Value Talks Guest Podcast Ep 13: Leadership, Healthcare & the Federal Government with Special Guest, U.S. Congressman Roger Marshall, M.D.

Value Talks, a ValueHealth podcast

Hosted by Travis Tasset, the Value Talks podcast explores a range of topics that matter to people, including healthcare, leadership, and culture. In this episode, I discuss leadership and healthcare with special guest U.S. Representative Roger Marshall, M.D.

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Transcript of Episode 13

Roger Marshall: We can do more collectively than by ourselves and from everything I have read, learned in life, is the great leaders are able to accomplish the most and that has always been my passion – to leave this country better than I ever found it, so, whether I was in medical school or running a hospital or as a congressman now, I want to achieve those maximum results.

Intro: Welcome to another episode of Value Talks. 

Dan Tasset: This is a special edition podcast and I have with us a guest, Dr. Roger Marshall. Welcome Dr. Marshall. 

Roger: Hey, Dan. Glad to be here. 

Dan: We are really about leadership, developing leaders both internally as well as externally here. We are getting pretty good followership and viewership, so, I am excited to have you here because you have, in my opinion, a really good legacy as a leader. So, thank you for coming and that is what we are going to talk about today. Let us get started a little bit. We have been friends probably now for 20 years, something like that?

Roger: Over 20 years, absolutely.

Dan: I think both you and I have this passion for developing leaders, starting with our own family and the people that we work with. Tell me just a little bit about your passion just in general for leadership, if you don’t mind?

Roger: We can do more collectively than by ourselves and from everything I have read, learned in life, is the great leaders are able to accomplish the most and that has always been my passion – to leave this country better than I ever found it, so, whether I was in medical school or running a hospital or as a congressman now, I want to achieve those maximum results.

Dan: Yes. So, you and I have talked often about, we should write a book at some point and I am pretty confident that we will do that and as we were talking on a recent trip that we took and we
were talking about the content of that book and we kind of encouraged each other to start keeping track of different thoughts and experiences we have had on leadership. There are a lot of books written on leadership but I think the book that we will someday write is more about the practical aspect of leadership from our own experiences. 

I think we started by asking each other the question, “What do you think is the number one leadership quality or the quality of a leader?” Just kind of start big picture. What is at the top of your list? As we would write this book, what would be the first chapter? 

Roger: Well, I think as people of faith we would talk about servant leadership as opposed to the king and ruler of all, but the great leaders of today I think are servants first, and how do you take that servant mentality, which of course Jesus was doing 2,000 years ago before it became en vogue, so, how do we take that faith and become great leaders?

Dan: So, unpack that a little bit for me. Servant leadership: give me an example of what that looks like in real life and for a minute let us hold off on your experience in Washington, DC as a United States congressman. We are going to talk about that in a little bit, but prior to becoming a member of Congress in Washington, DC you had a medical practice, you ran a hospital. Talk about your leadership in the community and in the business. Talk about servant leadership and unpack that a little bit.

Roger: Yes, I think it’s instead of walking into a relationship and asking what you can do for me, it’s what can I do for you? What can I help you to do to grow your medical practice if you are another doctor? What can I help you to grow your hospital? What can we do together? What can we do to take two plus two and make eight out of it? 

So, I think that part of developing rapport is, “Look, I want this to be a win-win relationship.” You and I have both learned if there was a deal where even if I was going to get 90% of the deal and the rest of the doctors were not going to get anything, that is a deal I would walk away from. So, I think it’s first of all serving the people around you and developing that rapport.

Dan: Yes, that is interesting. Sometimes when I get asked about what is the number one quality I use the word, a lot of times, “humility,” and in order to be a servant leadership you have got to have some humility around it, which people I think often confuse what humility means. I heard a really good description of it. Humility is not thinking less of yourself. That’s false humility. Humility is thinking about yourself less. In other words, thinking about the other person or being a servant to them.

