The Former Executive: David Balat, MBA

David Balat is currently the Director of the Right on Healthcare initiative with Texas Public Policy Foundation. He has a broad base of experience throughout the healthcare spectrum with special expertise in healthcare finance. He is a former seasoned hospital executive and CEO with more than 20 years of healthcare industry leadership and executive management experience.

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David Balat, MBA

Much Mr. Balat’s background in leading multifaceted organizations and revitalizing complex facilities in financial distress has given him the reputation as an industry expert. Mr. Balat uses his unique perspective to counsel members of U.S. Congress and the State of Texas House of Representatives as their healthcare advisor. He has been invited to give testimony before the House Oversight Committee in Washington D.C. as well as the state houses of Texas, Missouri, Alaska, and Kansas. He is a published Op-Ed columnist, author, and an active speaker and commentator on matters of health policy.

Mr. Balat’s Prescription for Success:

Number 1: Remember that the main thing is the main thing.

Number 2: Be brave.

Number 3: Document, document, document. Including journaling.

Connect with Mr. Balat

Twitter: @davidbalathc
Facebook Group: Right on Healthcare

Notable quotes from Mr. Balat’s interview:

Nothing happens in a hospital except for at the tip of the doctor’s pen.

I believe that healthcare is personal, not partisan nor should it be.

Here’s the thing with with all politicians regardless of party: They don’t know much about health care. They may say that they do, and latch on to a certain talking points but when you get into the weeds with them their eyes will start to glaze over.

Politicians today function as celebrities. I can tell you that what they say in public is very different from what they say in private.

In Healthcare, if it’s not written down, it didn’t happen.

Access the Show Transcript Here


[0:00] No hospital administrators today and if any of them are listening,
I caution you for what I’m about to say you’re nothing more than a glorified Hotel manager they’re implementing and policing the policies of the corporate office,
and we’ve seen over time the growth of these systems with these,
fat corporate offices that exact more and more of a tax from each of these Community Hospitals you know we have the same problem in these in these Hospital systems that we do and with the idea of government,
people in DC or people in the state capitol think they know best what’s.
What’s what should be done in our communities well you know the reason why Doctors live in the communities in the hospitals that they work is because they know their neighbors they know their Community they know what.
What’s needed.

[0:52] Music.

[0:57] Paging dr. cook paging dr. cook dr. Kirk you’re wanted in the OR.

[1:04] Music.

[1:29] Hello everyone and welcome to prescription for success.
I’m dr. Randy cook your host for the podcast which is a production of MD coaches.
Providing leadership and Executive coaching for Physicians by physicians to overcome burnout transition your career.

[1:48] Develop as a leader or whatever your goal might be visit MD coaches on the web at my MD because you’re not in this alone.
My guest today is the director of right on Healthcare
part of the Texas public policy Foundation he’s made quite a name for himself as an influencer of Modern Health Care policy in the US so thanks for joining me,
now let’s hear David belight tell his story.

[2:20] Music.

[2:26] And I am really looking forward to
what we call a special interest guest today most of the time as our listeners know we’re speaking to Physicians on prescription for success but today it’s my honor to be speaking with someone who is very supportive.
Opposition to his name is David Mallet he’s very politically active and we’re going to,
I have an opportunity to pick his brain and find out what’s on his mind and find out how he is
trying to help the physician community so David I really appreciate the opportunity to speak with you and I thank you so much for taking the time to be with us
I’m happy to do it and I’m looking forward to the conversation
I likewise and we like to begin with the origin story on prescription for Success I’m wondering if in your late teens when you were contemplating
going off to college and planning a career if anything like this was
even a dream at that point or phone out the when did the urge start to make its appearance.

[3:37] No politics played no part in any equation when I was a young man out I’m a child of immigrants so I was supposed to be a doctor it’s so hot that I so I in preparation for what I thought.
My vocation would be I worked in hospitals from the time that I could at the age of 15 years old back then what sort of work I started in medical records
back before it was electronic it you know they would bring me a big a big pile of papers and you take the top sheet off and you’d look for the proper record and you’d have those big shelves that you crank on the side to move here and there and you’d
you know populate that record with the proper document so that was my first job and I from there I went on to medical records and I was just an assistant
in there and just you know I feel like I’ve been through just about every Department in a hospital and when I was in college I worked my way through school I was pre-med biology and chemistry.
I was working in an ER as an orderly when that was such a position hmm and,
but one of the doctors I remember very clearly doctor doctor OD called me and he said David you know you do you do such a great job around here what do you want to do when you get out of school I told him I loved the dark rum.

