Replay-MN Governor Candidates Debate Health Care (CC) By Michael McIntee | September 8, 2010 LikeTweet EmailPrint More More on MN Governor Debates Live Subscribe to MN Governor Debates Live Follow this author Mark Dayton was absent as Tom Horner and Tom Emmer debate health care at St. Joseph’s Hospital in St. Paul. Debate with closed captions: Additional links: MN Governor candidates debate health care -transcript. Interactive transcript and closed captioned video of-MN Governor candidates debate health care View our live blog for this event. View our live blog for this event in a pop-up window Health Care Debate, St. Joseph’s Hospital, St. Paul MN, Wednesday, Sept. 8, 2010 Speakers: Mark Dayton, DFL candidate; Tom Emmer, Republican candidate; Tom Horner, Independence Party candidate; Tom Hauser, Moderator; Audience Members Transcript by Susan Maricle Moderator: So we’re gonna talk about the Governor’s race. And a couple of gentlemen have been kind, a couple gentlemen have been kind enough to grace us with their presence. And they’re very busy of course this time of year, and they I think have already set the state record for the most debates by gubernatorial candidates and I think they’re to be applauded for that. Let’s give them a round of applause for being so willing to do this. (audience applause) 00:17 Moderator: Well the format will be as follows. We have already introduced the candidates, but each candidate will be given 2 minutes for their opening statements that will be followed by questions, some of which have already been submitted by those of you in the audience, and I’ll have a couple of my own and then a little bit after 7 o’clock, 7:05, 7:10 or so, we’re gonna open it up to any questions you might have live here in the audience live here in the audience and Jody will be in the back of the room, the woman with the red coat, she’ll have a microphone with her. But without any further ado let’s go alphabetically on our opening statements and begin with Tom Emmer the Republican candidate for Governor. Tom? 00:53 Tom Emmer: Thank you Tom. (applause) Are you, whaddaya got, bells or guns that you shoot off? No, we’re in a hospital, it would be some kind of stat, right? I thank you all for being here, looking forward to the discussion with Tom and with the rest of you. We get 2 minutes for this so I’m going to be very quick and talk to you just about the message. I see great opportunities in this state and in this country today. I know that a lot of people don’t feel that way. A lot of people are getting up every day and they’re worried about this country. They’re worried about the direction the state and the country are going. They’re worried about their job, their family, they’re worried about whether or not their kids are going to have the opportunity for a better life than we’ve had. And after all, that’s what every parent wants for his or her child is in this country, I believe in the world, is that they have an opportunity for a better life than we have. A lot of the concern but I see a time of great opportunity. Yes, we have major economic challenges, but it’s time that we meet those challenges. That’s what Minnesotans do, that’s what Americans do when times are tough. We get moving. What’s the message that we’re delivering? Well, everybody else talks about needing more revenue, which is we must raise taxes. My colleagues believe you got to raise taxes. Government has to keep growing. Government folks cannot continue with this state that it’s going. You’ve got end of the biennium in 1999 we were spending roughly 30 billion dollars total. End of the biennium in 2009 we’re spending 60 billion dollars total roughly. At this stage by 2019 if you continue you’re spending 120 billion dollars. The math doesn’t work. It is time to look at what government does. It’s time to rebuild government, redesign it from the ground up, have it deliver the services that people expect in an affordable, sustainable manner so we turn over something other than just our debt to our kids. And then we have to address the real problem in this state, it’s an economic problem. We hve to crate an environment that is attractive to not only our existing businesses so they can grow but also to new investment. We must start to grow jobs again in our private economy. Once you start growing jobs you will grow new revenues, and you will be able to pay for the services you that you and I expect government to provide. Looking forward to a great discussion tonight. Thank you so much for having me. (audience applause) 03:09 Moderator: And thank you very much, Tom Emmer. We now turn to the Independence Party Candidate for Governor, Tom Horner. 03:14 (audience applause) Tom Horner: Well thank you very much thank you, thank you. Thank you to Sarah and everyone at Healtheast and St. Joe’s for hosting us, to the Chambers of Commerce, Kincaid’s, St. Paul Hotel and everybody for having us here. So let me start just by correcting my friend Tom on one point. I don’t think it’ s so important for the government to grow, I think it’s important from Minnesota to grow. I think it’s important for Minnesota to have new opportunities, for Minnesota to craft new solutions for the future. And you know health care maybe better than anybody else. I mean look what’s happening right here at St. Joe’s with your telescope care. Where neurologists from St. Joe’s can bring their expertise to Glencoe, to other communities around the state, with the level of of expertise, where they can look in the pupils of a patient’s eyes, and in an environment in which as the saying goes, “Time is brain cells,” they can help make those decisions immediately. They can make them with expertise. And they can make them at a level that is impossible if it’s just that hospital that doc in Glencoe working on his or her own. That takes high speed internet connections. That takes some public investment. We’re not a state that can say “We’ll just do away with government, we’ll just try to to figure out the status quo, we’ll just say to the private sector ‘You’re great, go it alone.’” I do believe the private sector is great. But I also believe there’s a role for government, a smart role for government. And that’s what I offer in this campaign. Y’know, where we have Democrats saying “Take the status quo and we’ll just make it a lot larger by taxing,” Republicans saying “Oh no, we’ll just do away with the status quo.” My answer: for so many Minnesotans the status quo isn’t working. And that’s what we need to change. With new solutions. Not just crafting a little bit from this a little bit from that. But new solutions, new approaches. That’s what I offer. And I too look forward to the conversation tonight. Thank you! 05:24 (audience applause) Moderator: Isn’t that the same signal they used to ward off vampires? 5:30 Tom Homer: (laughs) Yeah, I was waiting for the silver stake to come out. 5:34 Moderator: That might be next, so be careful. Among the many reasons you should be thankful that I’m not running for Governor, could you imagine trying to decide between Tom Horner, Tom Emmer, and Tom Hauser? There would have been mass confusion I think in the polling place. Let’s begin, our first question we will begin with Tom Horner, we’ll go in the opposite order of the opening statements, and again you each have 1 minute to respond to these. I know it’s never enough time but I think you’ve probably been through this enough that you will be able to handle it. Let’s start with something has been in the news just in the past week. Mr. Horner, do you agree or disagree with Governor Pawlenty’s decision to not apply for some federal health care grants that he says might get the state to tied into the new federal health care overhaul, and along with that, do you agree with the decision to take the 260 million dollars in Medicaid funding? 