Roger: Yes, I think humility in many ways is the opposite of pride. So, we talked about the greatest commandment is to love the Lord your God with all your heart and then secondly to love your neighbor as yourself. So, everybody knows that, but the greatest sin, at least according to Sinclair Lewis — is that his name? he wrote Mere Christianity — was pride, so, to be the opposite to that is humility.

Dan: Right, that is awesome. All right, so give me some others, so number one on your list on leadership is being a servant leader and thinking of others first, what can I do to help you? So, go to number two.

Roger: Let us talk about our leadership growth, maybe your road was a little bit different than mine, maybe it was the same, but as I think about leadership, where did I learn leadership? I learned leadership at my family supper table from my dad in many ways. How about the playground? So, did you grow up in Dodge or outside of Dodge?

Dan: It was outside of Dodge in a little farm community. It was a community called Windhorst.

Roger: I know where Windhorst is. Think about the lessons you learned in recess. You know, I’m not sure what you guys did but in the fall we played football and in the winter we played basketball and in the spring we played baseball and the bell would ring and you would run out there and you would pick teams, right? I figured, “Well, I might as well win as long as we’re playing,” so, what did leaders do? They volunteered and they scattered out the rest of the teams and by gosh you picked the best people you could and it is all about winning after all.

Dan: Yes, that is interesting. So, yes, if I look back on childhood, everything that we do prepares us for later years in life and I think the reason I have such a passion for leadership and wanting other people to be leaders is influence that we can have on other people. I just think we constantly underestimate the influence that we can have on somebody, some small word or some small comment, some kind action, a statement of encouragement.

I just could not count on both hands and feet the number of times where I said something to somebody and it might be a year later, it might be five years later, ten years later, somebody came back and said that that made a tremendous impact on my life and a tremendous difference. Can you give me any examples, or do you have a similar feeling about the influence that maybe people — and again, you do not have to be a big — over a lot of people or have a lot of big company or anything, even the smallest person wherever they might be has the ability to influence somebody else.

Roger: Well, I think, you know, just the people that I wanted to emulate, the best leadership qualities of each person in my life that had a significant impact and of course I talk a lot about my parents and my grandparents and how they modeled this life of being a provider, being a leader of the family, you know, just setting the bar high, being consistent and I had a track coach that made me think about him as we are talking here and he had a saying, “Don’t tell me, show me.” 

So, the first day we all get to college of course every one of us are superstars in our own high schools and everyone is bragging about how good they were and he came into the room and said, “Don’t tell me, show me,” and we went out and we worked our tails off. But I think that is very true, I mean, that was a college track kid trying to make his way through life but that has been on through the rest of my life, you know, do not talk about making good grades, do not talk about running a successful medical practice, just go out and show me. 

Just do the little things right every day whether you are playing shortstop in major league baseball or being a doctor. Do the little things perfectly every day.

Dan: So, clearly your parents influenced you in your life regarding leadership, regarding life in general, your track coach, anybody else? You became a physician, an OB/GYN, successful practice, where did that influence come from? Was that internal, external? How did that come about?

Roger: Well, I think again, you have great mentors through your whole life, so certainly medical school residency, great mentors. Where we were trained at, you know, you are looking at 25, 30 other doctors out there. Who is successful? Maybe we will define success a little differently than others, but the successful ones, you know, hard workers, are very consistent and you know, successful in their family life as well was always important to me.

Dan: Yes. All right, so, let us again, before we were talking a little bit about your medical practice and the hospital that you ran and all of that, as you know, most of our organization, Nueterra Capital, most of the assets that we have invested in our private equity company is all in health care, be it in technology and real estate and provider services but for the most part health care focused or at least it needs to have a big component. 

So, could we shift gears just a little bit? You’re in your second term in the US Congress and you announced not long ago that you are going to be running for Senate, a spot vacated by a long-term senator, the renowned Pat Roberts. We will talk a little bit about that.

Roger: From Dodge City, Kansas.

Dan: From Dodge City, Kansas. So, before we talk about your senate run let us talk a little bit about your experience in Washington, DC. Tell me what, if anything, was a surprise to you as you went up and began serving in Congress?

