elected office. That's the kind of commitment to results that will move beyond rhetoric and make a difference in people's lives. When it comes to economics and job creation, a governor who's got the experience in creating those jobs and the commitment to getting those results. That's what makes me distinct as a candidate for governor. I understand what it means to get results, and I will be accountable for those. That's why I'm running for governor of Massachusetts.
SAHL: Thank you very much, Chris Gabrieli, Tom Reilly, and Deval Patrick.
ALL: Thank you.
SAHL: And thanks to our sponsors as well, WBUR, MassInc, the Boston Globe. I'm R.D. Sahl, NECN. Good night.