Its my pleasure to introduce the president of American University Sylvia Burwell is u. S 15th president. And first woman to serve as president under her leadership. American became the first Carbon Neutral university in the united states, the first to launch an Antiracist Research and policy center. President burwell also helped to double our externally funded Research Dollars in just five years. She led creation of our comprehensive Strategy Change makers for a changing as well as our plan for inclusive excellent both of which have community at their core and are focused on ensuring all eu students can thrive and reach their full potential. President burwell, the university through the challenges of the last two years. We we were lucky to have a president who served at the highest levels in washington as secretary of health and Human Services and director, the office of management and budget. We could not have predicted how important those skills would be, how essential they are now as we emerge from even better from the pandemic. Im personally thankful for her partnership and support of both me and as epa. Please join me in welcoming president burwell. Your special guest for the evening, governor charlie baker. Governor is the 72nd governor of the commonwealth a message says he has proudly served this role now in his second term, the governor has moved massachusetts forward so it focused on bipartisanship and result driven leadership. He has Public Private partnerships to stimulate economic development. He reform the states environment and deliver tax relief to low income workers by doubling the earned income tax credit. He made historic investments in k through 12 education, fought the opioid and diversified the Commonwealth Energy portfolio prior to election as governor, he served in several administrations the state and was also a successful Business Leader in the health care field. We are here tonight to both recognize and applaud his work in result, getting beyond politics to get important work done. The book is an important guide for individuals and of Public Affairs, looking to find our way out of gridlock toward progress and results. Please join me in welcoming the governor. Thank you very much. And thank you for your incredible leadership of our Top Ten School of Public Affairs and number in dc. I will add and amy will hear from you a little later and thank you. Your leadership of the institute of and politics. Governor, thank so much for being here. Im excited. Have the opportunity for us to have a conversation. And im so excited to see all of our students and some other guests from the community i can see and thrilled to welcome you. I thought that we would start this evening by having you talk little bit about the book in terms a book that talks about four key steps to getting results and also a little bit as youre talking about the how students can hear about this book contributes i believe to helping people understand the importance of the role of Public Service and what it can mean for them. Because we have so many of our students who are engaging in that study, we are hopeful well go on to serve in ways that both you and i have had the opportunity and chance to share. So if you can start by talking a little bit about the book would be great. Okay. So first of all, thanks very much for having me here. Sylvia is actually one of the people who reviewed the book and truth be told, she had given it one of these. It probably would have gotten published. I got to know her when i was governor of massachusetts and she was secretary of health and Human Services because we had to negotiate a five year medicaid waiver with her and with her team. And i and i just want you all to know that having spent 16 years of my life in government eight as governor and an eight as a cabinet official in two previous administrations, the state level i know a performer when i see and you have a great performer in Public Service and your president. Thats my hope that shell take it easy on me for the rest of so the book was written with a friend, mine and a colleague by the name of steve kadish. Steve is a lifelong democrat. Im obviously a lifelong republican. I got to know him when i worked in State Government in the nineties and he and i together on a ton of different projects and he actually he voted in the democratic primary when i was running in 2014 and the republican primary and, ive never really talked about whether or not he even voted for me in the general election. But honestly, he was the easy choice for me to be the first chief of staff in our administration and. That was an odd pick. Usually when somebody gets elected their chief of staff when they enter office is who worked on the campaign and usually its your Campaign Manager or, you know, your Senior Adviser or somebody that when i pulled this guy of academia, he was the i think it was the provost at northeastern at that to come work in our administration. It was an unusual choice because he was democrat beat and going to campaign and see he wasnt kind of a non to a lot of people but steve is one of the best operator ive ever seen in a complicated organizational environment and government is very much that and he and i started talking in 2017 about writing a paper about sort of after 30 years of working together, public and, and in private industry, we thought it would be good to try to put some of that on paper because theres a lot of theres a lot of Academic Research what and why and and policy procedure and all the rest. Theres not much about how and theres a lot of how. Thats written in the private sector. Theres not much how thats written in the Public Sector. And how part is when you actually take the grand idea and turn it into real and in our view and we say this in the book, is that one of the things government to understand and the people who work in it need to understand is that if dont deliver on some of the promises, the commitments you make, you create a certain amount of cynicism in public generally and and the tendency in the Public Sector many times, especially among politicians ive probably been guilty of this is to over overpromise write and if you dont deliver what you say to people is its sort a negative message about whats possible and and i think one of the things this book is about is trying to say to a lot of folks, both practitioners and others that theres a lot thats possible and if you think about it through a framework, this one, you can get a lot accomplished. And that ability to get things done to accomplish them focus on that how, in my view, is part of what builds up the value the approach and the belief in what the Public Sector can and the book basically has four elements of the framework. The first one is people are policy and there are a lot of people who think people are interchangeable theyre not building a team is the most important thing. Anybody in any complicated has do and it should be respected and appreciated and taken enormously and and steve and i spent enormous amount of time both during the transition transition before we took office and