Brown University President Christina Paxson is the guest this week on Political Roundtable. Joining me on the panel are URI emeritus professor of political science Maureen Moakley and Brian Amaral from The Boston Globe.

Here's an edited transcript of our conversation.

Donnis: President Paxson. I'd like to start with the big news that came out in February about plans for an academic health system to be developed by Lifespan and Care New England, Rhode Island's two largest hospital groups, with Brown University. This has the potential to be an economic benefit for Rhode Island and to help to train future doctors at Brown University. But I wonder, will this increase the medical costs for average Rhode Islanders?

Paxson: So that's a really good question. And I think one of the concerns about mergers is that, you know, if they dampen competition, costs could go up. I don't think that's going to happen in this case. And there are several reasons why. One is that the Rhode Island healthcare market is actually very small. People think about this as being a big merger in the context of Rhode Island. But we all are the smallest state in the country. And we're very integrated into the Boston market, which is actually quite concentrated. In addition, Rhode Island has the strictest regulations limiting increases in healthcare costs in the country. So there's a lot of protection against healthcare costs.

The point that I think people don't really appreciate is that right now, Care New England and Lifespan, compared to major healthcare systems around the country, they're both sub-scale, they're tiny. And bringing them together will actually create a healthcare system that is still on the small side. You can't provide effective low-cost care with this sub-scale healthcare system -- it doesn't work. So I'm excited about this, because I think we're going to be able to provide better care to patients. I think it can be, bend that cost curve, keep costs from going up.

Where Brown comes in, you know, we have a great medical school, we're training doctors, we're doing a lot of really interesting biomedical research. We also have a great school of public health that is thinking really hard about how you use public health interventions to improve population health in a way that doesn't require as much medical intervention. So I think we can do something great in Rhode Island that we don't see anywhere else in the country. I'm very excited about it.

Donnis: This kind of collaboration has been talked about since the 1990s, you know, predating your arrival in Rhode Island. And one of the hurdles has been the institutional politics of trying to merge two different hospital groups, two different hospital boards. What will be the process for trying to iron out the details of governance for this proposal?

Paxson: Well, I think the governance issues, you know, as you said, I wasn't here before, but I've heard the stories -- the governance issues have gotten in the way in the past. My sense now is that the two healthcare systems, and again I don't sit in those boardrooms. But my sense is that they are in a very, very different place than they've ever been before. And the Coronavirus, the COVID pandemic, taught them, really underscored how they can work together well. They can collaborate, and that coming together, you know, put the governance battles aside. These are not-for-profit organizations. Their mission is to serve the well-being of the people who live in the area. And I think they're really fully on board with that. And so we have an opportunity now that we haven't had for some time, and I really hope it works. 

Amaral: Last month, Brown undergrads voted pretty overwhelmingly -- it was about 85 percent -- to support reparations for the descendants of slaves tied to the university's founding. Do you think the university should pay reparations to the descendants of enslaved people?

Paxson: Well, that's a really complicated question. And it's one that Brown has been involved with and actually leading discussions about for many years. So in 2006, under my predecessor Ruth Simmons, we issued something called the Slavery and Justice report, which was really foundational. It's been a model for what universities have done across the country. It actually said, you know, direct reparations was not the right way to go for Brown – we’re different from Georgetown. The university did not ever own slaves like Georgetown did. That's a comparison people often make. And that report came up with a set of recommendations that we have, by and large, followed to strengthen our ties to the public schools, to the start of a great new research center, the Center for the Study of Slavery and Justice, that is dedicated to understanding and addressing the legacy of the transatlantic slave trade.

Now, you know, we're in a different world now than we were in 2006. And so last summer, I established a task force on anti-Black racism, to really address the issues that came out of, you know, the George Floyd murder, Breonna Taylor -- you know, all the things we're dealing with as a nation. I'm expecting to get their recommendations later this month. I don't know if they'll recommend direct reparations or something that is, you know, reparations can mean many different things in many different contexts. So I don't know where we're going to go. I think the conversation is worth having. But again, note that Brown did not own enslaved people, claim to own enslaved people, at any point in its history.

Moakley: President Paxson, college administrators have to deal with the nettlesome issue of free speech, and allowing opposing ideas for students, as well as faculty. Students should be exposed to opposing narratives. And for faculty, the point of tenure is to provide an environment when they can study and research and teach ideas that may be out of the mainstream. In these polarized times, how do you handle these issues? Where do you draw the line?

Paxson: You know, if you go back even to Brown’s founding, the idea of openness and tolerance for other points of view, we were one of the first universities to say that people from all religions were welcome at the university. And if you go back to actions that the faculty took and the corporation approved in the 1960s, with a very strong statement supporting freedom of expression. Because that's what grounds academic scholarship. You can't advance knowledge if people can't discuss ideas, we know that. It's interesting, because sometimes Brown gets a rap -- you know, people say, Oh, you know, there's no freedom of expression of Brown. But yeah, that's absolutely false.