Roger: I think the first surprise: just so many good people and I know you would not think that to watch the television sets but just so many of the congress members are great people, their spouses are great people and we have been able to develop these relationships and gosh, even as I sit here and think about it, the same leadership skills that I learned in high school football are the same leadership skills that I am using today.

Develop a relationship with other people, genuinely care about them, love them, care about their family, who they are, all those things the way we practice business and that we have this tight-knit family of so many Republicans, Democrats that I really care about. I really feel like we are part of the same team.

Dan: Really? So, you know, that would be a complete surprise to me because I am sure most of our listeners as we watch Fox News and it’s completely partisan, you go to CNN and just the opposite. So, it really does not feel like anybody is working together, that  it is completely divided, is that really reality in Washington, DC or is it more collaborative than what it appears to be to us?

Roger: I think there is a lot of collaboration that has been going on and continues to go on but at the senior leadership levels there is obviously a little bit of friction between the President and the Speaker and that does trickle down. But I do think that at the core there is lots of great relationships. If you would come to spend a day with me you will see the Democrat ladies hug me, you will see the guys fist bump me, if I could bring you down to the House gym in the afternoon about 5:30 PM you are going to see congressmen belching and swearing at each other just like you do at your local YMCA.

Dan: Yes, interesting. So, Congressman Marshall, you announced a few weeks ago at the Kansas State Fair in Hutchinson, Kansas that you were going to be running for the Senate seat that we mentioned. Can you talk to us a little bit about that? Why are you wanting to take on that challenge when you probably have a pretty long, easy path for a lot of renewals in the US Congress? What is going on with the Senate? 

Roger: Well, Dan, you and I both have lived the American Dream. Think about what we have done. I was a fifth-generation farm kid, a first-generation college kid. I grew up, our family doctor was the most respected person in the whole community and I wanted to grow up and be like him and I got to do that. But education is this great equalizer that no matter who you are, who your parents are, what side of the railroad track you were raised at, that if you will work hard and keep at it you can be anything you want to be in this country.

I got to move back to Great Bend, Kansas, deliver 5,000 kids, got to raise four kids, all four of my kids had the same first grade teacher, the same high school math teacher, all those little things that make a community special and to be honest, I feel like this country is at a crossroads. Benjamin Franklin once said that after he walked out of the constitutional convention somebody asked him, “What is it, sir? Is it a democracy or a socialism plan?” He said, “It’s a republic, ma’am, if you can keep it.”

Do you not feel like right now that our way of life is being threatened? We have a group of people that want the government to totally run our lives, they want to run energy policy, they want to run healthcare, they think that Washington, DC knows what my patient should be doing and what doctors they should be going to see and what hospitals they should be using. So, I think we are at this crossroads and I think that here in the Midwest we still have these values. 

You know, what values are important to you and me? I bet if we listed five or seven values they are going to be a lot the same. We value our freedom, our independence, our faith, our families, our communities and I want to preserve that for my grandkids, I want my grandkids to have the same shot that you and I had. I do not want to give it to them, I want them to earn it but you know, why do we keep doing what we are doing? I think I am doing this because I want my grandkids to have that same shot that we had.

Dan: You feel that that is threatened in Washington, DC right now the way things are going. So, tell us a little bit more about the Senate race, where do you stand today, what does that look like, do you feel pretty enthusiastic about the race?

Roger: Yes, certainly we see a path to victory. It’s pretty amazing, since 1948 every senator in Kansas has a connection to the big First District. Four congressional districts in Kansas but 40% of Republican voters live in my district and so, whether you were Bob Dole or Pat Roberts or Jerry Moran, it gives you just a big advantage. We announced about two weeks ago the first seven days we had 400,000 hits on our social media, 115 outlets carried our story, having success raising money as well.

Everyone says they want to run for Senator but eventually you need to go out and raise some money as well. So, all those objective signs look very positive and I think we have a great shot at winning this. 

