The Most Dangerous Part of America’s Healthcare System Isn’t What You Think with Tom Mueller

Speaker 2 The story of dialysis is an amazing case study of good intentions being thwarted by bad incentives, poor oversight, and profiteering.

Speaker 3 When I was working at the Vita, the priorities were to get them on dialysis and get the next patient on as soon as possible. It was all about numbers.

Speaker 4 Tom Mueller is the author of How to Make a Killing: an Investigation of the Dialysis Industry.

Speaker 1 In America, patients on dialysis die one to two times faster than in any other developed country.

Speaker 4 This is What Now with Trevor Noah.

Speaker 4 This episode is presented by Whole Foods Market. Eat well for less.

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Speaker 1 Clorox

Speaker 1 Clorox toilet wand, it's all in one. Hey, what does all in one mean?

Speaker 1 The caddy, the wand, the preloaded pad.

Speaker 1 There's a cleaner in there,

Speaker 1 inside the bag.

Speaker 5 So, Clorox toilet wand is all I need to clean a toilet?

Speaker 1 You don't need a bottle of solution

Speaker 1 to get into the storage revolution.

Speaker 5 Clorox, clean feels good. Use as directed.

Speaker 4 I've never known you without glasses, now that I realize it.

Speaker 6 You actually have. When? Half of our relationship was without glasses.

Speaker 4 What? Take off your glasses?

Speaker 6 Remember this guy?

Speaker 1 No, actually,

Speaker 4 you're right, actually. Yeah, the beard, now it's like a flip.

Speaker 6 Because no beard, more hair, no glasses.

Speaker 4 It's like I've known every version of you.

Speaker 6 Do you know this guy?

Speaker 1 Eugene, where are you?

Speaker 1 I'm here. Oh, Eugene, you're back.
I think someone else is here. Where is he?

Speaker 1 Welcome. I'm just saying.

Speaker 4 Welcome to our idiot friendship, Tom. I'm so sorry.

Speaker 1 Thank you very much, Eugene. I feel like I fit right in.
You do, actually.

Speaker 4 You do. If you want to, you do, man.
You do indeed. Actually, you know why I feel like you fit right in is because...

Speaker 4 You've got like one of the most beautiful, weird stories of how you've lived your life, you know.

Speaker 4 And when I read your books, I can't help but wonder if the way you write and the way you've thought of writing comes from how you've lived your life. Like, just take us through some of this.

Speaker 4 So, because a lot of people are fans of your books, but I don't think a lot of people know a bit of your life. It's like, where were you born?

Speaker 1 I was born in New York City. Okay.
Left six months later, went to London and Paris.

Speaker 4 I like how you say that, like, you left. You're like, I'm out.

Speaker 1 I was lefted. You were like, I'm out.
I'm out, parents.

Speaker 4 I can't do this anymore.

Speaker 1 Yeah, when I say I was born in Columbia Presbyterian, my New Yorker friends say, yeah, but you're not a New Yorker.

Speaker 1 So I try to make that clear at the outset.

Speaker 1 And we moved around a lot in the United States,

Speaker 1 California, upstate New York, Texas.

Speaker 1 I did my high school in Houston, Texas, which I do not recommend, but it was an experience. I learned about football, which is something.

Speaker 1 And then, yep, we went east for college and then went to England for grad school and have really not lived in the United States since Ronald Reagan was president. That is wild.

Speaker 1 I spend half my time or more in the United States, and I technically live in the United States. But yeah, I've been based in Italy for 30 years or so.

Speaker 4 Do you think that some of that has affected how you're able, like, maybe I'm projecting here, but I sometimes feel, regardless of nationality, one of the best things you can do is remove yourselves from a situation to be able to see it better.

Speaker 4 Doesn't matter who you are in the world. Spend time away from your family.
Come back to them. You'll see them slightly differently than when you're always in it.

Speaker 4 And I feel like you've done that with America, with the corporations, with the way we see, you know, the way things just work.

Speaker 4 Is that, do you think that's partially because of just like how you've lived, where you've been?

Speaker 1 I think no question.

Speaker 1 Stepping back and looking at the way in which, for instance, you mentioned corporations, the way in which in America, corporations and money are regarded with a certain religious awe, whereas in other places, it's, you know, they are welcome and they are sometimes very powerful, but they're not the be all and the the end-all.