today hes not in the administration anymore. I still talk to him all all the time about. Personnel, people ultimately will in many cases, whether you succeed or not. And you need you need people who are subject matter experts. You need people whove managed in some environment before and demonstrated they can do it. And you need people who can be team players and and i know that sounds common sensical, but im telling you time and time again, people pick one out of three or two out of three and discover that theyve miscast somebody, that theyre not in the right role and. And that creates all kinds of challenges and for everybody else. The second is to follow the facts and theres two sets of facts you have to follow. One is what i call the hard facts, you know, the data, the information, the metrics way you measure it. The second part of following the facts is what we call points of pain and its what are the things youre hearing either from the people who are working in those entities or the people who are supposed to be served for them . What are they saying . You day in and, day out about how youre doing and how its going and steve and i work together, a Health Insurance company, a nonprofit called Harvard Pilgrim Health care, went into receivership. We basically were part of team that turned it around. It was the number one ranked health plan in the country for the last seven years. I was there for Member Satisfaction and clinical effectiveness but a huge piece of that turnaround was what was coming into the call. Both the provider call center and the member call center. And we collected that data and, that information, and a lot of that became the core of the problems to be solved. And i cant tell you how important it is most people, they just focus on, you know, the metrics, the spreadsheets you got to get to the points of pain. The points of pain are usually going to come from your customers, your vendors, your suppliers, people like that. The third part is to focus the how. And that means to really get real about what is it thats actually to make this better and to be willing to recognize, understand that the how may mean having change the way you do things and you cant power through it if you take seriously the stuff you learn around points of pain and you take seriously the information you gather from the the data thats available to you you will have to change the way operate. And in the Public Sector, particular, that can be complicated and difficult but you have to understand and recognize that thats a big part of getting there and. Then the final piece is push for results and and the way to think about push for results is track how youre doing and if its not working, have dont be afraid actually change what youre doing if its not getting you where you need to go in the Public Sector one of the hardest things to do to say i know three months ago i said we should be going this way but we need to be going this way. Just continuing. Go this way because youre uncomfortable acknowledging that you should be doing differently. All that really does is just, you know, now youre just into hole and youre digging a deeper and and one of the great challenges everybody in any big organized nation faces is are you willing to push for results even if they mean you got to acknowledge that some of what you were doing wasnt necessarily going where you wanted to go and you really need to go over here instead, but thats basically the framework. Thank you thank you. And want to let everybody know were going to do some questions from the audience at the end. So be thinking or i can cold call we need to if we get to that so in your book you argue you say Government Services are not just what should expect. They are necessary to nurture and protect our democracy as we think about this question of the chicken and the egg. Yeah. How much it is we got to have democracy before we can actually get the other things working versus other, you know, getting the policy, what we talk about in the book, how you think about that relationship of without a fundamentally working democracy we cant solve climate issues. We cant work on Mental Health issues. We cant work on addiction issues. We cant work on health. How do you think about that which we have to have working . At what level . I think theyre i think theyre related. And i guess what i would say is no ones ever really answered the chicken and the egg question. But the way i think about it. But you get results so i think you going the way i think about this is synthesis is what breeds. I mean thats just i know thats an old saying but a lot of those old sayings get that way because theyre true. And i think when when when government actually does something well that does just the opposite. It creates a sense among people that, yeah, that can be done and. And i think the belief in that is incredibly important if youre trying to figure out a way to sustain this idea of purpose, of democracy, i mean, if you look at the places where where autocrats and autocracies rise, theyre usually in places where. The argument they make is just give control of everything and everything will work, you know, the old saying about about mussolini in italy was he made the trains run on time. And i think i think the most important government has to do is demonstrate it can perform. And if it demonstrates it can perform, then people will be more likely to be willing to engage. And if you look, for example whats and and governments up against a lot of externalities i mean if you think about the role that the media and social media play i that is theres a lot of outrage in that game and theres a lot more negative anti than positivity. And most of the time you know the airplane that lands at the airport every single day the way its supposed to is not news. The one that crashes is and thats an old story but its also still relevant when government does what its supposed to do, its pretty hard to get people to Pay Attention to that. But people do it. They do experiences. One of the things we talked about in the book when we took the Lieutenant Governor and i discovered that there were 55 communities in western mass held towns mostly that didnt have access to High Speed Internet Service and and there were a bunch of reasons for it, which i wont into, but giving it to them, figuring how to actually make it work in communities. You were going to have two or three times as many telephone poles as you had people was a logistic challenge and and it was expensive. But we did it because our view was this is like water or electricity. You know, you cant live in and this is before the pandemic. Cant live in a 21st Century Community without it. And most of these places, you know if you wanted to use the internet, youd have to go to the library or sit out in the parking lot outside the pizza. Pizza shop. Or maybe you could drafter off the university if you had one. And i used to draft up Suffolk University when i was in State Government is wi in the statehouse is a very good but the interesting here was we about 45 of those community is hooked up by march of 