06:18 Tom Horner: Well,what I disagree with is the broad brushstroke that the Governor laid out. I’m aware of where he put the mandate out that he’s not going to take any of the the federal money without specific reviews. We do have to look at each of these programs and make sure that the money can be used in a way that advances Minnesota’s health care in a Minnesota way. We’ve done a lot of good things in this state. We have a good foundation to build on. But we also have the opportunity to use federal health reform, to leverage it in a way that works for Minnesota. So would I have accepted the 260 million dollars? Of course. And we knew the Governor was going to do that. And that was money that in January, he had said was going to be part of the budget, of last year’s budget, and the federal government didn’t act quickly enough. But I’d go it a step further. I believe that we also ought to take the early opt-in to Medicaid. I’ve set aside the money in my budget because I think that’s an important step, and I presume we’ll have more time talk about that as well. 07:17 Moderator: And Tom Emmer. Tom Emmer: Well, when it comes to what the Governor’s doing, I have to be clear, I haven’t read the grant proposals, I don’t know exactly what he was doing and why. I trust him to do that and I guess the statement when he says that every offering from the federal government should be scrutinized, I think that’s wise. I think that before you just automatically accept federal dollars you should start doing it due diligence and make sure that you are not committing the state of Minnesota to future financial liabilities that we may not be able to afford. These, some of these maintenance of effort provisions et cetera can be a real problem for future Legislatures, for the taxpayers. I think you have to do that due diligence with everything. The money that the Governor just took, I’m told that without reading the entire program did not have strings attached. But I do have concerns. Because it appears that at the county level it will create potentially some maintenance of effort situations that might put our already-strapped counties in a position where they can answer for something in the future. We should always be concerned about what we’re looking at when the money runs out. 08:26 Moderator: And let’s stick with Tom Emmer here. Along these same lines, Governor Pawlenty last spring turned down 1.4 billion dollars in Medicaid expansion money that would have required the state to pony up I believe 188 million dollars in order to access that money. The next Governor will have another window of opportunity in January to decide whether or not to take that money. If you are elected Governor, what would you do? :08:48 Tom Emmer: Well, at this point I would say no. And I have said no. And I know my colleague feels differently about it but this goes to the very essence of what Minnesota’s all about. I know we have hospitals, perhaps the one that we’re in right now, that are saying “This is free money, this is something we need to access.” I look at it a little differently based on what I have read. It’s not just 188 million that we’re committing. Over 3 years you’re talking closer to 430 million dollars that the state will have to get. More importantly, what it does is, it is based, it puts us in that same formula that the federal government reimburses us on, which is on volume of care. Minnesota prides itself on high quality low-cost care. The federal program that we are being offered would allow, it would only reimburse based on volume of services. That may be good for North and South Dakota, Iowa, Wisconsin.. It’s not for Minnesota. We need to protect what is the innovation in Minnesota, the quality of health care. And again this is one of those areas where if you take this money you are committing not only to 430 million over the next 3 years. But there’s no guarantee the money will be here or that it will be here after 2014. 09:52 Moderator: And Tom Horner, your thoughts on this. 09:54 Tom Horner: well this is an area where Tom and I disagree. I don’t think St. Joe’s or any hospital says “This is free money.” I think quite the contrary, they say “This is plugging a hole of lost money if we don’t take it.” And that’s the reality. And that’s the reality of health care is that if we don’t do these kinds of things, if we don’t expand coverage reasonably, building on the foundation that Minnesota has established, we don’t save money. Health care is a tax either that we’re gong to pay directly or we’re going to pay indirectly. Either it’s going to come on employers like I was before I started this campaign through higher insurance premiums that I have to pay for my employees, that they pay higher out of pocket cost, higher property taxes if you happen to live in Hennepin County and some other counties, to pay for the failure of the Legislature and the Governor to address this issue reasonably. It is not free money. It is not lost money. It is money that we will pay one way or the other. We ought to do it in a way that builds a stronger health care system. 10:57 Moderator: All right, our next question is one that was submitted by the audience. And Tom Horner we will begin with you. Would you leave all the money that is collected from physicians and dentists and others for the health care access fund to be used only for its primary purpose of Medicaid, the health insurance for lower income Minnesotans rather than take that money and use it to try to balance the budget? 11:18 Tom Horner: Absolutely, and I think this was a real lost opportunity for Minnesota, to again not show the leadership of using this money that was passed as a way to provide and build a stronger health care system in Minnesota. So we ought to use it for health care purposes, not dump it in the general fund as has been done to pay for general purposes for the government. Now we have an opportunity coming into 2014 with the federal reform that will take over some of these programs, to figure out what do we do with that provider tax. Do we use it in a way that that can build a stronger health care system? Do we end the tax? Do we end part of the tax? I think those are the kinds of questions that we ought to start asking right now. So that we can be thoughtful, so that we can plan ahead. And that’s part of the opportunity Minnesota has, to leverage federal health reform in a way that can provide lower cost higher quality health care for all Minnesotans, a stronger system that is going to work better for businesses, for individuals, for providers, for communities to the whole state. 12:25 Moderator: Tom Emmer. 12:26 Tom Emmer: I don’t think you’re attacking it that way though. I think it goes back to even the last question. First off, the sick tax should be eliminated. There is a different way to handle these programs. We need to start to lead. And what I’m hearing is frankly what we’ve been doing. I mean if we’re going to opt in to early medical Medicaid because, and I’m sorry, maybe I shouldn’t have said free money, but people think it’s money that’s going to come without strings attached and it’s going to solve our existing problem. We’re just going to be back here in the next 3 or 4 years again. Let’s start talking about how we solve the problem for the long term instead of just taking what the Federal government is giving us and saying “Well, this well this is going to get us through another two or three years.” We’ve got to start leading Minnesota. And on this we’ve got to reform the programs MinnesotaCare, GAMC, other programs like it that are supported, MinnesotaCare in particular from the health care access account. There’s a different way to do this and we can talk about that as we go forward. But we’ve got to start looking at doing it a different way because if we continue down this road you cannot survive. I respectfully disagree. 12:32 Moderator: All right. Who did we start with that last time? Was it you? So we’ll start with Tom Emmer. Another question from the audience. Total health care spending is expected to nearly double in the next 10 years that figure fluctuates a lot but we know it’s going to go up and go up a lot. The question is kind of broad so I’ll try to narrow it down. How would you address the rising cost of health care? Why don’t you give us, Tom and Tom, three key items, three places you’d start to begin to rein in health care spending. 14:00 Tom Emmer: Can I ask for clarification? 14:00 Tom Hauser: Yes. 14:01 Tom Emmer: Can I phone a friend? 14:02 Tom Hauser: Laughs Tom Emmer: Clarification would be, are you talking about for the public programs versus how we would attack day the cost issue in the private health care market? 14:11 Tom Hauser: Yeah Tom Emmer: I mean they’re two different things. 14:14 Tom Hauser: Let’s assume it’s the health care costs in the in the private market let’s assume that 14:18 Tom Emmer: The private market. All right. 14:21 Tom Hauser: Because that impacts more people. So what are the three things you would do? 14:22 Tom Emmer: First off, I would give individuals the same opportunity to deduct their health insurance premium expenses that right now we only give to employers. Second, I would want to see more pooling options and more choice for the consumer. We need to allow us, the patient, we need to give the patient the consumer the incentive to be more invested into their own healthcare. Give them the opportunity to create their own health care coverage by sitting down with their private health care insurance broker, going through the different coverages available. That means get rid of mandates and let people start to drive their own mandates and fit their coverages, and then give them an opportunity to pool with other similarly situated. And then the last piece if there’s only three, ‘cause I merged two together so it’s actually four 15:12 Moderator: You can do more than three if you like 15:12 Tom Emmer: I know it’s kind of 15:13 Moderator: You can get that in a minute 15:13 Tom Emmer: But I think we need to give you and I, again, empower the individual instead of having government tell us what’s good for us, empower the individual to shop one of the 1300 approved health insurance products across this country. We do it with auto insurance, we should start doing it with our health insurance. Give the consumer, the patient, more ownership of their own health care. They will take advantage of it. 15:35 Moderator: Your time is up. Tom Horner. 