Speaker 1 And

Speaker 1 again, stepping back into a place where you've been born and raised, you realize, my gosh,

Speaker 1 things really have changed here. And that's the last 30 plus years, things in America have changed at an accelerating pace and an alarming pace, really.

Speaker 1 But you can see that better if you're outside the bubble for a while and then you pop back in.

Speaker 4 How did you get into writing? Because I don't know if my research was correct, but were you in banking at some point?

Speaker 1 Yes.

Speaker 1 I did a a PhD in history and love history, but realized I was not cut out for academia. So I thought, well,

Speaker 1 I know languages. Europe 1992 is happening.
Let's try. You know, there were recruiters

Speaker 1 on campus checking for people who are interested in

Speaker 1 banking and...

Speaker 1 consultancies and various others. And I ended up at Goldman Sachs in London doing mergers and acquisitions, which for two years, which was a remarkably good experience from a business point of view.

Speaker 1 I met some of the most fantastic people in the world and I came away with this amazement that some of the most fantastic people in the world were swindled into giving their lives away for a modest amount of money.

Speaker 1 I mean, it was big money. What do you mean by that?

Speaker 1 They were indentured servants to this company

Speaker 1 and simply their lifestyles were terrible. Their incomes were very good, but

Speaker 1 terrible, terrible lifestyles. And that was well before the run-up to to 2008 and all the massive crime.
I was in a business where it's still the relationship was important.

Speaker 1 And if you screwed up with a client, you were done. I mean, you were finished.

Speaker 1 And then later, clients became sock puppets and traders replaced relationship bankers and you got 2008.

Speaker 1 So, you know, one of my closest collaborators were bosses and collaborators at the bank was on the 1NDB indictments. I mean, he was

Speaker 4 an investment banker. We're talking about like the

Speaker 4 2008 Wall Street crash, financial collapse.

Speaker 1 Yeah. I mean, they were testifying before Congress.
They were explaining why you could call a client a sock puppet and you could create financial vehicles. Wait, Tom.

Speaker 6 That's an actual term?

Speaker 1 The actual term, sock puppets, yes.

Speaker 6 Was it used within your circles or just within?

Speaker 1 Not within my circles, but

Speaker 1 the folks that I worked with who stayed at the bank, that's what they were talking about. Yeah.

Speaker 1 And again, trading is very, very different from relationships. Trading is one day at a time, I win, you lose.
I mean, there's a, it's a zero-sum game.

Speaker 1 So trading is at the end of my day, I close out my position and you are my counterparty. You're not my client at all.
And that means I can take advantage of you.

Speaker 1 And that's what happened in the run-up to 2008. Goldman was in particular, I mean, involved in all sorts of bad stuff, but they were basically building financial vehicles to fail.

Speaker 1 and then selling them to unsuspecting pension funds and various other, you know,

Speaker 1 innocent parties as a good investment. Yeah.
And then betting against them. That's insane, man.

Speaker 4 I still can't believe that that happened.

Speaker 1 Yeah.

Speaker 4 And then I, you know, what shocks me even more is that the ramifications were barely felt.

Speaker 1 Absolutely. Do you get what I'm saying? Yeah, yeah.

Speaker 4 It's one thing to go, something wild took place. It's another to go, nothing happened.

Speaker 6 But I think that's why a lot of people have sympathy and sometimes admire people who do white-collar crime, right? Because it almost feels like it's a victimless crime.

Speaker 6 If someone is bleeding on the side of the road and someone has a firearm in their hand, that's a crime. If someone says, I lost millions of dollars, and people go, How much do you still have?

Speaker 6 A couple of million more.

Speaker 6 There's no crime here, no farm. You see what I'm saying? Yeah.

Speaker 1 No, I mean, you look at Mike Milken. I mean, he was actually prosecuted and sent to jail for multiple felonies.
Comes out. He's the toast of the Nobel Prize community.

Speaker 1 He's got billions still in his foundation. It's no, I mean, white-collar crime is vastly more, it's the cancer of society.
It's vastly more damaging. It causes massive amounts of

Speaker 1 harm. But as you say,

Speaker 1 it's almost lionized in the business school community as something, hey, you know, you really is a risk taker, right? He's a real horror. You know, you talk about killers in business.