2020 and the other ten were on their way there. Those communities. Believe the Government Works because we solved their biggest and greatest heartburn, which was their inability be part of the 21st century and. I think i think we underestimate the power of doing something well and and i think the. I think that i that does matter when it comes to the issues associated with democracy. The there are a lot of people who are cynical about lot of things. And and you give, you know, you give, you give fire to those who want to promote that. When you dont get something done and get it reasonably well, i will well kind of stay on the democracy theme a little bit throughout. And one of the ways i want to stay on it is we had a survey that was conducted by the sign and it was called the sign of things to come, and it found that its pretty clever by the sign institute sign of things to come. I looked at branding and what it said is that it found that young americared wh the state of our democracy and feel its hard to make given the way the is set up. And when you about that question, there were that premise thats being expressed by young people across the country what percentage of that problem the articulation that the problem is system what percentage of that problem is substantive and percentage of that problem is a communication that were just not explaining to our young people how the system or that it does work. So you were putting percentages, how would you put this system . Can you tell me again what the what the system theyre dissatisfied with the state of democracy and feel. Its hard to make Progress Given the way the system is set up for them to make progress as people or for the government issues to make issues to make progress. Looking at, amy, to has looked at it in depth. But yes that was understanding of the system. I guess id say a couple of things. One is government plays at multiple levels. I think one of the Biggest Challenges we have is that most people pay a lot of attention to whats going on in their local or their State Government, which you know as somebody whos been a big piece of my career, both that makes me because a huge of the government that matters to and will matter to you is going on at local and State Government and the you know, the price the house you can afford to buy the apartment can afford to rent the parks that your kids and you will play and walk in the your kids will go to and that you go the traffic. You may or may not have to deal with the the downtowns and the vibrancy them. Im telling you, thats all state and local government and it doesnt get anywhere near the attention or the or the recognition that it deserves. If you look at so. Elections at the local level in massachusetts and i love massachusetts ive lived there for most of my life. You know, i believe deeply in the people and the institutions of, the commonwealth. I went to played all this time in public life. If i didnt a typical municipal election, you might get if you have a great one, you get 30 turnout. Okay. In a typical off year state election where youre electing members of congress, your state reps, state senators and, your statewide Office Holders like me, 50 is huge. Okay. The only time you really get everybody to come to the table is in the on year election when the president up and then you get maybe 75 or 80 turnout and believe it or not, theres a big difference in who votes and what they think. If you get 20 the turnout or 25 or 50 or 75 and, you know, weve been banging the drum on this one hard and it is really to get people to understand why those local and state elections are important and and yet and yet that is a lot of things that will matter to you as young adults will happen and get done. Its not to say that there arent huge issues at the federal level that matter. There are. But i think we dont appreciate. I mean, we got a lot work done in every legislative session ive been involved in and take a lot of the stuff weve done on climate. Its 100 bipartisan. We got one of the most comprehensive police. Police accountability bills in the country passed bipartisan. We were working on that before the murder of george floyd and all the rest that came with that on a bipartisan i think i, i think sometimes washington is kind of different story for a bunch of reasons. And im happy talk about that if you want to. Although i think know more about it than i do. But theres a lot of good that does happen. Government and just people all Pay Attention to it and i think thats too bad. I just want to covid im you in massachusetts. I had a front row seat for the way local governments, nonprofits, care providers, State Government, ems. I mean, it was astonishing to me the way people dealt with that and responded to and massachusetts Commonwealth Fund did a big study of how states covid all 50 and they use 65 metrics to measure performance. We finished just behind hawaii so i think of us as being one a but theyre an island and were the second or third most densely populated state in the country and were not exactly a warm weather place where people can hang around outside. So if you grade it on a curve, i think we would have done better. But the point here is that was a ton of that was states and locals and on the you know i completely agree in terms of this this point about states and things getting done. I put in a plug for itd be great if where we are sitting was a state. I will just mention that in terms of the district as we think through because is important relevant and i will say just emphasize the governors point. He knows this because i went to every angle when i was secretary of health and Human Services, i considered i called myself the secretary of the Kitchen Table because at hhs as you are working on the things that people actually care about at the Kitchen Table, you are working on all the things that make a difference in your life like you dont have to wait in in terms of the issues were working on at hhs and my relationships were with all the governors. How much time did we spend together not on health care charge, addiction, right . Yes. Yes. Im sure you that way and a number of your colleagues felt that i just wanted you to agree. It have been easy. Absolutely. But how much you know, mean how much time did we spend together, john and i spent that time. Vice president pence i medicaid was expanded when i was secretary in the state of and indiana terms of indiana actually had a very large hiv aids problem and worked with then governor pence do Needle Exchange in terms of trying to stop that whats happening at the state level. You know John Hickenlooper and another governor who democratic governor of colorado doing a great job on addiction, you know, in terms of those issues it does happen at the state level. And im fortunate that actually many years ago i did work that state house. There was no technology the state house at that point in time because, i was a governors aide to Michael Dukakis in terms of. So i. I did not know that. Yes, yes, yes, yes. So i spent time in that state house at that point back in the dark ages, you