[4:54] I’m going to I’m hoping to go into medicine I’m pre-med at the.
And he said and this is around the time that Managed Care was just coming in and he said David don’t do it and there was another dr. Chung was there there next to Alex is he he corroborated says he has a dog,
you know why do you want to get into medicine the first place I said I love patient care and love what you guys do with patience he says we’re spending less time with patients we’re doing more paperwork if you if you’re interested in patient care you consider nursing,
which was really shocking and disturbing to me and so I was introduced I think a few months later to a hospital CEO here in the well in the Houston area when I live there we talked and he says what do you want to be young man and I told him.

[5:33] He said what is it about medicine that that appeals to you and I told him what I.
What I thought appeal to me and he says what’s this that’s basically the way the my today looks as an administrator of a hospital and that was very intriguing to me and we talked more and more in the more I thought
I did talk to him he was very encouraging about his his position and I shifted gears went on to graduate school got my
master in healthcare administration and also an MBA and ended up working while I was in graduate school in a business office which is the one of the only departments I hadn’t worked in before just to learn the business of that type of facility.
And from there I went on to work for a number of big groups that ends up merging with each other and we’ve seen just merger upon merger and consolidation of fun consolidation here and especially in the last 11 years during
the growth of the ACA but you know it was happening back in in.
Late 80s early 90s as well and what I did learn is you know I at a very early age.
Took on a vice presidents vice presidency of a 50 million dollar organization we had 55 positions we had everything but inpatient beds it was Diagnostic Clinic of Houston in the medic Texas Medical Center.

[6:49] And I have no idea why they hired me doctor as a 27 year old man we was in organization of that size with that kind of prestige with that kind of budget I don’t know that I’d hired me today.
But I’m thankful they did but because they provided me with an amazing.
Education some of my my dear mentors came from that organization and they were the ones that really,
formed my thinking in the administrator that I was,
going to end up becoming and really the work that I do today I remember one of our urologist took me aside.

[7:29] He said David don’t listen to these guys that you work with I want you to understand one thing and one thing only.

[7:35] Nothing happens in a hospital except for at the tip of the doctor’s pain and when you think about that that’s actually very profound and when you think about it,
I don’t know that doctors even believe that because they’ve given up their power well that’s a very interesting point and.
I was on the verge of interrupting you for the last couple of minutes because of the profound nature of what you just told us and that is that you thought you would make a pretty good physician
and I bet you would have but it sounds like you are having a very hard time
finding people around you who felt that it turned out that way have I got the wrong idea is that is that the message you were getting
these were the Physicians I was around and it could have been where they were working but at that point in time when I was making the decision for myself and I’m very thankful
for how my career has gone because I feel that I’m probably doing better for the house of medicine doing what I’m doing now than if I were a physician so it was meant to be what ever happened but it was interesting that the Physicians that were friends to me,
that wanted to to advise me we’re discouraging me from from taking the steps towards becoming a doctor while becoming a physician.

[8:52] And they were just very unhappy with where they were and the future of their profession well I’ve got to tell you that that makes sense to me now I began my
medical training in the mid-1970s and when I started practicing things were much like I expected there would be.
But the pace of change and the evolution into what we see today.
Was profoundly rapid and it sounds like you were getting the message from some of the.

[9:27] People that were seeing the same things that I saw and the early 80s and.
The mid 80s and they were already beginning to be discouraged.
And didn’t want you to suffer the same fate so did you have the feeling I mean
when you reached that point when you were getting that message
did you feel like this is a great opportunity maybe I really can make a huge difference and I don’t have to be at the bedside to do that and if so has it really turned out that way,
you know I don’t think I had the foresight at that time I think I was looking for something that I could be good at that I could earn a living doing,
and the more I experienced what.

[10:16] Health Care in the hospital industry had become the more disenchanted I became and I think I’m just crazy enough that I’m I’m one of these fellows that,
you know I believe that there can be
a solution I believe that health care is about the doctor and the patient in the relationship that exists between those two that is the basic building block of what health care is and as long as we hold that relationship,
and we understand that Baseline building block then we can protect it and we can do those things to enhance it as it is rather than continuing to introduce middleman after middleman in between those two stakeholders,
well it seems like your goal was nothing short of noble and admirable.
And unlike the Physicians that steered you in that direction do you feel like you have made substantial progress.