Speaker 1 You talk about making a killing. Yeah, yeah, yeah, yeah.
That's a good thing. That's supposed to be a positive.

Speaker 4 They're a lot different than we do.

Speaker 1 Yeah. And if you're flying, you know, close to the to the wind in legal terms or beyond, it's viewed as an incentive.
There's no normative quality to a law. You break the law,

Speaker 1 it's wrong.

Speaker 1 They say, what are you talking about? I mean, how much do I have to pay here? What's the settlement? I'll pay it. Put it all at checkbook, write it.

Speaker 1 And while you're at it, individuals don't go to jail anymore. It's corporations, right? So it's the perfect crime.
I mean,

Speaker 1 you are lionized as a killer on Wall Street.

Speaker 1 You are covered by your corporation. So you individually aren't prosecuted at all.

Speaker 1 And when the time comes to write a check, you can write a check instead of going to jail and your corporation writes it for you and you keep your beach house. It's beautiful.

Speaker 6 You're the perfect person to be having this conversation with. In South Africa, we had the State Capture Commission.
Yeah.

Speaker 6 Did you read about it? I did. For those who don't know, it was

Speaker 6 an inquiry headed by a constitutional judge who's now retired that was based in South Africa to hear about widespread corruption in the government with private actors.

Speaker 6 So who were involved in having government contracts. That went on for, I think, almost two years, a billion ran later, not a single prosecution.
Everyone got away with everything.

Speaker 6 But when I was having conversations with my friends, even I would always say, why is it that whenever we talk about corruption, we speak about the person whose hand is caught in the cookie jar.

Speaker 6 So if you and I steal, we make a billion dollars. We still have to go buy Ferraris, Maseratis, Lamborghinis.
Who's selling us those cars? We have to go buy mansions. Who's selling us those mansions?

Speaker 6 Absolutely. Who's investing our monies? Where are those funds kept? Where are we making the transaction and the withdrawals?

Speaker 6 And I always think to myself, myself, I would love to meet someone who can make me understand why is it that even when corruption is thwarted, it doesn't go further than when people exchange the same money for goods.

Speaker 1 Those enablers, I mean, there is one whistleblower in finance who

Speaker 1 revealed that a certain bank, Wells Fargo bought it, was

Speaker 1 laundering money for the Sinaloa cartel. He said those enablers, those bankers had their finger on the trigger every time the Sinaloa cartel fired at them.
And that's true.

Speaker 1 I I mean, we cannot look at enablers, bankers, real estate people,

Speaker 1 corporate

Speaker 1 foundations,

Speaker 1 all the other folks that make their lives possible, tax advisors, all these offshore.

Speaker 1 Those are fundamental figures in the crime syndicate. And they are as responsible for every bullet that hits as the actual person who pulls the trigger.
As I would argue that they're more responsible.

Speaker 1 I mean, I would argue that people who do it just for the money, as opposed to a hired killer, I mean, I don't know what that person's background is.

Speaker 1 I don't support hired killing, but somehow it's even more sinister when you're making a killing by doing a killing. I mean, those people are not making a lot of money, right? The hitmen and women.

Speaker 6 They're most in the food chain.

Speaker 1 Yeah. They're just tools in the hands of these other people.
But we... We admire the lawyers, the white shoe lawyers and the big bankers and so on.
We admire them.

Speaker 1 They get their names written on the New York Public Library, all sorts of very special perks for them.

Speaker 4 You know what's amazing?

Speaker 4 Even when we think about our thinking of it, it's amazing that if you shoot somebody in the street, or if you rob somebody, or if you shoplift one of those, you have committed a crime.

Speaker 4 You are a criminal.

Speaker 4 But if you defraud millions of people's pensions, if you get millions of people addicted to opioids and, you know, now they're having overdoses, et cetera, this is white-collar crime.

Speaker 4 It's amazing that we've given crime a different name.

Speaker 1 But why?

Speaker 4 Do you know what I mean? Why is it a... No, no, this is a white collar crime.

Speaker 4 We've almost given it a respectability that it doesn't deserve.

Speaker 1 What kind of collar do the people who define it wear? They wear white collars. They're judges, they're lawyers.
They're the folks who are making these rules, right?