really didnt even use computers much at that point. I was typing on an selectric typewriter to do all of my work but agree that this question and that gets to maybe how we think about it. And i am going to come back to this issue of the difference between state and federal and as we think about that what works at the federal level for a president , is it the same what works for the governor . And by that, i mean, you know, a governor is often judged more by results when a president sometimes judged by results. But there is a part of this in our system that is also being as leader as leader for the nation. It is, you know, as weve just seen, our colleagues in great britain, after we see the death of the queen and, you know, they have a separated system and weve seen three prime ministers in how many weeks. But this question of is it actually different . You were going to go down that path. So, you know, answer is yes. Going, keep going yes, there it is different the the biggest difference is governors basically play on a state stage. Right. And even if its a big state, its not that hard to get from one end to the other. And its not that hard to for people to get, you know, kind of a good look at you and president s represent basically the western world. They represent western democracies have a they have an enormous stage they play on and what they say, what they do. They do it where they go it is very different than it is for a governor. I mean, we get judged on that stuff, but its its a its literally like the difference between playing on a on a very small but important, you know, Playing Field and on the biggest Playing Field of all with far more complexity than the Playing Field on i dont i dont get up in the morning trying to figure out how to deal with whats going on in russia the ukraine. I mean, i think about it in terms you know Reliance Energy prices in this winter but its the difference between the Playing Field at the White House Level and the Playing Field. The state level is huge and the difference in the playing level is huge is the difference in what youre judged on in terms of what you need to be. Maybe a difference in that in terms of this issue of, you know, you know, in great britain, they do have a king or queen in terms of the culture and the representation and youre supposed to be to the entire nation versus like what youre supposed to deliver because those are two Different Things. Yeah, i think. I mean, governors can certainly set a tone and i like to think that the tone we tried to set was sort of skip the noise and worry about the work. But i think the i think theres no question that when the Playing Field gets bigger, its harder to make the connection as personally as you can on smaller Playing Field. And, you know, the Lieutenant Governor of massachusetts karen pulido actually visited all 351 cities and towns in massachusetts thats in her first year. And shes been back to a bunch of them ive been to over 250 and ive been back to a bunch of them. I mean and i on a first name basis with probably every city manager mayor or select board member in the commonwealth and, and theres a, theres a sort of a presence and a connection there that between us and, the communities that we work with, that is, is defined by something other than. The speeches we give the press conferences we hold, the what we choose to talk. I mean, some of its about that, but its a much its, much easier to get to a much personal level and, i think for i think for because the playing is so big, they do get judged on a different kind of metric than we get judged on, for sure. Yes. Then also, i think the challenge in terms the results and being proximate to, helping with the results. I can remember my last year as when i was Deputy Director of omb. You you know, i did the entire it was his eighth year. So he knew a lot about the budget. Clinton but did the entire federal budget. You know what . We were going to propose for the entire federal in a period of probably 6 hours, you know, three two hour meetings to go through with. Yeah, yeah. In and he probably didnt know the whole thing. Yeah. Yes, yes. And but it helped that he was a governor but you know, it makes a difference in terms of also the breadth of the issues in of the time that they can span. And these relationships. Because while i well, i had a relationship the president s ability to have a relationship, every governor is a very thing and understand what the challenge i mean i yo yo i know the state legislatures a number of states and what they were doing their governors because we were trying to get things done. I needed to help with that. But cant do it at that level. Its a very different thing. So speaking of the executive branch, i want to actually go to your father. Okay. And something we share i share with the governors father is we both served at hhs and, we actually had the chance once when we were negotiating that medicaid waiver. And i heard got another one recently. We did. I heard actually heard last night about your medicaid waiver keeping up on these things. But we had a chance to go and governor bakers fathers partner just wondering, she had to sign off on it. Im here. Im the president. So i did not have anything. To do with it all. At the end, i heard all about that we had the chance to go and stand under and look at the governors fathers portrait, which is hung at our department because was deputy secretary of the department of health and Human Services. And so what i wanted to ask and have our here is a little bit about how your father influenced both how you govern and whats in the book. So my dad served in two administrations. He was undersecretary of health and Human Services in the reagan administration. He was undersecretary of transportation and the administration primarily because the secretaries were both from massachusetts. Thats john bowlby, was a former governor, was the secretary of transportation under nixon. Margaret hecklers, a former member congress, was the secretary of health and Human Services, first female secretary of hhs. Yes, and i mean, i think the storys a little broader than that. My mom my mom passed a few years ago, but my dad is still alive. But, you know, hes a republican. Shes a democrat. And they never for the same person and theyre happily married for 60 some odd years. And our dinner table growing up was was a light show. And people people used to come just to watch and until they got called on and then they never came again. But the thing i learned my parents was they were really good listeners, both of them. And it was a conversation and my parents were big believers that. You know, your receiver needs to be a lot better than your transmitter and and they werent having a debate or an argument or a contest. They were having a conversation and i came to believe listening. The two of them that. You learn more from people you dont agree with all the time then you learn from people you do agree with all the time. And thats why our cabinet was a big collection of democrats, republican and independent. And i continue to that the most valuable