15:37 Tom Horner: Well, changing the way we pay for health care doesn’t change the underlying cost of health care and that’s really the problem. We’ve got to figure out a better health care system that expands access and manages the underlying costs. We can blame insurance companies but they reflect the cost of care, they reflect what we’re asking for, they reflect new technologies, they reflect an aging population. We’ve got to be smarter than that. So a couple of things, one is that we do need to invest in prevention. I’m willing to say that we ought to raise the price of tobacco, because there is no good public policy that supports cheap cigarettes. And so we ought to have that disincentive. We ought to continue to coordinate care the way that Minnesota has already made advances, so that we can manage the 5% of the people who consume 50% of the cost. Then I think we need to look for new ways to solutions. We look at what St. Joe’s has done with the certified nurse midwives, reducing the c-sections to 10 to 12% of the births at St. Joe’s, about one-third of the statewide average. It is those kinds of creative solutions, real solutions that deal with the underlying cost of care that we need to address. 16:47 Moderator: All right, thank you very much. Tom Horner we’ll start with you on this next question. Sarah Krieger addressed this briefly at the very beginning. The current GAMC program design looks like it’s not working out so well and is forcing the state’s poorest and sickest into the emergency rooms. How would you fix it, is there a way to fix this program? 17:03 Tom Horner: Sure, I mean I don’t think anybody in here isn’t surprised that GAMC isn’t working out so well. I think there are a lot of people in this room who a year and a half ago said “What you’re proposing isn’t going to work out so well.” And so that it’s not working out well that St. Joe’s now has an extra 3 million dollars in uncompensated care, I think goes right to the issue that a lot of people talked about. The way we’re going to deal with that, though, is to expand access. I think the way we’re going to deal with that is to spend the money to do early opt-in with Medicaid. To expand the access to make sure that people do have coverage, that they can get the care. Look, it is a lot cheaper to treat somebody with high blood pressure than it is to wait until they come into the emergency room and treat them for a stroke. That’s just common sense. It is a lot cheaper to deal with people on GAMC, many of them with mental health issues, and to deal with them as preventive care, help live independent sustainable lives, than it is to wait until they’re in crisis. Those are the kinds of solutions we need and again, Tom, you don’t save money by saying we’re going to reject the federal dollars. You just transfer it to hospitals, to employers, to property taxpayers. 18:16 Moderator: And we’re out of time. Tom Emmer. 18:16 Tom Emmer: Well actually I think when you just take the lack of creativeness and say “We’re just going to keep doing what we’re doing, give us more federal money,” you don’t solve the problem for the long term. When it comes to GAMC, General Assistance Medical Care, we’re not treating these folks for high blood pressure. These are the poorest of the poor. You know that. These are roughly 40,000 people that we were spending 400 million dollars on every two years in the last biennium. Yes, there was a solution that was negotiated by both sides of the aisle that reduced the amount of money available to 250 thousand, roughly, somebody, 250 million, somebody can correct me, But the idea is we’re going to pinch the providers so that they have more incentive because there’s not enough money there to get these people off their, out of their emergency rooms and onto different programs? That doesn’t work. This is what I have been talking about. We’ve got to look at that charity care, the way the definition is used. We’ve got hospitals, clinics, doctors that want to provide the care. Every time you insert government into the business of charity, government is taking something out of it. It is time to empower the physicians that we have in this great state. Let them keep more of their hard-earned income by creating a situation where they can provide the charity care that they really want to provide. Get government out of the way. 19:30 Moderator: All right thank you both for those responses. Another question here, it’s a little bit vague we’ll try to narrow it down. I think I know where they’re going with this. And Tom Emmer, we’ll start 19:36 Tom Horner: Can I just ask for clarification, Tom (Hauser), on this last answer 19:38 Moderator: Sure. Tom Horner: Because you’ve kind of moved around on this issue, Tom (Emmer), and I just want to be clear. So are you suggesting that low-income care, the public health program, now ought to be charity care? So we’re going to ask hospitals, providers, clinics, to care for the low income and in return we’ll give them some kind of tax credit? And that’s going to cover the poorest of the poor? 20:03 Tom Emmer: Actually Tom let’s do it again. 20:05 Tom Horner: All right. Tom Emmer: Because I haven’t moved around on this at all. I’ve been talking about it for 16 months. I’ll try to make it more clear. 20:09 Tom Horner: Thank you. Moderator: We’ll give you 30 seconds. 20:10 Tom Emmer: If I can. If it’ll help. Because over the years as you know since you’ve been effectively your firm has been a lobbyist for hospitals 20:19 Tom Horner: No we don’t lobby, we’ve never lobbied, but thank you 20:21 Tom Emmer: Well, I’m sorry. Whatever the definition is. You’ve been representing hospitals for a long time. Tom Horner: Yes. Proudly so. 20:27 Tom Emmer: The government, the government has squeezed the definition of charity care and how you balance your books. That’s what I’m talking about. I’m talking about different from and I’m surprised we differ on this because I thought you and I would agree that the solutions that we have to start moving to are individual-based solutions, not big government solutions. What I’m talking about is trying to find a way to empower the physicians, the clinics, the hospitals that want to take care of these folks to get full credit for the care that they’re providing. Right now they get the short end of the stick when they go to bill. They’re getting reimbursed at 1990, 1999 rates. 21:02 Moderator: OK. 21:02 Tom Emmer: We’ve got to allow them to get full credit. Whatever that formula is Tom, the idea is Let’s pull government back. Let’s let people provide the charity they want to provide and give them the incentive to keep more of their income while doing it. 21:14 Moderator: All right, we’ll move on to our next audience question. Again, it’s a little bit vague we’ll try to narrow it down. It says, Do you think all employees are entitled to sick leave? I assume what they are talking about are people who maybe have part-time jobs where they’re not covered by a benefits program and oftentimes if they take a day off from work they just don’t get any pay. Should the state get involved with that, and I forget who went first last time. 21:33 Tom Horner: I think Tom (Emmer) 21:35 Moderator: Because you (Horner) asked the last question and now I’m all 21:38 (candidates laugh) Moderator: We’ll start with you. We’ll start with you. Tom Emmer. 21:39 Tom Emmer: Oh. I get to ask Tom (Horner) a question? 21:43 Moderator: Yes. No! I’m sure you will before long. For now, I’ll ask the question. 21:47 Tom Emmer: I don’t need to. We’re selling what we believe and we’re sharing that. In this case, should every employee be entitled sick leave? I think that’s up to the employer and employee. That’s an issue that’s negotiated between good employers with good employees. They determine how that’s going to be handled. I don’t think government has any business being involved in that. 22:05 Moderator: I thought it would take you less than a minute to do that. Tom Horner. 22:07 Tom Emmer: I defer the rest of my time to Tom (Horner). 22:08 Tom Horner: laughs Moderator: But you don’t have to take it Tom, if you don’t want to 22:13 Tom Horner: And I won’t. So let me tell you the approach that I took when I was an employer who didn’t lobby (Emmer laughs) but worked with very good clients that we were always proud of, including hospitals. I felt that we did have a responsibility to our employees. And so we took all of our time off, vacation time, sick leave, holidays, and said it’s personal time off. It’s personal leave. And you can choose to use it the way that you want. And so if you, the employee have a sick parent, a sick child, and you need a day off, take a day off. You get to make the choices. That’s empowerment. I am going to trust employees to make good decisions around the time off. That’s how we opted to work on this issue, not through mandates, but by encouraging employers to be responsible to be smarter, to work with employees particularly in this society changing where so many people now either care for young children or for aging parents. 