Speaker 1 I mean, you know, they are the people who see this. They see someone bursting into their house

Speaker 1 and robbing them or shooting them as a major threat. They do not see someone who is defrauding a pension fund and having

Speaker 1 elderly teachers eat dog food for the rest of their lives, which is something that happens.

Speaker 1 They don't see that as a problem. They're not elderly teachers.
They don't see,

Speaker 1 at the ultimate analysis, they don't see the common good as a major concern. They just don't.
It's a dog-eat-dog world. It's an Ayn Rand world.
And it's, I win, you lose. That's it.

Speaker 1 And that's ultimately why the heroes of finance, the heroes of the law and so on, are so clubbish and so in agreement,

Speaker 1 along with the judges when it comes to defining the social damage by certain kinds of crime and as you said white collar crime causes infinitely more damage and just erosion of trust erosion of respect erosion of this social fabric than any blue collar crime people don't realize how much the things they're experiencing in the world every single day are a byproduct of those crimes

Speaker 4 and while we'll never dismiss a murder or a robbery those crimes have far less of a ripple effect out into the world. Do you know what I mean?

Speaker 4 So when you see your town dilapidated, when you see your parents sick or a family member who is dying and can't get treatment,

Speaker 4 when you see

Speaker 4 your retirement fund disappear,

Speaker 4 those types of things have such a widespread effect. You know what I mean? They're more likely to create more of the thing

Speaker 4 that you don't want to see. And it's so crazy to see this.

Speaker 4 I actually actually wonder, like, how you had this, because your life is really, it almost feels like a series of trapdoors when I think of your life.

Speaker 4 You know, you, you're studying history and then you fall down this trapdoor. And then all of a sudden you're in London, you fall down a trapdoor.
And then at some point, you were studying music.

Speaker 4 You know, and then it's like, you fall down another trapdoor, another trapdoor. And then you stumble into this world that honestly, I think everyone should be grateful for.

Speaker 4 And for me, it was like, you know, when you were writing about the corruption in the olive oil industry, which seems like a, such a like light topic, you know, so when I saw that, that, I was like, huh, corruption in olive oil.

Speaker 4 Well, this is like a

Speaker 4 cute world to be in, but you expose so many of the layers. And then your next book, you talk about whistleblowers

Speaker 4 and the role they play in society and how we don't protect them enough and what they've done to expose what we're experiencing. And man, I feel like your latest book,

Speaker 4 I hate to say it, is

Speaker 4 more and more applicable every single day.

Speaker 4 You know,

Speaker 4 how to make a killing in healthcare in America is like,

Speaker 4 you know, you look at all the stories that popped up, the Luigi Mangione story. You know, you look at people

Speaker 4 going on strike or rioting in certain parts of the world. You look at because they're losing their health benefits.

Speaker 4 You look at people just losing faith in the societies that they live in, in the system.

Speaker 4 And when I read your book, I went, this guy,

Speaker 4 you didn't just critique it,

Speaker 4 you break it down on the, on,

Speaker 4 on the, like, the most minute levels.

Speaker 4 And I wanted to know, like, why you started with dialysis, because that's, that's like the, you know, the, the, the real crux of your book, but it exposes everything.

Speaker 4 You went, you go into dialysis. Why, why that topic? Help me understand.

Speaker 1 Yeah, well, I, as you mentioned, I wrote a book about whistleblowing, and I was interviewing a bunch of different whistleblower classes.

Speaker 1 So there's, you know, the big pharma whistleblowers and the defense contractor whistleblowers, the big bank whistleblowers, all these. And there was this weird outlier,

Speaker 1 dialysis whistleblowers, the finance people in dialysis

Speaker 1 who were bringing false claim suits, whistleblower lawsuits against the big dialysis companies. I'm like, what's going on here? And the dialysis companies were signing $400 and $500 million

Speaker 1 settlements at a pop. Their stock price was going through the roof.
Warren Buffett owned 40% of one of them. And I'm like, okay, what's going on here?

Speaker 1 My inner banker was like, bing, bing, bing, the board is

Speaker 1 going off. Yeah, yeah, what is going on here?

Speaker 1 And so I looked into, um, well, first I started with the finance people, then I worked my way back into nephrologists, kidney doctors who were working for these companies, and then gradually back down to the blood floor where dialysis is actually delivered.

Speaker 1 And that's when I realized this is not a chapter in a whistleblower book. This is its own book.