part of this job the conversations ive had with people whose Life Experiences are just totally different than mine and who see through a very different lens than i do and. My mother and dad really instilled all of their kids this idea that that you have to listen and its not a contest. And i and they could tell if you werent because if you just tried to of get at a point and just keep pushing it back, somebody they would eventually, you know, the thing and just say youre not listening the question they asked you about that was this whats your answer and and if you grow up in kind of environment you have a hard time sometimes understanding why there are so many people who or seem to be really good but whose receivers very good at all. And im telling theyre not getting as much as they could out of their own gray matter because of it. So i think that is one of the most important points that well tonight. And i would just it by why we think that we were given the ratio. Of 2 to 1. Yeah, like the ratio actually what the governor just said and i just think at a time when i think thats one of the big challenges and i think, thats one of the things that i think you the key amy all of us that are here that we so and we so hope we provide for you is help with that that that is a big part of what you come here to do in terms of the listening in the classroom but like this is not it is just general this concept of how do i take in and how do i really hear to your about your parents calling you, calling you on your stuff when you were just not really listening you may have been hearing, but you werent listening. And so i hope that that is an important thing that we all walk a topic related to the nation, something that we certainly see acutely on university campuses, but that it is an issue you and i had the chance to work on before. Is the issue Mental Health and, wellbeing as we call it here at the university, and try and think about it from the Positive Side as well. And you think about the issue of Mental Health, because youve done a tremendous amount of work, including recent legislation at the state. Whats your sort of framing approach to this issue . Mental health and wellness. Lets take it at the commonwealth of massachusetts. And then if you want to focus on how universities should think about it too. So the hard part about Mental Health, ill be interested to see what she says about this. The entire Payment System for health care in america is built on the medicare jassy we dont have a single payer, but that payer pretty much determines how gets paid for everything because building is done on a drug and in our behalves basis, medicare medicare in the u. S. And so far, i mean im not sure drug so medicare pays for technology thats what medicare favors they dont favor it doesnt favorite time right so all Time Based Services addiction services, Mental Health services, primary care gerontology, pediatrics, those arent things that get the big bang out of medicare. What gets the big bang out of medicare is the next advancement in science and technology. I mean, the whole thing, in my view, is set up to drive the Health Care System to get more and more technologically sophisticated. And its worked really well with respect to that. But at the same time, after all the medical schools, then make that their primary focus. Right. And thats where most people go and they go into medicine. If you look at the if you look at the district fusion of specialists to primary care providers, including sort of all the folks in the primary care space. Think most countries, at least democracies, theyre plus or 5050, right about percent of them are specialists, 50 of them are in these time based professions. In the us, its more like 30, 70 and and its moving more toward the 70 number and less toward the 30 number. And when i meet people are going into pediatrics or primary care or health, first thing i say to them, thank so much for your vow of poverty because we really need you. So we filed before the pandemic pandemic that basically would have pushed back against that whole fee schedule and at a state level require providers and payers to dramatically increase their spending on the time they i couldnt get passed and coming out of the pandemic Everybody Knows the Mental Health stuff in particular and the addiction issues were worse than they were in. I still couldnt get that passed, but we did get a pretty comprehensive Mental Health bill passed that will do a lot of things to at least get to the point where we have real parity around insurance, which has been an enormous fight for years. Theres one 800 number anybody can call four seven and get immediately connected to a clinician. If theyre in crisis. Theres a roadmap with peoples ability to access the system in a more systemic. Theres all kinds of payment reforms for people who go into the will pay back your loans will pay back. This will pay back that will pay back. But i really do believe that if you want providers in the Mental Health space, you have to willing to pay more because the move you know a pathologist or a dermatol makes like what a primary care doc makes i the differences are big. Its not like 20 or 30 . Its huge. And, and i also think we havent done a good job of leveraging or, engaging or supporting Nurse Practitioners in this space or psychiatric social workers or theres so many people who could be huge players this space. But to get them to be huge players in this space, we to do something that so far i havent been able to get at least my legislation legislature to do, which is to move to move the mountain a little bit more, the time based service and a little bit off of the Technology Based ones. So as im ill ill engage on that. Well have a little nerd out on health care issues. But please think of your questions and well well go your questions. I think i probably i would say to your comment about paying for time is im going to see in ratio in terms of poker pilots, in terms of i will take what said and actually take it to what i believe is the next level in terms of it. And that is we need to pay for outcomes. So im going to lean on that. But you need to in person, you need the human infrastructure. Yes, yes. But in terms of thats part of Delivery System reform, so we need to reform them the fundamental system and a part of how you do is get to the place where you pay and you are willing to pay for the outcomes, because once youre going to pay for the outcomes what youre going to come to is knowing that the time it takes for therapist to get outcome that were seeking and of the biggest problems has been the measurement. So you know, you use as a proxy for, you know, what it is so i dont about the technological of it, but i think the big switch we need to make there are two very large switches. We need to turn in health care and we need to do them in education as well. And one is put the consumer at the system is the center. And you talked about that in your pain points point the pain point thing you weather it with the consumer was the actual person the individual you talked about this but both