23:09 Moderator: Just a couple more questions, questions that have been submitted ahead of time. If any of you in the audience have a question you want to ask tonight we’ll do that in just a moment. But this is an interesting question, I don’t think either of you needs a minute to deal with this one but it is interesting. And Tom Horner, we’ll start with you. Would you consider spending time in any Minnesota emergency room to see healthcare up front? Even if it was just for half a day or a day. And do you think you’d learn something from that? 23:32 Tom Horner: Yes, I’ve done that and I’ve learned a great deal. And I would be grateful and eager to do it again. 23:37 Moderator: You may be extended an invitation by somebody in the room, because that was just submitted tonight. Tom Emmer 23:41 Tom Emmer: Absolutely, but please keep in mind, Jacquie and I have 7 children, we spend an awful lot of time in emergency rooms right now. (audience laughs) 23:51 Moderator: All right, on that note, again Jody in the red jacket back there has a microphone. If anybody in here right now has a question you’re just dying to ask one of these candidates, we’ve got a question right up here. 24:03 Jody: If I can have you step over this way, so we can catch you on camera. 24:07 Moderator: And again, you’ll each have a minute to address this. We’ll begin with Tom Emmer after he asks the question. 24:15 Audience Member: The University of Minnesota Medical School has very high tuition and is under extreme financial pressure. What’s your position regarding support of the medical school in view of the fact that the biotech industry, which is dependent on the medical school faculty in a variety of ways, is one of the state’s largest industries? 24:35 Moderator: Tom Emmer, start with you, you’ve got one minute. 24:37 Tom Emmer: Well first off it’s to stimulate more growth in those jobs. That’s number one. If Minnesota, which since 2005 has added over 2200 jobs in state government. There’s no other sector of our economy that has grown by 7% during the same time. If you want the uni – the great University of Minnesota medial school, the University of Minnesota itself, to not only survive but to thrive the way it should, then you’ve got to start not only allowing our existing businesses to grow again in this state but you gotta start attracting those high quality high-paying jobs that drive the university. And frankly drive everything else we expect out of government. So that’s why we’ve rolled out a jobs proposal that immediately starting in 2011, January 2011, will reduce the corporate tax, will give a 10% exclusion on pass through income in small businesses, LLCs, s-corporations, closely held corporations. That’s the purpose of those proposals, is to get an immediate stimulation in our economy, to allow businesses to start to reinvest in people which in turn drives more revenues, which in turn will support the great schools and including the University of Minnesota Medical School. 25:53 Moderator: And Tom Horner. 25:54 Tom Horner: Well, this is an area where again we’re not going to do it without government even though Tom has voted against bonding bills that created the biosciences campuses at the campus of the university of Minnesota. If you talk about the need to invest in life sciences, not just the med tech, but all the other emergency – emerging life sciences, we need that research. Basic and applied research at our four-year schools. We need the investment in the biosciences campus that has been created at the university, which right next door to it, has a private sector campus including venture capital. So we need those to create the revenue, create the jobs, to create the money. I agree with all of that. But you don’t do it without government. On the issue specifically of the higher tuition, I think we do have to be wary of that. One of the great things, look at what what’s happening at the University of Minnesota Medical School I Duluth, where they have I think it’s one of the highest rates in the country of new physicians, primary care doctors, going into rural Minnesota to practice. Getting some of the rebate. I think it’s those kinds of programs that make sense for everybody, that again we need to invest in now, to save money to produce better health, to produce a stronger Minnesota in the long run. 27:07 Moderator: All right, thank you both for those responses. Do we have another question? 27:10 Audience Member: I’m Bill Klein, I’ve been on the Inver Grove Heights City Council for 1 years. During that time I’ve seen what were paying for health care go up 10, 15, almost 20% every year at least for the last five years. It’s out of control. Our budgets haven’t been going up, our employees, their salaries are frozen for the last two years. tell me why is health care escalating at such a drastic percentage? I want to hear from people why health care is probably the highest thing escalating that I can possibly think of. I’d like an answer to that. 28:00 Moderator: All right Tom Horner, you’ve got one minute Tom Horner: Sure. Moderator – to solve this whole problem. 28:02 Tom Horner: Yeah, no problem. (audience laughs) But I think, I think everybody in this room knows the answers. We want a lot of what we don’t want to pay for. We’re insulated from the cost. We’re an aging society demanding more services, and we have a terrific health care system that is producing more and better and sometimes more expensive solutions. We’re healthier, we have an opportunity to live longer, diseases that were fatal not so long ago now are curable. We live healthier lives, we live longer lives because we have the opportunity to be healthy. We have to make fundamental changes and it’s not just by saying “Let’s treat it like auto insurance,” where we have a rate book and you can say “All right, if you have a dent in your right fender it’s going to cost X amount of dollars,” that’s not how health care works. You just can’t bring in a bunch of other state insurance companies and say “Okay, there we go, we solved the problem.” You can’t turn the poor over to charity care and say “You take care of it, good luck.” We still pay those costs. We need fundamental reform. We need to figure out how do we have different outcomes based on a whole different approach to healthcare. That’s what Minnesota is doing. That’s the opportunity we have. If we’re smart about it. And honest about it. 29:14 Moderator: And Tom Emmer, it’s your turn. 29:14 Tom Emmer: I didn’t realize we differ on this again. It’s about markets. You know the state of Minnesota, the problem is that too much government involvement. We had great people back in the seventies. It’s not a party thing, but they thought they could make a good system better and they started creating these different options to pool health insurance, create different ways of doing it whether they’re HMOs, all these different styles. Now we’re just band-aiding as we go along. And I hear this talk about how you can’t, you can’t get any effect on price if you empower the consumer. I disagree strongly disagree. In this state we have too much government involvement. You’ve gotta pull it out and allow, look. We have the best quality health care in the world. There’s a reason why Saudi sheikhs fly into Minnesota. There’s a why we are very proud of our health care system. We have the access. People can go to emergency rooms. Is it where we want them treated? No. It’s the highest delivery cost we have. So how do you improve access? Well you gotta lower costs. That’s the issue. How do you lower costs? You empower the consumer with more choices. You give them ownership over their own health care and they will start to make those decisions, the most, the highest value for the dollars that they’re spending. That’s how you do it. You drive cost down by allowing people more choice. Right now we’ve got government making those choices for the people. 30:35 Moderator: All right. Tom Emmer, Tom Horner, thank you very much. And we have another question. 30:39 Audience Member: Yes gentlemen I’m actually running for public office myself, for Ramsey County Commissioner, Andy Noble. I’m curious what you guys have studied in other states as far as privatization and wanted to know what your thoughts were about the successes or failures but other states have had with privatization of assets and certain systems. 31:01 Moderator: Tom Horner. Oh is it Tom Emmer? 