[11:12] Well I do and if I may add I’d like to maybe continue with my career,
and then share with you the progression that’s led me to today absolutely
I am fascinated by this I’m glad I did become a hospital CEO and one thing that I was very disappointed in.
Was my colleagues in the hospitals,
by and large did not like Physicians they didn’t like having to deal with them they were intimidated by them but the goal was to exercise,
power and authority over them and I do hate to get into interrupting you but it’s a conversation please do you are you’re right on the thing that I think
just absolutely destroys the soul
of most of the Physicians that I know and then I have to admit eventually destroyed my soul.
And that is I’m out here trying to take care of sick people I’m out here trying to do the very best thing that can be done for my patient and you mister hospital administrator or.
Seemingly doing everything you can to make sure that I do not do you run into that.

[12:34] Attitude from Physicians,
I do I do but not as much anymore and I’m actually quite disappointed and saddened that so many Physicians have lost hope and part of what I do now
I hope that by the end of this conversation that people that are listening will have at least a glimmer of hope
yeah and I hope we can take it there too and I guess the next question is and I think probably what the majority of Physicians who listen to this podcast would like to hear is why is it,
that if you are in the position of managing the,
operational side of a Healthcare System why would you be so dismissive
Physicians when they tell you that it’s getting harder by the day
to do what they got into the profession to do why would they why would they seemingly on a daily basis think up things to make your life harder.

[13:36] You know Hospital administrators today and if any of them are listening,
I caution you for what I’m about to say but if you have disagreement with me feel free to reach out you’re nothing more than a glorified Hotel manager they’re implementing and policing the policies of the corporate office.

[13:57] And we’ve seen over time the growth of these systems with these fat
corporate offices that exact more and more of a tax from each of these Community Hospitals you know we have the same problem in these Hospital systems that we do and with the idea of government
people in DC or people in the state capitol think they know best what’s what should be done in our communities
well you know the reason why Doctors live in the communities in the hospitals that they work is because they know their neighbors they know their Community they know what what’s needed they can address the needs of
the folks that they see at the grocery store Church
but there’s this the corporatization the commoditization of healthcare and really if medicine has been
something to make the practice of medicine not even
that really the practice of medicine anymore its they want to make it more algorithmic that’s why they see it’s perfectly okay to put advanced practice nurses or PAs on the same level as Physicians you’re all are now providers there are no
there’s no position it’s the there whitewashing all of it and assigning new words with new meanings and
who is it that’s gaining all the the financial reward well it’s the administrators it’s the folks that are leading these so-called nonprofit but I prefer to call them tax exempt because
there’s nothing.

[15:20] That is really of community benefit to their communities yeah that’s about a very fascinating point for me if I had looked at the Long View many years before I would have thought that,
the nonprofits thought the you 501 C 3s the,
faith-based Healthcare organizations and people that were established or at least Hospital organizations that were established with the express purpose of making sure that everybody got
good health care you would think that they would be the place.
Where a physician could practice and feel like they were finding really supportive people around and the truth is.
You really can’t tell them you can’t differentiate them,
from the big corporations you know the hca’s and it wasn’t my intention to call names but but the big.
Healthcare organizations that the hospital corporations that.
Her clearly so totally in charge it’s hard to tell.
When you’re involved in one of those hospitals which type of organization that you work for do you think I’m.

[16:40] Just do this without been measured with the wrong people in my Mi you know am I misreading that impression.
No you’re absolutely right in fact and we’re doing some research right now I work with the Texas public policy foundation and we are research-based organization that’s one of my jobs the other is I founded an organization called free to care that advocates,
for both Physicians and patients but now you’re exactly right the research that we’re doing now is showing that for-profit publicly traded hospitals provide more in the way of charity care than,
these nonprofits these religiously-based hospitals many of the nonprofit’s are again the tax-exempt says I prefer
they are sending their their patients to
to court they’re suing them they’re sending in the collections they’re putting liens against their home they’re doing a lot of terrible things and.

[17:34] That’s why we continue to see so many people that are declaring bankruptcy due to medical bills.
And I think that the if we could have a representative of those groups here and I wish we could but I think that they would they would simply object that they didn’t really have any choice because of.
The financial demands that are placed on Hospital operations do you think there is any Merit in that argument at all how free am I to cuss.

[18:04] We’re not right you know in my early days I worked in a broadcast radio station and we were under the rules of the FCC and you couldn’t couldn’t color Outside the Lines
but we have no such restrictions well let me know I’ll try to keep it as mild as I can’t that is complete and utter bullshit
and I’ll tell you why many of these large systems that are that are doing the things that I described earlier they have.
Billions that’s B with Abby
if billions of dollars in offshore accounts in their foundations in there you know operating accounts and their for-profit arms of their insurance companies or now we’re seeing some of them even starting travel agency
our travel nurse agencies that’s not an argument that
that’s going to fly and I’d be happy to take on that debate with any of them now that is different for some of the rural hospitals and some of the Community Hospitals and you know those are near and dear to my heart because
as I left the big box hospitals that’s where I went I became a turnaround specialist.
And hospitals that were on the brink of financial failure or deeply in distress facing a bankruptcy they would they would hire me to come in and and get them on their on their feet so to speak.
Then how’d you do that.