Speaker 1 Because as you said, Trevor, I mean, it is, it is a perfect microcosm of what can go horribly wrong when you put profits before patient care.

Speaker 4 It's also a terrible story of how a miracle can be turned into a curse, right? Because you look at when this technology is invented, you know, and I only learned this from your book.

Speaker 4 It's not like I knew this before reading the book. I didn't either.
You look at this world where it's like dialysis is miracle. Yeah.
It's like, wow, we've invented this way to basically, you know,

Speaker 4 an external kidney. Yeah, an external mechanical kidney.
What have we done?

Speaker 1 Yeah.

Speaker 4 And in such a short amount of time, it goes from miracle to, oh no, this is a curse on people's lives, on their finances, on their futures, and on their families.

Speaker 1 And I was like,

Speaker 4 when you stepped into it, what made it the perfect place to start? Like, what would people not understand about dialysis? Like, they might be like, oh, yeah, what makes dialysis so big or so unique?

Speaker 4 Or why dialysis versus everything else? What was it about this specific topic?

Speaker 1 Well, first of all, as you say, it was a miracle. And it's such a miracle, such a breakthrough, the first replacement organ

Speaker 1 that had the potential to save millions of lives.

Speaker 1 And it was such a miracle that the U.S. Congress got involved.
I mean, they were, this is 1972, the early 70s, 1972, the actual law was passed.

Speaker 1 Congress got involved at a time when, and this is going to take you back, at a time when the Republicans, the Democrats, the insurance companies, the AMA, everybody had their plan for national health.

Speaker 1 The U.S. was going to have national health.
And they viewed dialysis as breakthrough cure, which had hit the news in a way that made it very difficult for them to ignore.

Speaker 1 There was who decides who lives and who dies. There was Life magazine cover stories about this.
There's Edward Newman

Speaker 1 doing NBC reporting on it.

Speaker 1 And it's pretty blunt that the folks who were chosen for the very few chairs that were available survived and lived pretty well for decades. And the rest.

Speaker 1 were dead. I mean, they had no chance at all.
They were condemned to death. So Congress got involved, and they made it the one and only Medicare for all program in 1972, signed by Richard Nixon.

Speaker 1 And that is at a time, literally, where everyone is thinking we're going to have national health. Everybody else, I mean, most other countries around that same time adopted national health.

Speaker 1 Australia, which is

Speaker 1 the counterpart that I compare the U.S. to a lot in 1972.
But then Watergate consumed Nixon. The Vietnam War went ballistic.

Speaker 1 You know, the OPEC oil embargo, stagflation, and the entire government pivoted from build a great society to cost-cutting and Reaganomics very soon after.

Speaker 1 And government's the problem, not the solution. Damn.
And we've never looked back. We've never gone back.

Speaker 1 So dialysis, from a historian's point of view, is a really interesting sort of relic of a different era where the government felt and the people felt the government had a role in taking care of human beings.

Speaker 1 That's an important part of being a citizen, is getting health care. So we once thought.

Speaker 1 And then the dialysis, the fascination to me of this treatment, which is done wrong, it's a sort of an incarceration.

Speaker 1 I mean, you need dialysis three times a week, minimum, minimum, minimum, three, three and a half hours each treatment, or you die.

Speaker 6 It's as simple as that.

Speaker 1 They own you. If it's a good organization, they are looking out for you.
They're saving your life every single time.

Speaker 1 If it's a bad organization that's run like Taco Bell, which one of the former CEOs actually bragged about, this is how we're going to run this company, Then they own you.

Speaker 1 They actually possess your body. So it reminded me, one of the lawyers who got in,

Speaker 1 in order to help a lot of patients who have contacted me, I've been contacted by over 3,000 patients and family members since this book came out and long before.

Speaker 1 One of the lawyers who really got it was a former Innocence Project lawyer. So people

Speaker 1 unjustly incarcerated, people on death row, mostly black and brown.

Speaker 1 And he said, oh, I get it. He had just retired from the Innocence Project because Illinois had done away with the death penalty and it was a major success for him.

Speaker 1 And I said, you've got to get involved with this involuntary discharge from the dialysis of facilities. And he said, I get it.
I get it. You're trying to bring me back onto death row.