31:03 Tom Emmer: Well, I know in the state of Indiana I believe it Is, the state of Indiana has taken their public employees and given them more options with health savings accounts and the like, empowering them. It has dropped costs dramatically, health care costs for the public employees in Indiana. Which frankly is a state that’s enjoying much success compared to the states around it which are the traditional tax-and-spend models whether it’s Illinois, Michigan, Ohio. Those states are suffering. They’re in fact, their economies are suffocating. Indiana’s is growing, this is one. I think there’s another one, a little different than MinnesotaCare. We proposed a change in MinnesotaCare that would create a private health care premium voucher as opposed to the turnkey insurance program that we’ve got in Minnesota. By some accounts it would save 150 to 300 million a year by allowing at the individual who qualifies for the benefit to participate in the private market, getting government out of the business of administering that. That’s been done in Florida as a pilot program, and has enjoyed some success as well. 32:08 Moderator: OK, Tom Horner. 32:09 Tom Horner: Well, and I know that Representative Emmer frequently uses the Indiana example. I’ve known Governor Mitch Daniels since my days in Washington when I was Chief of Staff to Dave Durenberger. Mitch was, actually the first person I met in Washington was my wife Libby, who was a staff person for Hubert and then Muriel Humphrey, one of the later people, one of the next people I met was Mitch Daniels. And Mitch Daniels will tell you that yeah, we can privatize some things, but we also need the federal stimulus dollars. Indiana has much higher unemployment rate than Minnesota. And you know, lookit Tom, I mean what you’re saying just flies in the face of experience. As a small employer, as a guy who’s run a business, I know that in the 1980s small businesses were being kicked off insurance rolls left and right because we had these huge spikes in premiums. Minnesota got together, made some really smart policy reforms about small groups, and now I’ve been able as an employer to provide really good benefits to my employees because Minnesota government created a level playing field. We’ve done some good things with policy. Do we need to do some better things? Of course. Do we need to do some changes? Absolutely. But we need government as a partner. And I believe that’s the reality. 33:18 Moderator: All right, thank you both. And another question. 33:21 Audience Member: My name is (unclear) and I am a hospital internal medicine physician here in St. Joe’s, actually. I’m going to start actually by answering the gentleman’s question here when he asked about why is healthcare more expensive. You know, and I can give you two facts. Probably the number one cause for expensive health care is end of life care. We spend about 30, more than 30% of our health care money on end of life. So we start people on you know on demented people, sometimes in their eighties, on hemodialysis, we put pacemakers, so we use the technology that we have to extend the end of life, instead of making it kind of a peaceful end of life, peaceful, short, we extend it to make it long and very expensive. That’s the number one, probably, cause for expensive health care. Number two is pharma, pharmaceutical, the pharma lobby basically, and medication being expensive. (Unclear, 34:25) for that long, new medications. We’ve only had them for a few years. And they’re allowed to that do public advertising and they have tax deductions on doing these public advertising. And then the patients show up in our offices say “I need this expensive medication.” It’s very hard for a doctor to say no and that’s one driver for health care. So, from here I would start 34:47 Moderator: You’re elected! 34:47 (audience laughs) Audience Member: So sorry for this long question. But my question now, what are we gonna do now about these two things? Number one, how can we do something about end of life care without using it, and the political football you know, death panels, the comments everybody knows. And other thing, what should we do about the pharma? Should pharmaceutical companies have tax deductions for doing these direct advertising for medications that are very expensive? 35:21 Moderator: All right, so Tom Horner, there’s two questions there. You’ve kind of addressed the idea that you know we’re able to live longer – 35::25 Tom Horner: Right. Moderator: – he’s kind of coming at it from the other direction. 35:27 Tom Horner: Right. And so I think one of the things that was lost in the federal health reform because of the way it was politicized was the provision that would incent and provide reimbursement for providers to provide counseling to help people understand what their decisions were. I mean you talk about an informed consumer, you need an educator in order to have an informed consumer. And so we ought to incent and reimburse providers to have that kind of counseling. We ought to have that kind of discussion. But we also ought to continue with the coordinated care for chronic conditions as people lead into their end of life decisions. I mean, some of the really interesting things that Mayo is doing with its insured population, substantially reducing hospitalizations by identifying the early warning signs and keeping people out of the hospital. Now again that involves technology. It includes high speed internet and it includes the interaction. You know, on the pharmaceuticals frankly I don’t know what the answer is. I’ll throw another problem at you. I mean, it’s not just the long lead time, but I mean how many different drugs do we need to cure toe fungus? And yet, if that’s where the money is, that’s what pharmaceuticals keep developing. We need to incent them to develop the drugs that are really going to take care of the more pressing issues. And I think that’s really the greater challenge. 36:48 Moderator: All right, well there go my dinner plans. (audience laughs) Tom Emmer. Without invoking toe fungus, answer the gentleman’s question. 36:54 Tom Emmer: No, but before I do I just want to point out I’m disappointed that Senator Dayton couldn’t be here but Tom (Horner), I just want you to notice that Ted the tracker from the Democrats is here right in the back. 37:05 Tom Horner: Well, and let’s introduce Abby, let’s be fair and introduce Abby from the Republicans. 37:10 Tom Emmer: Where’s Abby? Tom Horner: Abby, say hi to everybody! Go on Abby! Moderator: Who’s Abby? Tom Horner: Oh, who’s Abby! Come on! Tom Emmer: Well I don’t have any trackers? Do you have any trackers? Tom Horner: I’ve got two! You only have one. Tom Emmer: You’ve got two! I don’t got any. Tom Horner: And, and, you only get one because I don’t believe in that. Tom Emmer: Actually, you’ve been trackin’ me for a long time, so we’re gonna count Tom Hauser: I have a GPS in my car, I don’t know what that means Tom Horner: As I said to Abby, just call, we’ll set up a time, Abby, we’ll spend two hours talking, you don’t have to wander around. 37:35 Tom Emmer: Hey Horner. Stay away from Abby, all right? Now. Second. Second, Ted’s been invited to our Christmas party. So you and Libby are invited as well. 37:43 Tom Horner: Thank you. 37:44 Moderator: I’ve forgotten the gentleman’s questions back there. 37:47 Tom Emmer: No, I’ve got ‘em, I’ve got ‘em. 37:48 Moderator: They had to do with end of life care and pharmaceuticals. You’ve got one minute. 37:52 Tom Emmer: First, I absolutely bristle at the idea that we have to start counseling people on maybe it’s your time to go. That’s not the right thing. And doctors today, it actually flies in the face of what our great physicians do right now. That suggests that physicians aren’t sitting down with their patients and saying, “Look, this is where you’re at.” You know, I’ve had family members that I’ve lost. And they had very, very direct conversations with their physicians who they trusted about what they could expect. And then decisions were made based on those discussions. Those are happening already. And for bureaucrats and politicians to suggest that they have the answer by, cause they’re going to create, it’s just an excuse for sayin “We want to cut off your ability to purchase additional health care if you want to for your end of life care.” And when it comes to the pharmaceuticals, these are primarily financial issues, but they relate back to the public influence that people buy in government. These are the lobbyists, the public influence firms that go out to Washington and get the pharmaceutical industry those benefits. I think that’s the issue that needs to be addressed. Other than that it should be a free market. 39:00 Moderator: We’re running short on time cause we want to make sure we get people out of here by seven thirty. We’ll take the questions from the people who are up there. You’ve got ten seconds to ask your question, we’re going to give you each thirty seconds to answer and I want to make sure we get through everybody who is standing. So, make ‘em simple. 39:13 Audience Member: Also, very quick question, but maybe a tough response. My name is Jeff Kauffman. I’d like to hear your proposals on economic development for the state of Minnesota in ways to balance our budget because we have to as a state. The federal government doesn’t have to but we do. 39:27 Moderator: Tom Emmer. 