education and health care were designed not with the consumer at the center they were designed with the provider at the center. The faculty and the when flip that model and you about designing what were going to do with the consumer at the center and measuring outcomes and the measurement of outcomes. I want to you know to the point of being honest about results and governing and stuff like that i got to tell you it is really, really hard to measure those outcomes. That is that is one of the Critical Path issues that one struggles with. You know, as i was this, is what i worked, spent lots of time on in terms of trying to do it. And that is the hard part is i think as you were starting to reflect, its really hard to measure these outcomes at times and flip the system in that way, but thats where the whole thing needs to to move and you will get to and it will lead to Different Things. How should do primary care in this country and that will lead to the other point you made, which is operating the top of your license. Why do we think now youre going to be able to get hearing aids, you know, at the drugstore instead of through a provider, right. Get people to operate at the of their license. Thats what you need in terms of the kinds of things that youre doing. So once you start changing the system, start doing these tactical things will get there. So i agree with you to stop this top of your license thing. Its a real issue in so many ways. Yes. Yeah, it is a complete issue in terms of. And it is. And it also solves problem that we have been in the budget sides of governing. Right. And economically the gini coefficient which in organizations the ratio of what the lowest paid person is paid to the highest paid person and that differential. And so we need to raise and like having people go at the top of their license and then paying for that is how you raise you know you can solve another problem too it interacts with the broader economic issue. Okay enough of the nerding out on the details of health care. Why dont we start with our questions and i think we were going have one of our students. Austin, i think youre going to start us off tonight and everybody whos asking a question, if you dont mind, introduce yourself and your affiliation with the you, because we have all kinds of folks here. That would be terrific. I, austin drake, im a junior studying history. So in class by sga and im the president of acr. So this questions kind of more specific to have a partizan environment but i also from massachusetts im also from outside. Because this is a more constituent minded question looking to the future like obviously retiring now but like how can Republican Party in massachusetts succeed . Im looking at the polling now. Were not doing as well as we did with you know, your past to governors races where you won by pretty substantial margins. How can we like as republicans like stay true to our values but also continue to and advance those in a very deep blue state that is so i mean i think the massachusetts 60 of the electorate in massachusetts are independents, 30 of them are democrats and 10 of them are republicans. And and nationally, the the unenrolled have been growing as a percent, the total since 1990 or so. I think theyre i think the narrows might be as high as 48 in some of the polling ive seen. Well, and what that says to me is theres bunch of people out there more every year who are not you know. Check the box partizans. Theyre not all this on this and all this on this. There, here, here here, here, here, here, here, here. Right. And since i happen to be. That way, that kind of works me. I worked for two governors in the nineties who were fiscal fiscal discipline and socially moderate to the point of liberal in cases before that was unpopular the Republican Party and. But i happen to believe thats where most of america and and its certainly most of massachusetts is i think thats the reason why you know the there are twice as many independents as there are democrats and six times as many independents as are republicans. And i think thing that that anybody you know, needs to keep in mind when theyre running for office got to be true to yourself. I mean, you got to youve got to believe what you say, because theres nothing that will strip the bark off you like a statewide race if you dont really know where what you believe. Right. I mean, people can smell that very far away. And so my answer that one is, you got to be honest with what you are and who you are and what believe. But you need to recognize and understand whether youre a republican or a democrat or an independent. Theres a heck of a lot of voters there in the unrolled space who do not line up. Check the box this way they care about a lot of Different Things and they see them differently depending upon context, facts in life, all kinds of things and so that means to me you can succeed as a republican if your belief system in your value system is one that you know, recognizes and understands that people. Most people dont just line up on one side or the other, they take it. Well, my mother and father, i mean, the debates and discussions they had were like data and i think, honestly, at the end of the day, the way most people think about this stuff. Thank you. I think we have a student over here. I think. Hi, im rachel masters of Public Administration in the school of public. So a follow up on that one. Where are you from, rachel from saint louis, missouri. A follow up on that one. If you do think there kind of a lot of independents that arent lining up with each party, do you think that more states should be moving towards like ranked Choice Voting or other policies that could get more independents elected to statewide office . I think ranked choice has sort of alaska is is very different than maines is very different than new york i mean there so someone says ranked Choice Voting to me it depends to some extent on which one theyre talking about. I do think i do think open primaries which we now have more of than we used to are good thing because they get more people involved in in their preliminary elections and and, you know, i think municipal i ran for the selectboard in the town i live in thats a nonpartisan race doesnt what your party is top three finishers win know i think we should have more elections like those. I think the ranked choice thing can work. It depends a lot on which version youre talking about and whether or not whoever it is its doing it has the infrastructure to actually tell you who won the night, the election. I mean, i thought it was too bad that it took ten days, two weeks after the election, after the in new york city to get around to telling people actually won. I think that hurts silvias. Comment about democracy but i definitely think this idea of giving more people a shot at that first round would be pretty interesting. Yes. Gentlemen here and then well come over. Hi, im from new jersey, but i spent a lot of time in massachusetts. I go to the cape a lot. The the cape bridge replacement project. Didnt receive a first round of competitive grants, but this