Speaker 1 Oh, damn. Punch and the gut.
That's exactly what it is. Suddenly saw what he meant about this combination of health care and incarceration.
So to come back to your question, this is,

Speaker 1 let's say, one of the most extreme cases of health care delivery, where you need it and you get it. If you don't get it, you're going to die.

Speaker 1 At the same time, you have to follow the rules that whatever organization is taking care of you is laying down or you don't get it.

Speaker 1 And there are good organizations and there are good facilities and there are wonderful people

Speaker 1 and they do a good job about focusing on the individual and their individual needs, as with all medicine.

Speaker 1 But there are big companies that are running things on an assembly line, one size fits all basis. And they're really looking much more at Wall Street than they are at their individual patients.

Speaker 1 I mean, they are hedge funds with an exposure to healthcare. That's not an overstatement.
They are financial vehicles with exposure to healthcare.

Speaker 6 How complicit or how complicit is

Speaker 6 the average person who buys stock in these worlds?

Speaker 4 Did you look at me when you said that? That was weird.

Speaker 1 Complicit is our

Speaker 4 complicit. No, it's Tom's world.
No, no, no. But what you, you went.

Speaker 1 How complicit are you? The average person. And you looked at me.

Speaker 1 You looked directly at me

Speaker 4 as if I've bought stock in any of you.

Speaker 1 Explicit. Yeah.
A friend of yours.

Speaker 1 That was really weird. Wearing a tan face.
Ask your question and look away from me. Don't be looking at me like that.
Look the other way when you say that.

Speaker 4 I've never bought any stock in a healthcare. You look the other way.

Speaker 1 Don't do that. No, take that back.

Speaker 1 I take it back.

Speaker 1 You feel better now.

Speaker 6 People like to wash their hands off of something that is innately horrible when people say, if there's insider trading and you give me a tip off and I put a million dollars in something and I make a lot of money, but if I put $5

Speaker 6 because my banker said I should, and this company ends up blowing up like it does, and it does the things that you say it does, how complicit am I?

Speaker 4 It's an interesting thought of like how far away do we get the blame for? Because

Speaker 4 yeah, like, do you

Speaker 4 if I'll expand on that, it is, it is a difficult question.

Speaker 4 But do you think people know when they're investing in these companies? Like the average person, do you think they know what they're investing into?

Speaker 1 No idea. No, I think they have no clue what they're investing in.
And

Speaker 1 all of the signaling, all of the PR is about. health and wellness and thriving united health, just to take one example.

Speaker 1 But

Speaker 1 for me, the individual investor, you should probably do your homework because that's part of your responsibility as a citizen.

Speaker 1 But the people who are really complicit to me are people like Warren Buffett. I mean, you own 40% of a company.
You've owned it for a long time. You yourself have made a killing in this investment.

Speaker 1 You should be kicking the tires on what's going on, right? I think that's very important. And I think people should be able to call folks on that.

Speaker 1 Now, he might argue that this is a good investment and what I'm doing is investing. And that is precisely the argument.
And there is zero social

Speaker 1 obligation on my part. I am an investor.
And that's sort of the Ayn Rand approach, right? Or the rigonomics approach is

Speaker 1 ultimately it means that you don't have a social responsibility. And in fact, there's an argument that says social responsibility in running a company is actually should be illegal.

Speaker 1 I mean, your only legal obligation is to shareholder value.

Speaker 1 That's another of those insane things like corporations are people and money is speech. One of those completely idiotic, insane things.
Corporations are people?

Speaker 1 This is United. Yeah, citizens United.
Corporations are people as a legal entity.

Speaker 1 And their money and any money is speech. Those are two things that are the same.
Yeah, that's one of the worst.

Speaker 4 The worst decisions America ever made. It's preposterous.

Speaker 1 I mean, if you think about it,

Speaker 1 that's crazy. It's crazy talk.
But we've been fed it so many times, you know, with our problem that we ultimately say, oh, well, it must be true. I got those really smart people are saying it.

Speaker 1 Not only is it insane, it's also hugely damaging because, of course, then the corporations with their speech are going to go in and buy politicians. That's what our, I mean, the U.S.

Speaker 1 campaign system, campaign finance system, is illegal in most countries. Yeah.
I don't know how it is in South Africa.

Speaker 4 No, no, no.

Speaker 1 But a big company can't come and give you a million bucks.

