This is the first installment of the Harvard Political Review‘s interview series with Massachusetts’s candidates for governor. Donald Berwick, one of three Democrats remaining in the race, previously served as the administrator of the Centers for Medicare and Medicaid Services.
Harvard Political Review: What are Massachusetts’s most glaring problems as Governor Patrick leaves office?
Don Berwick: I’d say poverty and inequality and their derivatives. We continue to be a state with high levels of disadvantage for significant portions of our population that get reflected right across the board in terms of variation in performance of schools, in poor access to suitable housing, and in continuing homelessness for thousands of people. It continues to get reflected in people feeling they can’t have secure jobs. They can’t get to and from their job. They can’t make ends meet even if they are working full-time, and that’s a plague in the country, and it’s right here at home.
HPR: A clear issue as well is healthcare, and that is something in which you have a tremendous amount of expertise. I’m curious, what challenges did you face when you were leading the Institute for Healthcare Improvement (IHI), Medicare/Medicaid, or the National Demonstration Project for Quality Improvement in Healthcare, and how have these challenges helped prepare you for being governor?
DB: First, I’ve worked for thirty years on trying to make healthcare better in this country and all over the world. We still have a long way to go. So Massachusetts has the same issues with healthcare performance that much of the country does. The two big ones are the way the healthcare delivery system functions: it doesn’t actually meet the needs of patients and families with a level of reliability and commonsense that it should. It’s very focused on hospitals, for example, but we can do a ton to make sure that people never go to a hospital, stay home if you have a system focused on teamwork and prevention and anticipating problems instead of trying to catch up all the time.
We could have a better healthcare system, but it’s going to take gubernatorial leadership to help us get there as we try to migrate from a system that is really focused on volume. It makes its money on volume, producing health. That’s been my wheelhouse for substantive work for years and decades, and I can’t wait to try to bring that to the Commonwealth. Part of it is a broken payment system; the fragmented payment system in healthcare is extremely costly. It hurts businesses because businesses bear those costs in an employer-sponsored insurance system, and it hurts the commonwealth because such a big chunk of the state’s budget, forty-two percent of the state’s budget, is healthcare. If we’re going to work on poverty and justice and opportunities for people, we need to have money. We can’t afford to waste it.
I am the only candidate firmly supporting Medicare for all at the state-level in a single-payer healthcare [system]. I’ve seen that through my whole career, and I know that it can do better for people at a lower cost. I ran Medicare and Medicaid, and it’s a single-payer system for 47 million people and our overhead rate was miniscule compared to what it is in the complex insurance system. The other thing about my background, although it’s a healthcare background, is that I’ve been an executive for my whole career. I started a non-profit organization, IHI, as you said. I grew it from a seedling grant to one of the largest organizations in the world that works on healthcare, so I know what it’s like to build an organization and help it thrive. We never laid off a single person, even during the Great Recession. I did have the experience in Washington of running the largest agency in federal government, by budget – it’s $820 billion per year – and that was a chance both to use my executive skills and to understand even better about what can happen when government agencies and functions are well led. All of that I want to bring to the corner office.
HPR: Transitioning to education, another subject about which you are very passionate. Your website states that one of your goals for Massachusetts is having an education system that gives every student the opportunity to succeed. How do you plan on evaluating teachers to ensure that Massachusetts’s students are learning from the finest? Also, as someone who attended Massachusetts’s public school system, what is your plan for the Massachusetts Comprehensive Assessment System (MCAS), and do you fear that teachers will teach to the test?
DB: I did go to Massachusetts public schools, all of my children did. They were raised in the public school system here. Overall, my education plan involves three different major components: one is universal pre-kindergarten, so three and four year-olds are getting ready for school; a second is reform of what you are talking about, which is elementary and secondary reform; and a third is better support to the public higher education system – twenty-nine community colleges and state colleges and universities in the commonwealth are a terrific resource.
Back to your question … the pendulum has swung much too far toward standardization and, as you said, teaching to the test. That means that teachers are feeling like they haves handcuffs on. They’re not allowed to exercise creativity and focus on the development of the whole student and learning in the broadest sense. In the school system, they end up in a compliance-oriented system, which is always a mistake. When I ran Medicare and Medicaid and IHI, one of my major focuses was what kind of executive leadership, what kind of management actually helps people grow and develop, instead of demoralizing them. So, we need to push that pendulum back. Keep some of the testing, of course. We want to know how things are going, but we need to invest far more in teacher development, which supports teachers to acquire even better skills, share what they’re learning, and to focus on the development of the whole child. Teachers are not the problem; they are the solution.
The important thing here is the [teacher] evaluation process. It’s the process of learning and exchange through which these professionals can develop into even better professionals. That would be my philosophy and my approach with respect to the education system. There are other technical issues around resources. Massachusetts, as you may know, has a formula for distribution of support for cities and towns, and the formula has not been revised in twenty years. It really needs to be redone so that the places that really need more help can get more help.