39:27 Tom Emmer: First off, the budget issue. You’ll hear that we have a 5.8 billion dollar deficit. In fact the state of Minnesota, based on current revenue projections, the next Governor, the next Legislature, will actually have almost three billion more to spend than it has today. My colleagues say they have to raise taxes in this state because they gotta pay this 5.8 billion dollar deficit. It’s a deficit on paper. In fact, if we agreed and I’m not saying this ‘cause I believe we need to redesign a smaller government, if we agreed we were not going to spend one more nickel in the next biennium and change any program, theoretically based on current revenue projections, state of Minnesota would have a surplus. How do you stimulate the economy? Economic development? You lower taxes. You eliminate and streamline the excessive and unduly burdensome regulatory environment that we have in this state. You unleash the entrepreneurial spirit that is in Minnesota. You allow your existing employers to start to grow again. And make Minnesota attractive to new investment and new opportunities, new jobs. 40:29 Moderator: Tom Horner. 40:31 Tom Horner: Well, let me say I do agree with Tom, the deficit is on paper, it’s on the loan documents that school districts have had to take out to borrow money to pay for the money that the state stole from them. It’s on the loan documents that businesses are gong to have to take out because now the state is saying we want your accelerated payments on, on sales tax. It’s on the loan documents that cities are having to take out because they’ve had to cut fire and police. It’s not a deficit on paper! It’s a real deficit. It is only like somebody saying today, “I’m going to go out today and buy a $20,000 car because next year I think I’m going to get a $10,000 raise in salary.” Yeah, we’re going to have more revenue. The problem is, Tom, the Legislature, Governor Pawlenty, spent the money two times over. It is a real deficit that requires real solutions and most of all, it requires honesty with the people of Minnesota. And so in 30 seconds can I answer the question? No. That’s why I’ve put out a very comprehensive program on my Web site, horner2010.com that deals with tax reform, how we’re going to lower the sales tax rate, broaden the base, do the business tax reform, that is going to drive Minnesota jobs. Spending cuts, redesign, but also make some investments in health prevention, in early childhood learning, in older adult services, money that we spend now so that we’ll get a better return down the road. 41:51 Tom Emmer: Do I get my clarification point at this point? Real quick? 41:55 Moderator: Yes. REAL quick. 41:56 Tom Emmer: I would ask Tom (Horner) this, I asked you this in Duluth yesterday, Tom Horner: Yes 42:00 Tom Emmer: Will you agree to take this so-called outline that you’ve offered as a plan and take it to the Department of Revenue and have them do the runs and show everybody what you’re claiming, if it really does work. 42:11 Tom Horner: Yep, and in fact Tom I have done that to the same extent that you have. Nobody in the Revenue Department hasn’t vetted either of our plans. They have looked at the numbers and they’ve said my numbers add up. But more importantly, Art Rolnick for 25 years, the senior vice president at the Minneapolis Federal Reserve, one of the most respected economists in this community, he looked at the three plans: yours, Senator Dayton’s, and mine. And what did he say? Horner’s is far and away the best. I’ll take Art Rolnick’s word for it. 42:40 Tom Emmer: Again. What I will ask again, and very respectfully, 42:43 Moderator: I’m gonna go out and get a sandwich 42:45 (audience laughs) Tom Emmer: Tom (Hauser), this is important. Because these people want to know that the plans we’re offering actually work. We did check with the Department of Revenue, apparently they verified it but they haven’t done the runs. I will tell you, I asked today to have those runs done and am asking you because I’m going to show you that what I’m proposing does work. I would like you to assure everybody here that you are willing to take your so-called plan, give it to the Department of Revenue, and have them actually do the firm run so you could show it to people and the public. 43:14 Tom Horner: Absolutely! Tom Emmer: Good. 43:17 Tom Horner: And my so-called plan is actually a plan that is called Horner2010 Minnesota Works, and it is on the Web site for everyone to see. I’m not sure all the candidates can say that, Tom (Emmer). 43:28 Moderator: Next question, we’re gong to move as quickly as we can. I hope you don’t mind going an extra few minutes. This is getting good! Go ahead. 43:34 Audience Member: Great, good evening, and thanks for the lively discussion gentlemen. I just have a really quick question. If elected, would you support zero-based budgeting with the alignment of the strategic mission for each of the agencies or cost centers to the basic purposes of government in Minnesota? Thank you. 43:56 Moderator: Tom Emmer. 43:57 Tom Emmer: Yes. 43:59. Moderator: Tom Horner. 43:59 Tom Horner: Yes, I support it but the reality of it is, we’ll never get there. So what we ought to do is outcomes-based budgeting. Start with the priorities that we want to achieve. And then back up from there. That’s a much more effective way to do it, a much better way to do it, and a much more politically viable way to actually get it done. 44:14 Moderator to Emmer: Did you want to add to your answer, or was yes good enough? 44:18 Tom Emmer: Well, politically viable, that’s business as usual. That’s talking about the way we’ve been doing it, just giving it a little different flavor. It’s time that government live within its means, it’s time that we set our budgets based on what we have now, (audience applause), not what we want. 44:34 Tom Horner: Right. And I would say, I would say that business as usual didn’t just start today. It started 6 years ago when you were in the Legislature, and have yet to introduce a balanced budget bill, yet to introduce a reform, yet to introduce a redesign, yet to say “Here’s a new way of doing things.” For six years. 44:51 Tom Emmer: Tom (Horner), actually, I do have a record. That you can go look at. 44:56 Tom Horner: And I have. 44:57 Tom Emmer: Well then good, because you’re misrepresenting it because I have offered reforms. And they’re all there to be seen and I hope these good people will do that. And I would respectfully ask that if you’re gong to represent that you do it honestly and tell folks there have been reforms to MinnesotaCare. There have been reforms to the Legislative process. There have been tax reforms. You name it, in every area just about I’ve offered proposals over the last 6 years, and yeah you’re right. It’s, there’s a lot of business as usual in St. Paul, we’re looking to change that. 45:28 Tom Horner: And Tom (Emmer) if you’ve had all of those reforms, I can’t imagine then why the challenge you have in just putting them on your Web site. 45:35 Tom Emmer: It’s mostly cause of lobbyists 45:37 Tom Horner: Let everybody see it 45:37 Tom Emmer: It’s mostly lobbyists 45:38 Moderator: Next question. 45:39 Tom Emmer: I’m having fun with him, I’m sorry. 45:40 Audience Member: Ron Hanson, I’m the immediate Past President of the Twin Cities Medical Society. And a number of us there look a lot at medical economics. And if you notice in the Wall Street Journal today a whole host of companies once again indicated that they’re going to raise insurance premiums between 17 and some-odd percent. And many of us who think about this from an economic standpoint understand the previous gentleman’s question on increasing premiums as sort of a result of the cost shift that occurs in the true cost of providing care, versus that which is reimbursed by state and federal programs. Many of us are quite concerned about upcoming federal legislation that there’s a potential that reimbursement rates for federal insurance could be somewhere based near Medicare, Medicare and Medicaid rates. And already you’ve seen that cost shift occur at Children’s Hospital, where they just sent out a letter last week that said they’re going to have to reduce between 200 and 250 FTEs in the hospital. I mean, that is in a sense de facto rationing by the fact we’re going to actually reduce the resources. You talk about cost, quality and access. And most economists will say you can only have two of those three. It is very difficult to deliver all three effectively, and maybe can’t be done in real economic systems. I guess my first question, and the only one I’ll have time for, is the direction that the country and the state is going, with accountable care organizations, some of us providing the care are quite concerned that once again the providers will sort of be the de facto backstop financially for how this is going to work. Minnesota Community Measurement is providing a lot of statistics or so-called benchmarks to try to determine quote unquote how well physicians are providing care. And then there will be tiered and rated and accountable care organizations 47:32 Moderator: Can you boil the question down just so we can respect everybody’s time? 47:34 Audience Member: Yes. And so, I think you guys get the, it’s complicated, right, and it can’t be done 47:38 Moderator: Yeah, we picked up on that tonight. 