And it's also interesting that the groups that complain about that are often the ones who are first to criticize our students when they do things and say things that they don't agree with. It's interesting. You know, I don't think universities should be places where students are coddled. I think the, you know, our job as educators is to make sure that students’ minds are opened and that they are open to a wide range of views. I think we all know, though, that there are limits to speech when it verges into harassment and discrimination. And there are clear regulatory reasons why we can and should create an environment where, you know, people are free to speak, but they're not attacked in a hostile or discriminatory way. But sometimes that gets to be a hard line. By and large, I think we navigate it pretty well.

Donnis: President Paxson, a 2017 study found that students at 38 colleges, including Brown, were more likely to come from the upper one percent of income strata than the bottom 60 percent. Are universities like Brown perpetuating the power elite by not taking more aggressive steps to address that imbalance?

Paxson: College access in America is a major issue. And we need to get more students from lower- and middle-income backgrounds into higher education. And when I say that, I'm not talking about privates, like Brown. I'm talking about the vast majority of students in America -- college students are at public institutions. And I'm a big advocate for public education, too -- that needs to be supported as well. So you know, what are we doing? We are need-blind; there are not many universities in the country that accept students regardless of their financial need.

When we admit students, we meet their full need, which means you know, we don't say, great, we'd love to have you, but we can't afford to give you the scholarship that you need to come. Three years ago, we eliminated loans from financial aid packages. So those were all converted to grants. We've seen steady improvement in the breadth of students who are coming to the university. It's in the high 40 percent received financial aid. And we'll continue to make progress on that. It's a really important issue.

Amaral: Along those lines, the Globe reported recently that large selective private colleges were seeing a dramatic rise in the number of first-generation and low-income applicants. And this was linked to the decision by most schools to make standardized test optional. Brown is currently optional for standardized tests for the 2021-2022 cycle. Is there any notion of making that a permanent fixture of applicant applying to Brown?

Paxson: It's definitely something we're discussing. And I, you know, we just admitted our class this year. They'll decide in the next couple of weeks whether they want to come to Brown. I was on a webinar with thousands of them and it was so much fun. I think the experience of this year, we'll take the lessons, we'll analyze how it affected our applicant pool and how it affected our matriculation patterns. And then we'll go from there. But no -- we haven't made a decision on that yet. But I think it's a really good important question.

Moakley: The Biden administration is considering student loan forgiveness. Some argue that across the board forgiveness would disadvantage students who went to public colleges because they chose a less expensive option than those who opted to go to more prestigious colleges, where they've incurred greater debt. How do you think this loan forgiveness program should be structured?

Paxson: An across the board loan forgiveness program would be regressive. It would benefit wealthy people over less advantaged people. That's not what we want to do here. You know, I think about, you know, typical Brown student who before we start putting loans in financial aid packages, might graduate with $10,000 worth of debt. And then they're launched into a career where they can afford to repay that debt. And you know, earning, you go work at Facebook, you go work at Google. It just doesn't make any sense. The only loan forgiveness that I think makes sense is very targeted -- that we're making sure that we're targeting people who are not earning enough to cover their debt payments. And especially targeting people who, frankly, were scammed by their schools. So there are students who went to for-profit universities that really didn't serve them well and incurred a lot of debt in the process. And those students I really feel sorry for, because I do you think they were scammed. You know, I would favor very narrowly tailored debt forgiveness. But the other thing to keep in mind is that debt forgiveness now isn't going to help the people who need to go to college now, right? My own focus is on improving access for the current students who are in middle school, high school, who really need those college degrees if they're going to have good careers ahead of them. empower the economy.

Donnis: Brown announced this week that it will require COVID vaccinations for students returning this fall. What is the mood and what is your outlook on how the university is prepared to resume a more kind of normal experience this fall?

Paxson: Well, our public health experts have been very clear that you know, we can have a close to normal experience. If, if, this is important, the reach the vaccination rates that really protect the community as a whole. And that's both for students as well as faculty and staff. Requiring employees to get vaccinations is a difficult issue. There are legal issues, we haven't gone there yet. But we can require vaccinations of students. The reaction from students and their families has been overwhelmingly positive. Some families have said, you know, this is not right. This is a violation infringement of liberty. But I'm thinking of the well-being of the campus as a whole. There are two issues that I think are important here. One is any student who can't come back to campus for health reasons, or they can't get a vaccine or something like that, they will still be able to study remotely. The other concern that we have is, we're working very closely with our international students who may not be able to access an FDA-approved vaccine before they come to campus in September. And we're committed to making sure that those students will be able to come back even if it means they get vaccinated once they come back to Rhode Island. So I think it's a good decision. We're seeing lots of other schools fall in line there. And this is what's going to make it possible to open.

Ian Donnis can be reached at Follow him on Twitter @IanDon. Sign up here for his weekly RI politics and media newsletter.