[19:25] You know it was you’re going to laugh knock you know what I did the one thing I didn’t that I did that the group before me didn’t do.
Is I worked with the doctors you know if you if you keep the facility clean.
And you hire a good anesthesia Group which is important to your surgeons and to your patients if you go out and you turn your rooms over quickly so that,
a surgeon can do more procedures in a day if you give them times that they want to work you know suddenly you’ve got all these guys they want to come U 0r,
imagine that so if you know I say that to folks and they say they couldn’t have been that easy you had to go in and chop people or fire folks and I really didn’t do a lot of that I really didn’t there’s there’s a normal amount of attrition.
When a new c.e.o. comes into,
into the c-suite but you know I would focus on developing relationships with Physicians I never wanted to employ them never wanted to try to control or,
hi I’m Rhonda Crow founder and CEO Forum D coaches here on our X for Success we interview a lot of great medical professionals on how they grew their careers how they overcame challenges.
And how they handle day-to-day work.

[20:49] I really hope you’re getting a lot of great information but if you’re looking for an answer to a specific problem management or Administration challenge.
Or if you’re feeling just a bit burnt out like maybe you chose the wrong career.
Well then there’s a faster way to get the help you need now it’s not counseling it’s coaching.
RX for success is produced by MD coaches a team of Physicians who have been where you are I know you’re used to going it alone but you don’t have to.
Get the support you need today visit us at my MD to schedule your complimentary consultation.
Again that’s my MD because you’re not in this alone.

[21:35] We’ll get back to our interview in just a moment but right now I want to tell you a little bit about physician Outlook.

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[22:39] And now let’s get back to it.

[22:40] Music.

[22:46] I find that that’s a very unusual attitude amongst.

[22:51] Hospital administrators in the 21st century unfortunately so.
I’m glad to know that it actually can work if you just put it into practice but I think it’s just something that.
That we see less and less I’d like a lot I’d like to know a little bit more about.

[23:12] Right on Healthcare just see what does that mean is that doing the job correctly is that being in the right wing of the political parties what’s the meaning of right on Healthcare.
Well it’s I didn’t choose the name it was it was it was given to me but I prefer the first interpretation that you had which was we’re correct.
In the way that we view Health Care you know I do work for a conservative think tank.
But I believe that Healthcare is personal it’s not partisan nor should it be.

[23:48] It’s been weaponized it’s become a political football and that’s to the detriment of,
so what we do here is we as I mentioned this earlier as you know the mission is to amplify the voice of doctor and patient to hold sacred that that relationship because again that is Health Care
so we work on policies that free up Physicians a free up patients and that.

[24:12] Mitigate the existence of third parties that don’t belong in between those two stakeholder there are a lot of those aren’t there oh goodness I I could be employed for several lifetimes.
Would you mind you don’t necessarily have to name names but I would like you to go through the list of categories of the people that make it hard.
The federal government insurance companies Pharmacy benefit managers hospitals state governments organizations that claim to be Healthcare experts but have never worked a day in a hospital or ever held a patient’s hand.
Those are just a few so I think we’re in the territory that kind of fascinates me the most David and it gets really difficult to even talk about politics and.
20 21 but you know if there was going to be anything that.
Politicians ought to be able to agree on I would think that Healthcare is it and yet it never.
Seems to happen I’m interested to know if you have any insight on that at all.
Yeah and after I hear from you I might offer some ideas of my own but we’ll see how this goes you’ve actually asked that question just a few moments ago but it was it was regarding administrators.

[25:39] Aha so let’s look at the trend the reason why there’s not a disagreement just because it’s designed.
To pit people against each other that pitting of parties against each other.
Ultimately results in more power for the federal government and that’s what that’s what hospital administrators want that’s what governments want that’s what organizations want they want to they want to be the ones that are referred to as,
the fixer the solution for Health Care isn’t it interesting.