47:40 Audience Member: So I’m trying to figure out what you fellas think about the direction of accountable care organizations and how we’re going to make people accountable for outcomes. 47:50 Moderator: Tom Horner. 47:50 Tom Horner: Yeah. And I think you’re absolutely right, and I think we continue on this path, that federal programs will cut reimbursement. And they don’t want to deal with the real issue. And so we see y’know that Mayo Clinic I mean the example of Atul Gawande that often is used, Mayo Clinic provides Medicare at a higher quality for half the cost of McAllen, Texas. We’ve got to change that. I don’t think we change that by pretending that we can get rid of federal health reform. It’s not going to happen. We can change it by acknowledging that federal health reform is not the prescriptive plan that some make it out to be. It is an opportunity for Minnesota to engage with the federal health reform and to leverage it with some of the accountable care organizations, coordinated care, medical homes, those kinds of programs, to make sure that everybody is treated fairly, that providers are reimbursed at a fair rate, that Minnesotans have access to high-quality health care, that employers pay a fair share, and a transparent share when they buy insurance, all of those things. I don’t think we get there by pretending that we can just go to a charity care system for the poor, or that we can just bring in more insurance companies and everything will be fine. That’s just not the reality of the health care marketplace. 49:04 Moderator: Tom Emmer. 49:05 Tom Emmer: Well, certainly the way we’re doing it right now is not working. To say on the one hand, “Yes we’re absolutely headed there” but on the other hand say “That’s why we got to participate in every federal dollar that’s being offered to us in every federal program.” That to me doesn’t make sense. Again, I said it earlier, you have to evaluate every federal program as it comes into the state of Minnesota. What’s really being offered, but more importantly what are we committing to for the long term. When you talk about things like this, are we just going to ignore this problem that has been going on now for years? What incentive is there going to be not just to provide the care but what incentive is there going to be to generate the next generation of great physicians that we have in this state? If your future is you’re not going to even be able to provide the care you’re offering at cost. Because that’s where we’re headed. But it’s time to start thinking out of the box, and you know you can mock the term “charity care,” whatever you want. But the problem is we have too much government involvement. You’ve got to allow the marketplace to work and you’ve gotta trust in the people because people in this profession do want to care for their fellow human beings. Give them the incentive and the opportunity to do that, start to pull government out of the process and you will see the system start to balance itself I believe. And you know what? If you don’t trust it, at least give me the opportunity, at least give us the opportunity cause clearly what we’re doing is not heading in the right direction. 50:27. Moderator: And our final two questions. Go ahead. 50:29 0:50:30.229,0:50:33.449 Hi, my name is Joel (Unclear, 50:32) and I’m a medical student. Rural primary care I think is a topic that needs addressing. And as a medical student I know that one of the only ways to increase the number of rural primary care physicians is going to be a financial incentive due to student loan debt. And one of the only ways to do that is going to be to increase reimbursement to decrease student loan burden or some other option. I was curious what specifically would you do to increase the number of rural primary physicians coming out of Minnesota. 51:03 Moderator: Tom Emmer. 51:04 Tom Emmer: First off, primary physicians are in jeopardy period. Got nothing to do, well it does have something to with that, you know, what you can offer in greater Minnesota, how many people want to be there. But primary physicians you know where the money is today is some type of specialty so people are moving in that direction. And frankly they’re bypassing primary physicians. I think the future because the primary physician is incredibly important to the future of health care in Minnesota. It’s not going to happen by continually centralizing the care offerings in the bigger and bigger clinics. It’s going to be empowering consumers so that they can make real choice. And when it comes to rural Minnesota this is a place where I would absolutely say there are things that we can do in terms of empowering the private sector in order to provide programs that will attract people to greater Minnesota to set up their practice. Whether it’s a loan forgiveness, a scholarship, whatever it might be, we should be looking at every option. 52:01 Moderator: Tom Horner. 52:02 Tom Horner: Well, a couple of things. I mean first of all, we do need (coughs) excuse me, we do need a robust economy in rural Minnesota, and I’ve laid out a very specific plan on how rural Minnesota can have that kind of robust economy. But secondly, when you look specifically at our rural health care system, we do have to look at programs like the Medical School at Duluth that is incenting doctors to go into rural practice settings and practice. And that does that a role for government. And that’s the reality of it. But beyond that, we also need to make sure that those physicians have the opportunity to practice the best health care. And so that’s going to take creative programs like St. Joe’s TeleStroke program where doctors can connect with experts in Minnesota, around the country. That takes an investment in high speed internet. We need to make sure that we’re looking at programs like GAMC and we don’t impose the burden on rural hospitals and collapse that infrastructure. Otherwise we won’t get doctors out there. And lastly we need to be open to looking at mid-level practitioners, alternative practitioners. Those kinds of practitioners that can expand care. Again, St. Joe’s a good example with the certified nurse midwives. 53:16 Moderator: All right, our final audience question. 53:17 Audience Member: I’m Grant Abbott, I’m the Executive Director of St. Paul Area Council of Churches, changing topics, I’m not a doctor. I have a workforce question. Tom Stinson, our state economist, Tom Gillaspy our state demographer, have been going around the state talking about the new normal. The fact that in 2020 we’re going to have more people over 65 than under 17 for the first time in history. And they also let us know that in the under-17 group it’s growing more and more diverse. And among that diverse population, fewer than 50% are graduating from high school, fewer are going on to college. And fewer are graduating. So as the baby boomers who are now leading many of our corporations retire, and we have a coming workforce that isn’t even graduating from high school, where’s Minnesota going to get the workforce to be a leader in the global economy? 54:07 Moderator: Tom Horner. 54:07 Tom Horner: Well, I think that’s a great question and in a minute I can’t do it justice. I would urge all of you to read the editorial in yesterday’s Star Tribune that took a detailed look at the education programs of the three candidates and said Horner’s the one that we ought to trust. Not just on education, but he’s the one willing to bring new ideas to the table. He’s the one who can bring different parties together to get things done. So quickly we need to do a couple of things. We need to invest in early learning. We need to make sure children are coming into kindergarten fully prepared for success. We need to allow teachers to teach. We ought to turn schools over to the expertise of teachers. And allow them to make their best judgment about how to succeed with the kids in front of them. We need really good principals, good schools have great principals. That’s going to take another investment of money to identify those people who have the skills to be principals, to make sure that they have the residency the mentoring, and then we are going to have to sit down with Education Minnesota and other people and say We do need make some changes in seniority. We do need to bring in more qualified teachers in some technical areas and do some of those kinds of things. But we also need to look at the achievement gap, how we resolve that. Again all of these things are spelled out and I would urge you to take a look at the proposal. 55:25 Moderator: Tom Emmer. 