guys paying. Do you . Do you . Are confident thats going to happen and if you can just elaborate more, its obviously an example of how you know whats going on in the commonwealth is reliant the federal government. How is the commonwealths relationship with federal government played out during the eight years that youve been governor . So, you know, its funny, the most of the people always say, you know, that the that my relationship be with im a governor therefore my relationship would be with the president. Actually no. My relationship is with cabinet secretaries. So when you say that, you know, you got to know the governors really . Well, thats just another example of how well she did this job when she it because she understood who are was and think the i had different relationships with different people each of the administrations that i worked with. But it was almost all at the cabinet secretary level and it was usually issue specific. With respect the bridge the thing i would tell you. I mean, the bridge is owned by the army of engineers, right . The cod canal was dug by the army corps as a defense process. Right. They wanted a quicker path to get one end of the bay to the other. So they just cut a hole through the elbow of the cape. And but once they cut a hole through the elbow, they then had to build a bridge to get to the other side. My goal i them we will pay. And these bridges are very all their way past their useful life. They need to replaced. We said to them is well pay our money for the connections on the new bridges you build the new bridges we will pay to connect. All right and we will give you as much Technical Assistance as you want on fixing bridges. And the deal that made with them was, you build the new bridges. There yours, their past, their useful. Youre going to spend hundreds of millions, probably of dollars trying to keep repairing them, and youre going to i mean, and youre going to make people nervous about whether theyre going to these things or theyre very big ships that go through the cape cod canal. So these bridges set like four, three, four stories off the canal. Mean, you are way above the water when drive when youre driving over that thing. What we said is you build. You build the new ones. Well pay for all the connected activity. And then well them over and maintain them going forward. And the part thats been hard has been to get the army corps to agree that theyre going to i mean, some of the conversations have even sounded like they want us to pay for their bridges. I dont really think thats even an either appropriate or makes any sense mean they really need to put the money on the table to their bridges. Were perfectly happy to work with them. And well pay for all the other stuff. And thats kind of the deal made with them a couple of years ago. And wed love to see them actually. But my primary relationships are with cabinet secretaries. I could do an seminar on the army, but were not going to do that. We are not going to do that tonight. Im going to take from over this side, gentleman over there, and then well do one more. Yeah. No, the army corps. Thats a whole. So i apologize in advance. Voice im getting a bit cold to go. Just make a short about the cape cod bridge. Im actually from southern plymouth. Im a town meeting member elected there, plymouth. So also a local, but i see the cape cod bridge as much more of a death wish or a death trap than anyone else. Because i dont go for vacation, go to get groceries at the Market Basket across bridge. But going back up, it is to go back to your comment on local government and people not paying attention. So in plymouth as happening with most municipalities in massachusetts, people are debating whether or not to scrap town meeting for city and mayors because believe theyll be able to pay more attention to people and get services and more deliverable when in reality if youre in town meeting and you have hundreds of people on hundreds of different committees working for you generally you dont get the attention on government that you would need to appreciate it and you generally get more personalized results. What is your thought on that . Thoughts on that . Do you believe City Government is more beneficial than town . And how do we get people to Pay Attention . The good effects that come out of more personal sized forms of governance. So i mean, the answer to that one, and this is not a dodge is it depends. Right mean in some swampscott which is where my wife and i live and where we raise our kids, its 14,000 people. Three square miles. Its got the population of actually of a small city, although it doesnt look like one. And when we moved there, they didnt have a town manager. The selectboard basically everything. And they all had jobs. And so a lot of stuff didnt happen. And so i got in a local issue, which was a that we put together to determine whether or not we should change our charter to at least have a town manager and we wrote up the charter, the select board sent it to the legislature. The legislature endorsed it, thereby making it possible for us to put it on the ballot. We put on the ballot and a lot of people showed up to vote on that. And they voted that they wanted to have a town manager and. We have one. And i think its been a giant step up for the community having. One note neck the choke, choke every something doesnt go the way its supposed to and but i think representative are you a representative town meeting or can show up. Thats how i got elected. Okay. Theres two kinds of town meetings. Theres town meetings where anybody can show. So you could literally have 50 people there. You could have 500. And then theres town meeting where a local elections when they vote on School Committee members and Planning Board members and select Board Members or city council members, probably not city council as much. They vote for town meeting members. So those folks become, your representatives and meeting. I like the forum i like the town meeting form of government always have. Its one of the quaint Little Things we have in massachusetts. Its been with us for ever and ever. But i think Community Going to make that decision based on the county and the times and what it is they think makes the most sense for them. I do. When you get into those at the local level, people do Pay Attention to that stuff. I was amazed at how many people showed up to testify when we started talking about change in the charter and and that was i mean when its in your own backyard that kind of stuff it gets people attention when you want to build a new school, when you want to do any of that kind of stuff. Thats when people show up. But but i wish they would show up more on the regular routine elections that people have because they do matter. I take it you like representative form of government on good. Okay, were going to one more and then amy, im going to come to you the gentleman right here. Yeah. And im sorry we cant take all of your calls questions. Im so i love that everybodys here asking please. Thanks so much. My name is paul, a senior in the school of Public Affairs. And