Dan: So, the people that do not know you that are listening right now, talk about your overall, where would you consider yourself to be, a social fiscal conservative? Unpack that a little bit for us.

Roger: Yes. I mean, I think I am a traditional, Bob Dole, pragmatic Kansan. Certainly my dad taught me to wear my faith on my heart and not my shirt sleeve but my faith permeates everything about me and my actions I hope. So, certainly you are not going to find anybody more socially conservative than I am. I think the biggest problem the federal government actually has is our budget, that we are spending more than we are making and that is unsustainable. 

I think that I am going to Congress to help fix things like health care and we do need to secure our southern border but we also need to fix a broken immigration system. I am a big Second Amendment person, a big person on pro-life as well, really it boils down though is I am running to stop the left’s social agenda. Somebody has to say, “Enough,” we are going to draw a line right here and say, “no more.” We believe in competition, we believe in giving patients, consumers choices, all those basic properties are rules that this country was founded upon.

Dan: Wow, that is really good. So, before we move into health care for a minute, I think the thing that I mostly sit around with other CEO’s or talk about is always we talk about the southern border. Obviously terrorism, security for the country, then we talk about trade, that is a big discussion and of course health care. So, can we just dive a little deeper on each of them if you do not mind? I know one of the things that has impressed me about you is how quickly that you are able to pick up on big picture regarding each of those subject matters. So, talk about immigration, southern border for just a little bit, give us how you view that.

Roger: So, I have been to the border twice, it is a crisis. It was a crisis  a year ago and it’s ten times worse today. You and I have both done some mission work and that is what this reminded me of, is being in a mission setting where you just could not handle the volume of people that we are dealing with. So, our border patrol officers, our doctors, our nurses, they are all doing the very best they can but they are just overwhelmed and they are so overwhelmed being social workers and nurse aids that the rest of the border is unguarded.

So, unfortunately, a large number of terrorists, of criminals, or drugs are being let through that border. We have to secure our borders, part of it needs to be a wall, we need more technology, we need more drug dogs, all those types of things. The plan that we came up with was actually authored by DHS, they told us exactly what they needed and that is exactly what the president has asked for and that is the legislation that I fought for. 

But I am also the person who thinks we have a very broken immigration system. You know, in Kansas we have 70,000 jobs dependent on an agriculture guest worker visa, we have several thousands folks, so, I think we can fix all those problems, it’s very doable. I think that I could sit down right now and I have with five or ten Democrats and we could figure out a comprehensive immigration plan to fix that. 

So, that is probably the most frustrating thing in Congress right now is I know how to fix these problems but I am not going to be given a chance because frankly, Nancy Pelosi does not want us to solve any problems.

Dan: So, move over to trade for just a minute. So, I know this is a big issue with you being a Congressman, being a big First District in Kansas, obviously trade for the agriculture community and the rural farmers is a big deal. You know, we sit here as lay people when we hear about what is going on with China and all the terrorists and all of that and I know you recently were in New York and were on with the president and I guess the prime minister of Japan, is that right?

Roger: That is right, Prime Minister Abe was there. 

Dan: Yes, so, obviously the president has a great deal of respect for you or he would not have been having you stand beside him and I think you were the only congressman there, right? 

Roger: That is right.

Dan: Yes. So, tell us about that. Just start with the big picture, international trade and then kind of, you know, China, Japan and then narrow that back down to Canada and Mexico for us.

Roger: Right. So, American agriculture, we are so blessed in this country that we can grow more than we could ever eat. What a great problem, we only spend about 8% of our GDP on groceries. Just incredible, most developed countries are spending twice that on their food and that allows this country to do lots of other great things. So, agriculture is very dependent upon trade. Mexico and Canada are number one and two partners, since the NAFTA 1.0 agreement came out we have quadrupled our amount of exports to those countries. 

Dan: So, when you say Canada and Mexico are number one and two, in terms of total export dollars?