[26:09] Isn’t it interesting dr. cook that when you hear politicians talk about Healthcare when they say well you’re going to lose your health care going to give you health care has it ever occurred to you that they’re not really even talking about health care they’re talking about health insurance
why is it interesting nicely why is it today
yeah that that we have conflated health insurance with health care what you’re right into the territory that makes me most suspicious David and that is my impression
of politicians is they never really speak their own thoughts,
they speak the thoughts of their biggest contributors and pharmaceutical companies instrument makers Hospital corporations,
lawyers the list goes on and on of people who have loads of money to put into there.
Particular cause but the difficult part for me is why is it that the people can’t stand up and say we don’t like.
Either of you guys.
Both of you are doing it wrong nobody is giving us what we need how are we missing out on that they’re not playing their part people are so hopeless,
like we talked about earlier not just Physicians but patients as well we’ve been so conditioned to just take what we are given.

[27:33] And that has got to stop there really has to stop if you want to have hope and you say you want to have hope then you’ve got to be part of the,
there’s just no other way around you know some people would give the advice well be involved in the political process and get to know who your who your politician is I don’t think that’s enough
my advice is have them know who you are and many of those politicians actually aren’t opposed to that.
If you come to them with Solutions and not just the problems and you say look whether I’m an individual and this is what I’m experiencing and I’m in your District or I’m a part of this big National Group like free to care that I run
here are the materials that we have and this is what we see is being part of the problem.
But here are solutions here are some ideas that we think that you can you can really be successful running on.
And I want to support you doing it that goes a much longer way and yes the pharmaceutical groups in the attorneys and all these other special interest groups they have a lot of money but what are the what is that money used for.
It’s used to to campaign and get votes right well where the voters so we need to stand up be informed.

[28:42] Take part get involved and take back what is important to us or what we say is important to us which is that relationship
between the doctor and patient so tell us some things that right on Healthcare would like the general population to get excited about oh goodness well as far as the work in the think tank we have been at the Forefront of
other forms of altar of coverage and you know insurance is not the end all be all there there are other forms of coverage or people can find ways that they can protect themselves at an affordable rate we are
working on the backs of the advocacy group free to care in promoting the.
The transparency of pricing in hospitals which were still getting quite the fight back from them so that’ll be a big help wouldn’t it wouldn’t it yeah I absolutely think that and I think the next step in many doctors already do this is you know put your cash rates out there.
Put your cash prices out there and let patients know and be the leaders in this but we absolutely want Physicians hospitals to show us their prices and they’re still woefully.

[29:47] But we’ve been at the Forefront of that you know on the free to care side which that group alone you know we’ve grown to 32 member organizations where a C4 which means we get to be involved in.
In the political process and we have a seat at the table but in those organizations that represents little over eight million people nationally and over 70,000 Physicians were just over half the the the membership of the AMA.

[30:12] And we’re continuing to grow and we’re going to continue to be the voice of the physician that the appropriate voice of the physician because the AMA sure ain’t doing it
yeah that’s been a complaint of mind for literally half century I was introduced to the AMA during my first
we can practice I think and as you can imagine the only thing that they really showed any interest in,
from my perspective was that they wanted to make sure that I financially supported the AMA pack and my County Medical Society pack and probably a couple of others as well,
and that was about it
I haven’t really seen any substantial change in the am I over that half-century have you now know you haven’t been watching a half-century but you get the idea well I’ve been able to look back and see what they’ve done and you know
they make their money on developing the cpt’s so there’s there’s that and there’s also
CME education so that’s where they make their money it’s not from the membership so you know if you look at what’s important today ma
they are a mouthpiece of the federal government they supported universal healthcare they’re talking about the environment they’re talking about gun policy and they’re talking about everything other than,
what’s important to Physicians right now and I’m really not using their resources to protect the practice of Medicine.

[31:40] Yeah you mentioned universal healthcare is that necessarily a terrible thing is it something that we would never ever be able to live with.
Well you know I think it’s important that we look to see what other countries experiences are and you look at the NHS and you look at Canada and you look at Costa Rica you look at.
Some of these other other countries now are there some some positive aspects to it sure are there largely negative experiences and
and perspective and perceptions by those that live in those countries absolutely if you’re looking at what’s going on in the NHS there’s such a shortage of primary care physicians
that they’ve even considered having in the primary care office group visits of 15 people they have.

[32:24] Implemented rationing so if you have cataracts you get your first cataract taken care of and if you can see pretty well they’re not going to authorize the second if you’re over a certain age and I can’t recall what that age is you’re probably not going to get a hip replacement
so you know does that really work for people it might work for for the government and they say a lot of great things about what they’re doing for their Nation but when you look at the individuals
what do they end up doing many of them if they have the means they come to the u.s. it when Mick Jagger had you know heart heart condition.
He was going to stay in Britain or the UK he was he was going to come here I can’t tell you the number of Canadians that come to the u.s. for surgery same for Costa Rica I’ve been down there and they have.
You know complete Universal care.