im a lifelong resident of foxborough, massachusetts. Its so big home of the new england patriots. Who had really bad night last night numbers numbers. You know, my graduate degree at kellogg, my question is, in a crisis like covid, theres a lot of data in large volumes coming in and maybe its telling you Different Things. Whats the best way from an executive perspective to organize your team in order to interpret that accurately . That is a really, really good question. So we did two things very early in the covid thing. One was we set up a command center and the command center was run by the secretary of health and Human Services, sudders. And then we went plucked a whole bunch of people. We really thought were smart either from State Government, just from other lives. Wed had and built kind of a team to out and borrow them. A lot of them we just borrowed from hospitals and and other organizations and say, can we have these people for what we was going to be a few months right and ended up for a couple of years. And there was so much information around that we all looked at each other and said, this is nuts. And so we and this is one of the advantages of having worked in the health care space. Right. I know a lot of people in it and i know a lot of people in it in massachusetts. And we happen to have a lot people who know a lot about health care. So we called a bunch people and we put together a medical advisory which had six or seven people on it. We talked to them every wednesday afternoon, virtually nobody knows who they were. This was 100 off the record. We could just ask them about all this stuff that was flying around and get their point of view on it and and having that ability wednesday to know that i was going to be talking to these people and that they were going to be telling me exactly what they thought and not worrying about what anybody in the Public Domain might think about it or anybody on twitter say about it was incredibly valuable and the back and forth between them, right when we would talk about almost anything around vaccines and transmissions and testing, you know, antigen tests versus pcr tests, the long tail, i mean. Was probably the most important thing we did in terms of trying to center ourselves and figure out what we actually thought, given the swirls that were going around data and then what kinds of decisions that we would make as a result of that really. That was a really big and hugely important thing. And, and almost nobody, nobody even knows for the most part that we did it. I would just add that the other when youre in those crises is as quickly as possible getting to what are the prime issues so that youre setting know in terms of your goals and objectives because then as youre reviewing that data and analytics from all different places, you review it in a context thats prioritize sort of whats most important. Let me be specific. When we and i said this at the in that march, we knew that covid there were two things about covid that led you to understand something very quickly in terms of like these prime issues, covid was transmitted not like ebola. It wasnt transmitted. You would have to touch fluid. We knew it was transmitted more easily and it was asymptomatic in a number of cases as soon as you knew that you knew testing had to be one of the biggest priorities testing was going to be an unlock in terms of preventing spread testing was going to be an unlock in terms of all kinds of things. And so as youre getting those together, they help you do what i just said. But that would be the other part. I would add when youre in the middle of these crises and its youre just swirling and its all coming you do have to, like take step back and understand what are the most important things and to understand. The most important things you got to look at the past. But look at the current because everybody did think a little more like ebola and, that sort of thing versus no, no, no, no, no, no this is different in terms of what we do. You and governor i will. Thank you. It was really good by the way. Were team. Weve done this, done this before on all kinds of issues. Thank you. So can we thank our speakers for tonight. Everything that we did, this is incredible i have. Yeah. I want to thank you, jim burwell and governor baker, for just an incredible conversation and leading us in this conversation. I also want which at did feel like massachusetts town hall and as there is have your constituency we could have you know theres a of massachusetts representation tonight and a big huge thanks thanks to dean wilkins in the school of Public Affairs for partnering with us on this to this conversation, always trying to bring to you all new and programing. And so think her so much shes an incredible partner have in this governor your insights were so appreciated your book is so in tune with the mission of sign and the culture that the president and her Team Building here at American University to encourage dialog with our students, our faculty and staff and of course, our alumni. We appreciate that as well. And i want to say a special thank you to both of you for your Public Service. I think that should be applauded as. There is so much on your and in thankfulness we should give for people who decide go down this path, something we hope many our students here in this room in campus will consider as we all try to convene and some, you know, try and solve of our most challenging problems. I make one comment about that. Yes, i talked see, as i said from northeastern, thats where i stalham and my dad taught there for 15 years. So we did a a big student town hall there. And one of the questions somebody asked was, you know, why why do the why go into the Public Sector space is so hard to get things done . But were about and and i you know, i spent 16 years of my professional in State Government. I spent six doing local government stuff. Im telling you, there is nothing you will do anywhere else. And i dont care what you do for work where you will grow as much as you will if you take advantage of the opportunities that are available you in public life, you get in front of and the people you get in of and the issues deal with and the challenges you face. Theyre just different. You know, ive spent a bunch time in the private sector. I had a good time. I really enjoyed. It was important to me and i really appreciate a lot of what it brought to me and my life. But im telling theres nothing like theres nothing like what . Get out of working in the Public Sector. And it bothers me immensely. And its one of the reasons we wrote the book that so much of what is in the Public Domain about the Public Sector negative for a whole bunch of reasons which we actually didnt much about. And yet if you were to say to me, you know, would i trade one day of the 16 years that i spent in government and State Government for something . The answer is no, because its really unique and special and and it will you things you will learn about and about the world around you that you just cant learn anywhere else. So do it at some point. It will be a great