55:25 Tom Emmer: Tom Gillaspy, to actually to add to what you put out, said that we are on the verge of the greatest labor shortage that we’ve ever seen. This is going to be one of our greatest challenges. But it goes back even to what the primary care physician, the medical student was asking. If you want to fix this you don’t do it by raising taxes, growing more government. You do it by lowering taxes, streamlining regulation, making Minnesota once again the place for opportunity. Remember the sixties and the seventies? This is where people came to go to the University of Minnesota and our other great colleges. They got married here, and they raised a family here. Why? Because this is where all the opportunity was. This is where 3M, IBM, Honeywell, Control Data. We were growing businesses. We need to get back to doing that. And then when we do, you’ve got to identify, you can’t just let the union boss control where our schools are going. Somebody’s got to stand up and say You know what, this is about the kids, their parents, and it’s about the great teachers that we have in this state. We must have alternative teacher licensure, allowing good adults that are prepared to offer things in science and math, cause we have a shortage of science and math teachers in our state. We need to allow that so we can attract people into those areas. Even though we’re still doing well in science and math in this state we’re falling miserably behind on reading in Minnesota. In Minnesota we have fallen miserably behind in reading. You have to increase the standards that we require our teachers to pass in order to become licensed. Did you know that a teacher in this state can remain licensed for up to three years even though they can’t pass what is essentially a ninth grade basic skills test? We absolutely must recognize that now is the time to take our education system to the next level. Because today we’re not just competing with Wisconsin, Iowa, North and South Dakota, we are competing with the world. And I look forward to having a lot more of this discussion when we have more than thirty seconds. 57:25 Moderator: All right sir, your time is up that somebody had submitted. I just want to throw it out there because I think it is interesting and it pertains to what’s going to happen in the future. What should the Governor do to improve broadband coverage and speed availability statewide and how would you go about paying for this? And I know when my dad was a doctor as a radiologist and he was working up here in the Twin Cities he used to drive back to places like Hastings and LeSueur because they didn’t have their own radiologist. Now you can do a lot of this remotely through broadband. So as we as this pertains to healthcare how important is this, Tom Horner, to expand and improve that system statewide including in the rural areas? 58.00 Tom Horner: I think it’s an essential part of our infrastructure, and I’m the only candidate that has been willing to say that. I think that in some areas we ought to do it as a private investment, where we have the population density. And other areas, and we’re seeing great success in areas like Monticello, it can be a private/public partnership. But there are some parts of the state where it is going to take public investment. And we need to do it because long-term if we want to open the whole state to world-class education, world class health care, world class economic development opportunities, high speed internet will be the highway of the future. It will be to our next generation what the rural electrification was to our parents and grandparents. We need to make that investment. And to think otherwise, I believe is to live with the status quo. 58:45. Moderator: And Tom Emmer. 58:46 Tom Emmer: We all agree, contrary to that we all agree that this is a very important issue for the future of Minnesota. We’re ignoring the fact that we have much of this state, we already have access. Can it be improved? Absolutely. Where we disagree is government doesn’t do this better than the private marketplace. Get government out of the way. Look at the cities that have actually taken this over. It has been a miserable failure. Take a look at Paul Bunyan Telecom. They’re already reaching very small populations, up in the very northeastern corner of the state. Why? Because there’s a market for it. If government will get out of the way and allow them to make those investments, if there’s a market they will reach it and that’s really what this issue is about. When you let government get involved it actually slows the process and it gets in the way. 59:31 Moderator: All right, thank you both for taking time. Let’s have a round of applause before we get to closing statements. (audience applause) Don’t go away yet! 59:38 Tom Emmer: Nice job, Tom 59:39 Moderator: They’re each going to have two minutes to give their clothing – closing statement, you don’t have to take the whole two if you don’t want to. We’ll go in reverse order of what we started with. And I’ll begin with Tom Horner. 59:48 Tom Horner: Well, thank you very much and again, I think you see clear differences. Look, I got into this race because I do think there is a need for a centrist common-sense approach to solutions. But I don’t think that the centrist common sense approach is take a little bit from the right, a little bit from the left, mush it together and hope it works. We do need complete new thinking about how we’re going to approach some of these challenges. It’s not just to say “Government has no role, trust individuals, trust businesses,” there is a role for all of us, for community, for society, to do things better, to do things differently, to do things more boldly and that really is my message to you, is that this is a year when Minnesota is at a critical crossroad. We do have to make decisions. What has been working in the last several years, what has been done in the last several years isn’t working We need to be smarter. We need to do things differently. We need to do things where we have Democrats, Republicans and Independents at the table, figuring out what is the best solution, what is the new solution. And I think fundamentally at the end of the day, the issue that I think is going to decide this election will be leadership. Who has the vision who has the temperament, who has the experience to bring Minnesotans together to find that common ground, to move the state forward? And so here’s what I would ask of you. A couple of things. First is, we need to ask two questions: What kind of a Minnesota do we want to live in, and what are we willing to do for it? And secondly I would ask you this: if you want bold leadership in the Governor’s office, it starts with bold leadership among you the voters. You need to think every bit as differently about this election as I want to think about the future of our great state. So with that, thank you to the hosts, thank you, thank you to Tom and Tom (Emmer and Hauser), and it’s been a great opportunity to be here with you. 1:01:42 Moderator: All right, thank you Tom Horner, and now Republican candidate Tom Emmer. 1:01:47 Tom Emmer: Thank you as well, Tom. It is an honor to be here. And think about it. It is an honor and a privilege to run for the office of Governor of the state of Minnesota. There is a distinct choice this year. On the one side you have a couple of candidates that essentially say the same thing that I’ve heard since I was a young man old enough to understand in this state: government has run out of money yet again in the state of Minnesota. So what do the politicians do? What do the people that have been involved in building government all these years do? They look right away to the hard-working men and women in this state, the businesses of this state, and they say “you just need to pay a little bit more.” You know what, you could talk about taxing the rich, that’s not going to solve your problem when it goes right to the heart of every small business in this state. You can talk about spreading the sales tax and dropping it a point but when you’re now going to tax garage sales and the kid who mows your lawn and haircuts, where will it end? I believe it’s time for a new direction in the state of Minnesota. Based on the reception we’ve been getting over the past several months we believe that a significant number of people in this state, hopefully the majority in this state, agree with us. It is time to look at government itself for once. It’s time to redesign government so that it efficiently delivers the services that people expect, and then do what we absolutely must do. Instead of constantly representing government and protecting government at the expense of the taxpayer. Let’s start to empower the taxpayers, the citizens of the state of Minnesota. Then start to grow their opportunities. Let’s remember this country, this state was not built by government, it was built by people and it will get moving again if you allow people once again to have the opportunity to realize their full potential. That is the only future that will set Minnesota back on a path of success. That’s the one that we hope to have the opportunity with you to create in the state the next four years. I look forward to having more of this discussion over the next 56 days. Thank you very much. 1:03:40 (audience applause) Moderator: All right, thank you Tom Emmer.