[33:12] And I was working with a when I was there I was working with a missionary and his wife came home one day and tears and she had a real bad aggressive cancer diagnosis.
And they said yeah we need to get an ultrasound done prior to scheduling the surgery and that was why she was crying.

[33:31] The ultrasound was scheduled for 12 months out so you have access access is there you just may not live long enough to get to.
Well you know we hear a lot of those kind of stories when the discussion of Universal Health Care.
Comes up but on the other hand I know of at least one nation that seems to do very well with it and that’s Germany actually have.

[33:56] Some close friends who feel like you know they just don’t they did they don’t have any complaints about it at all.
Is that because they’re doing something differently than the Canadians they’re not really a universal system.
They are more of an employer-based system so the employer will cover a part of the expense they’re the they’re the only other country
other than the u.s. that has some connection to the employer when it comes to the insurance prices so I wouldn’t consider them to be
the universal or government-run Health Care System the one well I would say the two that people usually talk about.
Pretty consistently as a good model or Singapore and.

[34:45] Now Singapore’s actually they do require some skin in the game so they have Universal hsas the health savings accounts but more importantly when you look at those those Nations you have.
A relatively small geography.
You’ve got most of the population in surrounding some some metropolitan areas you’ve got a lot of uniformity.
In ethnicities amongst the folks in those countries through so would that necessarily mean that that system would work.

[35:22] In a country like the United States where we have such diverse geography we have such diverse ethnicity where we have such diverse everything it may not be.

[35:32] Appropriate to say that works there so it’s going to work here although those countries would fit inside the state of Texas.
Well we’re sort of wandering into the what if territory and there’s.
Probably not much to be gained from that and I want to get back and give you an opportunity to to talk a little bit more about how right on Health Care can help us.
With right on Healthcare that’s again the work of what I do in the foundation and I work with the the legislators here in the state of Texas.
But that doesn’t limit me from working at the federal level as well I did work with the prior Administration we’ve done a little bit of work in this one it’s much more diminished because they’re of a single mind they want to expand and
they would expand Medicaid they want to expand the ACA so there’s not a lot of creativity in terms of what other options there might be.
So which is unfortunate because again we have scenario you are you talking about all of government or one party in particular I’m talking about the current Administration Hi-C okay yeah so it’s just a little bit more of a challenge but yeah.
Here’s the thing with with all politicians regardless of party.
They don’t know much about health care they may say that they do the latch on to a certain talking points but when you get into the weeds with them their eyes will start to glaze over.
And that’s why I say that especially the listeners of this this program regardless of what party you’re in and and I would say it shouldn’t matter what party you’re in.

[36:58] Talk to all of them go to go to Democrats go to Republicans go to Independence tell them your stories one of the most important things you can do and this is in this is part and parcel of what we do.
With right on health care and free to care is we are learning to become.
Storytellers because you have a lot of you have a lot of stories every patient you see is a story share those share the plight that you go through I know how much time you spend on the phone with insurance companies.
Who aren’t authorizing a medication you know is going to be effective for your patient talk to him about that talk to him about the additional administrative burden there is.
With prior authorization talk to him about the challenges with there’s only one game in town when it comes to a hospital and they’re exercising their leverage in such a way that they’re bullying you.
You talk to him about that these are things that the government should be involved in this anti-competitive behavior is something that they should be involved in.
Absolutely or the hands of the politicians tied because of the dependence on money from Big Business.
Which unfortunately was Unleashed when the healthcare Finance reform was deemed unconstitutional but it is the money just too big to fight no I I can’t and I won’t believe that.

[38:19] Is it an obstacle and is it a big obstacle absolutely I’ve been in a politician’s office and I’m not going to tell you who it is or even his role.
But I just told you it was a man though you know he said David what are we going to do about drug prices and I said well I’ve told you.
What some of the solutions are and I won’t go into the long list of things that I offered him and he him Danny hard he looked up and he looked down he looked back at me and he said David campaigns are expensive you know that that is an issue and that’s how I hear that a lot.
Yeah it’s and they are and they get more and more expensive but I tell you what do they what do they why are they expensive.
So they can get ads it’s so they can get flyers and so they can send out emails and text messages to who to you and if they’re not hearing from you they’re relying on those older methods.
Do you think voters have reached a point where they are much more inclined to vote along party lines as opposed to voting for their own self-interest yes.

[39:21] Yeah me too unfortunately yeah because it’s easier.
It’s a path of least resistance people don’t want to take the time to know what the issues are to know who the candidates are and where they stand on those issues especially the ones that are important to you so yeah but you know it’s,
it’s part of our job too.