Roger: For agriculture, yes. So, that is why the USMCA agreement is so important. The president has negotiated a great deal for us, not just for agriculture but it will mean many more, thousands more, for Kansas alone, manufacturing jobs as well as increased exports as well, several hundred million dollars in exports for Kansas. So, that is very important, that is my top legislative priority is to get the USMCA passed. 

In short, it’s standing on Nancy Pelosi’s desk, we have the votes to pass it but she is not going to let us vote on it until she gets another pound of flesh out of the president. Like you just mentioned, the president did recently negotiate a treaty with Japan and this does not have to go through congress, a bilateral agreement like this, he is able to sign it and it does not have to go through congress. Japan is the number one export market for beef, pork and wheat, all three really important products for Kansas.

So, whenever you increase business with your best partner 5%, it has got to be a good deal. So, those are some small pieces of the puzzle. To talk about China just for a second; however bad I thought China was cheating us it’s ten times worse once I really dived down deep into the situation. China steals $500 billion of intellectual property from us every year. 90% of the fentanyl, the illicit opioids that come into this country, are made in China.

90% of the counterfeits, counterfeits like fake Rolex watches and Nike shirts, all those things, 90% of them are made in China and come in through Canada. Every year they subsidize their wheat and corn grower $100 billion in excess of WTO rules. So, they constantly are cheating us and we do have to stand up to them and it’s amazing, my farmers are still hanging in there with the president, they realize how critical this is. 

We give them unlimited access to our markets, so, all the apples, iPhones and iPads that they can make, we let them bring them into our country but they do not let us sell wheat in China, they do not let us sell beef in China. So, that is what the president is talking about, we want free, fair and reciprocal trade. 

Dan: Wow. So, explain a little bit about how does the tariff work and what is the purpose behind it? We sit here and we talk and use those terms and I am not sure all of our listeners understand what that looks like and what sort of impact it has on trade imbalance.

Roger: Well, let us take the first example, so, the president put a tariff on solar panels made in China, so, that increased the price, I do not know, maybe 25% if that is what the first tariff was and then China turned around and put a tariff on sorghum, milo was what you and I grew up calling it and we saw overnight the price of sorghum drop a dollar a bushel; from three and a half dollars to two and a half dollars a bushel.

So, in Larned, Kansas they are sitting on 400,000 bushels of sorghum and overnight the owners of the co-op lost $400,000. The largest taxpayer by the way in Larned, Kansas. What is interesting though is, you know, President Trump keeps saying that China is paying for it and what he is trying to say is they are manipulating the currency, so, they are devaluing their currency and so far the American consumer is not seeing a lot of the hit, otherwise we would be seeing a lot more of our consumer price index going up. So, so far some of the wholesalers are taking hit and China is taking that hit.

Dan: Wow. So, let us switch over to health care for a minute and I know we have had the Affordable Care Act under the Obama administration, you know, kindly referred to as Obamacare and you know, it was maybe well-intended but obviously not very effective. I know that you have got to be– being a physician in Congress– been asked to help write the Republican health care policy, what that platform is going to look like, can you give us a little insight as to what you are thinking?

Roger: Yes. So, first of all I think it’s interesting today that both the Democrats and Republican think the ACA was a dismal failure and now the question is what are we going to replace it with? So, both parties want to replace it, so the Democrats want to replace it with complete takeover of health care by the government, if that does not scare anybody then you better go look and see what is happening in some other countries. 

Dan: It makes you wonder if that was not the intent of the Affordable Care Act to begin with. It’s going to fail, intended to fail so that we have no other choice but to go to the single payor, what they are calling now Medicare for all, but anyway.

Roger: Exactly, yes, absolutely right and even if you listen to Joe Biden talk a little bit about his Medicare option, again, it’s one more step towards that Medicare for all. So, the Republican solution is going to look something like this and I want to preface this by saying the president invited me to the oval office– it has been now two or three months ago– to talk about our health care solution and we talked for about 30 minutes about agriculture and trade and realizing, I was only given 10 minutes, so, I was already in trouble with Mick Mulvaney for going past my 10 minutes.