HPR: Do you plan to do that as Massachusetts gets rolled in with the Common Core curriculum being pushed by the Obama Administration?
DB: Yes, yes. I think Common Core, as I understand it, has some advantages over the MCAS system. It’s a little more open-minded in terms of how it’s concerned with problem-solving skills, not only so much knowledge acquisition. Even that is too limited. I want to be a governor to help our school systems expand the supports for the arts, the development of ethics, and self-esteem and citizenship skills in students. That goes beyond anything a standardized system can capture.
HPR: A recent survey by Thumbtack and the Kauffman Foundation found that Massachusetts’s small businesses gave Massachusetts a D+ in employment, labor, and hiring regulations, an F with regard to environmental regulations, and a D in ease of starting a business. You stress innovation and making Massachusetts an attractive place to do business. How can that happen at the small business level? Specifically, what obstacles do you plan to remove, or what legislation will you hope to add or push to make Massachusetts a more attractive or alluring place to start a business and to hire and employ?
DB: There are five, at least five, elements to what a job growth or business development strategy would look like from a progressive point of view. The first is smart growth: having communities that have the support to develop mixed-income housing, safe transportation options, parks, good schools in the neighborhood. When communities are attractive, then businesses go there. When people go there, businesses go there, and that’s jobs. So smart growth and community development is key.
Second is the innovation funding system. We have several in the state in biotechnology funding, clean energy – and they pay off handsomely. I would increase our state’s use of small amounts of capital and low-interest loans: things that help entrepreneurs get started. I think incubating innovative industries pays off a lot.
The third is education reform. You and I just talked about that, but there are ways to get schools better aligned with businesses and communities. I’ve seen this develop worldwide. There are good examples around the country. Schools and vocational schools that are in better relationship with the needs of the economy help grow business.
The fourth area is worker rights. We should be the best place to be a worker. We need worker pay to go toward a living wage with earned sick time, disability benefits, and equal pay for men and women. Seattle is going to a $15-hour minimum to wage, and they’re no fools. They know that that money circulates and generates business.
And the last that I’ll mention is business friendliness. There are business regulations that make no sense, and they hassle business. I think it’s perfectly fine as a progressive, and I’m the boldest progressive in this field, to talk about simplification of the atmosphere of businesses, to make sure that everything businesses have to do under regulation actually helps somebody and isn’t just left over from the nineteenth century. The other thing with policy in respect to business is single-payer healthcare. If we go to Medicare for all at the state level, according to the models we now have (which are well-worked out for Vermont and would apply here), healthcare costs would fall very quickly and very dramatically, and we’d get the burden of healthcare costs off businesses. They have money now to invest in innovation, planned expansion, better deals for their workers, and product development. So there’s a sample of policies that I would be using to try to grow the economy and the opportunities for businesses.
HPR: You mentioned clean energy as a means of strengthening the state’s business environment. You desire for Massachusetts to be the first carbon-neutral state, but what’s your opinion about the proposed Tennessee Gas Pipeline that goes across Western Massachusetts and terminates in Dracut? The pipeline would dramatically increase natural gas supply, although it passes through precious ecosystem territory.
DB: Yes, I’m very concerned about [the Kinder-Morgan pipeline]. I’ve said that I do not think it should be built given the current information we have today. We don’t yet have a plan for gas supply. The commonwealth will need some gas, but I’m not at all convinced that we can’t have the natural gas we need without building this very expansive infrastructure. And, in the long run, we should be decreasing our use of natural gas. That would be the plan. I have trouble understanding why we would build an enormous, massive, multi-billion dollar infrastructure when our policy agenda would be to not need it. From the data I’ve seen thus far, I’d definitely hit the hold button on that proposal.
HPR: Lastly, a recent Boston Globe article has indicated that the Massachusetts’s Teachers Association is currently lobbying to water down the current disclosure bill that is in the state house. I’m curious what your opinion is on campaign finance reform and whether you’d be interested in Massachusetts reverting to public-financing of elections.
DB: Yes, I believe that we need dramatic campaign finance reform. With the donation limit we have for the gubernatorial race, which is $500 per person per year, that is a good rule, but the influence of big money is still evident everywhere. I think we need much more transparency. I’ve stood firmly in favor of increasing transparency among PACs and Super PACs – who donates what, when – instant information on that. I would love to see us go toward campaign finance reform as far as full public-financing of campaigns with limited duration and limited total expenditure. That would help campaigns make far more sense and be less whipsawed by the role of big money, which controls far too many votes and far too much energy in campaigns.
This interview has been edited and condensed.
Image Credit: Wikimedia Commons