[39:42] Dedicate those people I gotta hand it to the politicians do you have perfected the art of inflammatory rhetoric and fear mongering and.

[39:52] That’s just a terrible terrible thing yeah I don’t know if I told you this but you know I ran for office I got so
frustrated I was going to bring that up and I really do want to hear about that if you’d like to share the story and I think it’s I think it’s a it was a good segue I was so frustrated I got to the point where I just wasn’t able to do as much to mate to really affect change
and I was approached to run for office I ended up running for for US Congress and Houston ended up losing in the primary thankfully,
to Dan Crenshaw your say thankfully why are you thankful to lose well because the path that I would then go on has allowed me to be more influential.

[40:33] And more effective than if I had been a single member of Congress in addition to that I really don’t see myself as as a.
As a celebrity type and that’s what members of Congress are nowadays there’s they’re celebrities that’s how they stay relevant that’s how they raised money your gauged.
By the.
Republican and Democratic caucuses by how much money you can make the amount of money that you can raise for yourself and for other members of Congress determines,
what committees you get on so if you can raise a whole.
Boatload of money you can get on an 8 a committee like Ways and Means or Energy and Commerce so it doesn’t have a lot to do with.
Your knowledge and your ability to command a certain subject matter it’s all financially based.
That’s a little disturbing it’s a lot disturbing and it should be but I I’m thankful because I advised at the federal level I have about a little over I.

[41:34] God have to make a list I think about a dozen House Representatives and 34 senators and then in the state of Texas about that many or more.

[41:44] So I having the ear of those folks is.

[41:49] Allowed me to be able to spread the message that I have on a wider scale than had I just been a lone voice that’s a good yeah that sounds like a pretty good start,
I want to ask you sort of a theoretical question if you can name three very important issues that you would like.
For that small Cadre of.
Congressional representatives to get behind and cultivate some cross-party support what would those three things be it would be it would probably be categories that.
Include lists of things that we can do so increasing bringing back Primary Care placing more of an importance on primary care so number one.
Promoting competition this number two.

[42:36] And although transparency would fall under competition I’ve put it out there as a third category because we can get deeper into the weed so having transparency not just for pricing but for relationships for.
Whether there’s a conflict here there here that transparency thing is just absolutely crucial for me I mean even
when I was actively practicing on a day-to-day it became so difficult for me to know what my own patients what cost my own patients we’re going to face when they were in the hospital and then after I retired
and had to undergo some fairly complicated I surgery the number of gotchas on that bill.

[43:24] Hmm you know you would think that a medical professional with 44 years of experience would have an idea of what was was coming and that was not the case.

[43:35] Well David I really enjoyed this conversation,
as if I could I could keep you on for hours you it’s really helpful to people like myself who have only seen Health Care from the provider side.

[43:52] To have these conversations with someone who has a much broader View.
And I really appreciate you being here to share what you’ve learned with us and and your forecast for the future I have a question for you doctor.
Alright let’s hear it do you have a little bit more hope I just don’t right now David I’ll tell you the,
acrimony around American politics at this stage has got me more discouraged than I have ever been you know I grew up in a world where Republicans and Democrats,
argued on the floor of the two houses of our government day in and day out they were very passionate about what they believe and they spoke up,
for what they believed in but at the end of the day they voted and they agreed that we had a deal,
and that we were going to go forward and the time would come when we would want to change those things.
And you know I’m living in a world now where that just simply never happens.
The idea of Reaching Across the aisle and trying to see things through another person’s eyes seems to have disappeared.

[45:16] From American politics and I’m just very discouraged I don’t like feeling that way
but that simply is the reality that I see every day we don’t open newspapers anymore but you know if I look at my Twitter feed or.
The kind of nonsense that we deal with that’s what I see so it’s very difficult for me to be optimistic at all.

[45:43] Here I am for you to give me some reason yeah awful do you remember when I told you that politicians today function is celebrities.
I do I can tell you that what they say in public is very different from what they say in private I’m sure.

[46:00] And so that being the case that’s why it’s important.
For more people like you and for your listeners and you know people who are very well educated and have experience and stories as I mentioned to go and use you as resources,
say you know I understand what this what you’re saying mr. Insurance executive but let me tell you what this person in my district set
and that carries a lot of weight with them being you know again whether it’s you on your own small group of your rotary club or organizations like the one that I leave,
persevere persist because the only hope that that will be.