I took a breath to talk about health care and the president said, “Wait a second, Roger, one thing, whatever you do, take care of pre-existing conditions.” You know, I went to DC to fix health care, I want everybody to have true access to health care and by the way. I do not think Medicaid is access to health care, I think that we realize that patients with Medicaid still struggle getting access to health care.

So, number one I want to embrace that situation. I have spent the last four years of my life trying to think what is the best way to take care of the pre-existing conditions and we are going to do with a combination, a couple of steps, but one of them would be we want people to go as easily from their job health insurance to the individual market as easy as you go from job to job. So, we will apply some of those rules to that market to allow it to happen more freely and then we think there needs to be some type of a federally funded but state-run reinsurance pool.

We will do some things like expand health care savings accounts so that patients, consumers can use pre-tax dollars in the individual market just like you use them in your job situation. I think direct primary care is going to be a big part of this. I think that whether it’s a navigator or a doctor and nurse practitioners and social workers helping people navigate through health care, I think that that is part of the solution as well. 

But eventually, as you and I have talked, the biggest problem with health care is the cost of health care. Really people like Medicare, patients like the health insurance through their job but it’s the cost of it. So, if I can drive the cost of that insurance down then more people are going to have access to it, that would just be intuitively right. So, I think next we have to talk about how we are going to drive the cost of health care down.

There is not one magic bullet, it’s not going to be one little bill that that is going to fix this but the things that you and I have always been talking about, we have been talking about for four years now is transparency, innovation and consumerism. So, any legislation that will make healthcare more transparent, promote innovation, allow patients to be consumers again is going to result in driving that cost of health care down and did I mention –?

Last point; everybody that is listening, they want me to balance the budget, they want the federal government to quit spending more than we are taking in. the largest line item is health care, 28% of the federal budget is being spent on health care. The first step in balancing the budget is driving down the cost of health care. 

Roger: Wow. So, we sit here and we talk about– I think what you said for me is most profound is that you did not say we need to lower the cost of health insurance, we need to lower the cost of health care, which would in turn lower the cost of health insurance and make it more accessible.

Roger: We hope so.

Dan: I think one of the things that bothered me most about the Affordable Care Act was insurance subsidies, which is not turning the patient into a consumer, it would just rely on the health insurance and it does not work that well that way, right. All right, so, we are about done with our time, I want to wrap up real quickly. 

So, being a servant leader and following your advice, what is it that I can do for you, what is it that we can do for you, our company, the listeners, the people around? Because for the most part we are going to be pretty fiscally conservative, socially conservative, the listeners that I have, not everybody and I respect everybody’s opinion, what can we do to help you in your senatorial race?

Roger: Well, I think the easy things are following us on social media, all those things, but really it’s going to take money to win the race and I wish I could sugar coat this in some direction but we have to go raise some money. Doctors are notorious for not wanting to get involved in the political process but if they will just Google “Roger Marshall” or Google “Kansans for Marshall” there is an opportunity to give money online and that is what it’s going to take to win this race.

You know, what could be at stake here is the senate majority that if we would lose this senate spot to say, Kathleen Sebelius, who is waiting out there in the wings to see who is going to win this primary, so, that is how important this seat is, it could easily flip the majority. If Kansas loses this senate position, most likely the majority will be flipped.

Dan: That is awesome. So, we will continue to work for fundraising for you, Dr. Marshall, as well as keeping you in our prayers, it’s going to be a big election, it’s an important time in our country’s history.

Roger: That is the other things people could do is if they want to throw a fundraiser event for us, we are going all over the country, this will be one of three open seats across the country for the senate, an open race without an incumbent in it. So, this will gain national attention and the Democrats will be trying to figure out if they could possibly get this seat to flip. We just lost a governor’s race here not too long ago. Less than a year ago Kansas lost a governor’s race, so we want to make sure that that is not repeated in the Senate.

Dan: Right. All right, so, thank you very much, Dr. Marshall, really appreciate you having and spending the time. Thank you.

Roger: A pleasure.