[46:40] Evident to us is the one that is the one that we create and if we give up on it then perhaps hope truly is lost but I’m not ready to give up
well I certainly hope that it is night and I can tell you that what you’re talking about is precisely
what we at MD coaches are trying to do and that is we’re trying to help Physicians who
really want to be part of the conversation and try to equip them with the knowledge and the understanding and the language
to be able to get their point across because I think
they’ve been marginalized oh yeah they are looked upon more as overhead and they are as important members of the healthcare team.

[47:36] And I certainly want to see that changed but in medical school and in residency and in Fellowship training that’s not the kind of training that we get right so.

[47:50] Our hope is that we can be a part of equipping Physicians to demand a place at the table at hand know how to State their case in a way that will be persuasive,
well I’m thankful for for your group and wish you all the success
well that’s very kind of you and I give I really appreciate you giving me the giving me the opportunity to give you my little sermonette there but I would like to get the focus back on you and this is the,
point in the program where I’m actually going to close my mic and get out of the way and David belight of right on Health Care is going to give us his
personal prescriptions for success.

[48:34] You know I didn’t have to think too long about this if I were to go back and give myself a prescription.

[48:41] For what I would recommend it would be these things remember
but the main thing is the main thing there’s a lot of distraction there’s a lot of things that people will try to get you caught up in the just aren’t important and that’s why it’s important to be so to be mission-based.
And to understand.
What the first principles are and we talked about what health care is what are the what is what is the basic building block again it’s the doctor-patient relationship is so long as you hold that.
At the center everything falls into place but if you get caught up in this and that it’s easy to lose focus so I would say the first of my prescriptions is the main thing is the main thing the second.
Let’s be brave we’ve come into a world now where.
People are cautious of saying what they think and are worried about how they will look to other people and I understand that I get that.
But at the same time I think that in this world people still admire those individuals.

[49:46] Who are brave enough to be themselves not in such a manner that you were rolling over people but you’re willing to share what you believe.
And explain why you believe it.
I feel I feel in fear that those individuals are few and far between and the third one that I would absolutely go back and tell myself is.
Document document document we’ve all heard that in healthcare right if it’s not written down it didn’t happen and this may be this may be an odd one.
For the show I don’t know if you’ve ever had this one as a prescription but you know journaling has become an important part of my life both.

[50:26] Personally and professionally and I can confidently say that it’s been a game-changer the amount of things that we do in a given day is just,
the baffles the mind we do we do so much but if we take time to reflect and we record what we’ve done and our thought process is to why we did it having that on record really has been helpful for me
and I sure do wish I had done it as a younger man as a younger executive I think I would be much more I would have been much more emotionally intelligent.
As the administrator I think I would have been able to share my successes in a much more succinct manner.
Because it’s all right there those are those are my prescriptions for success and I hope that’s helpful to somebody.
Well David I bet it will be and I’m really grateful that you took the time to join us today and share your prescriptions with us not only your prescriptions but.
The little capsulized story of your career it’s been fascinating and I’ve enjoyed the conversation before we go I want to give you an opportunity to let our audience know.
Where they can find you I’m sure you have websites or seminars or books that you’d like to publish so please this is your opportunity to tell us.

[51:43] Where you can be found
I appreciate that I did dr. cook it’s been a real pleasure talking with you I’ve enjoyed it as well so thank you for your time and just the thoughtful questions I’m actually starting to write a book so I don’t have anything available probably not for a year or so,
but you can find you can go to Texas and just about everything I’ve ever written is there if you can go to if you go to the issues button you can actually search by my name.

[52:09] That’s Texas you can find me on Twitter David balot HC for healthcare,
also you can find
find us on Facebook there’s a private group called right on health care if you ask to join I will let you in and then I mentioned several times are our advocacy organization free to Carefree the number two
care dot-org
take a look at the website there you know we are a completely nonpartisan group we have liberal Democrats conservative Republicans and everybody in between.

[52:46] And we talk we say and talk about health care,
because in such a way that it is personal it’s about the patient and I would encourage you to go there is lots to read there’s lots to look at and if you have any questions please feel free to reach out to me on any of those platforms I just mentioned
David balot director of right on Healthcare part of the Texas public policy Foundation.

[53:09] It’s been fascinating talking to you and I really appreciate you being with us today thank you sir.

[53:16] Thank you so much for listening today remember.
You can get more information about our guests as well as here then face my rapid fire questions at our patreon site.
And while you’re there you can also subscribe to the podcast give us a rating and hopefully offer suggestions on what you’d like to hear.
In future episodes thanks very much to Ryan Jones who composed and performs our theme music for us.

[53:46] That’s all we have for now so please be sure and fill your prescription for success with my next episode.

[53:53] Music.