Speaker 4 So ours is you can in South Africa. They make these big donations.

Speaker 4 But I was shocked when I first came to the U.S., I was shocked at how many things are legal here and just full-on bribery where we're from and in other parts of the world.

Speaker 4 It's just like, it's just bribery.

Speaker 1 This is bribery.

Speaker 4 Half the stories that make the headlines in South Africa, politician got a private jet flight to this place and was put up in a hotel for a weekend and went out for, and then spent this much and got, and then you come here and they're like, no, no, no, that's that's lobbying.

Speaker 4 What are you talking about? That's not

Speaker 4 bribery. Free speech.

Speaker 1 Free speech.

Speaker 1 First Amendment. Yeah, they're expressing themselves.

Speaker 4 This poor company needs to speak. Are you going to silence the company? Oh, poor company.

Speaker 6 We're going through that actually right now where officials from our version of the DMV went to France

Speaker 6 to solicit, you know, to hang out and be on private jets, expensive dinners, expensive gifts with a company that will print driver's licenses.

Speaker 4 They have the exclusive contract, essentially.

Speaker 1 And it's massive amounts of money.

Speaker 4 But it's exactly what you're saying. And when you, you know, when we talk about complicit, I love that you use that word because

Speaker 4 When we talk about somebody like Warren Buffett, I go, I will not call Warren Buffett good or bad or whatever, but it is interesting, it is interesting that we would never accept that excuse, let's say from another person,

Speaker 4 if it turned out they funded the Sinaloa cartel, you know, if they owned 40% of it. Like imagine if you said to somebody, I own 40% of the Sinaloa cartel.
They'd go, you're a criminal.

Speaker 4 And you're like, no, no, no, no, no. I just invest in the Mexican drug cartels.

Speaker 4 I don't engage in it.

Speaker 1 They're good investments.

Speaker 4 They're great investments.

Speaker 1 Rapidly growing, good market share.

Speaker 1 All of the return on assets is awesome.

Speaker 4 But look, do I condone everything? Of course I don't. But I'm not there for the murder.
I'm just there for the investment.

Speaker 4 There is a level of asking yourself, like, you know, like

Speaker 4 who are, if everyone gets to say that they are not responsible, then who is responsible?

Speaker 6 Yeah. I think it's also how things are phrased, you know, an inquiry, an inquisition, a, you know, white-collar crime, corruption,

Speaker 1 bribery. Yeah.

Speaker 6 It's theft. All of it is just theft.
And I was asking you before we started that, what is it that makes

Speaker 6 people steal?

Speaker 6 I know what would motivate someone to tell the truth and blow the whistle. I can kind of figure it out.
You get tired of how things are. You go, I have to make a change.

Speaker 6 I have to be the change that I want to see.

Speaker 6 But in your research, what makes someone go, here's a million dollars that's supposed to go to public good, and I'm just going to buy a nice car and a nice house?

Speaker 1 Well, first of all, steal from the necessity. I'm hungry.
I gotta eat. My family has to eat.
I get that. I'm not condoning it, but I get it.

Speaker 1 And a lot of that is caused by the white collar crime we were talking about earlier, right?

Speaker 1 But second of all, if you

Speaker 1 ultimately,

Speaker 1 if you and your peers are an aggressive corporate culture and you talk about how you really got to push things, you really got to go for the throat, you know, all these sort of sports/slash-killing analogies of war.

Speaker 1 I mean,

Speaker 1 corporations as war-fighting machines. Yeah.
That's kind of, you know, penetrate and

Speaker 1 take, you know, enemy territory, this sort of thing.

Speaker 1 Then you're going to naturally push hard and you're going to do things which are potentially illegal, but maybe, you know, there's this sort of nudge, nudge, wink, wink.

Speaker 1 The compliance department says we're doing everything just right. We have a gold-plated compliance department.
Plausible to know.

Speaker 1 Go on, go on. Off-camera, you can do, you know.
But then

Speaker 1 there's this worship of of money and the way in which people keep score in their lives. I mean, it's hard to figure out when you're doing the right thing.

Speaker 1 If you're saying, am I doing the right thing today? By, I don't know, by writing a book, by doing a comedy show, by talking.

Speaker 1 It's hard at the end of the day or the end of a year to say, I've done something really important. It's easy to count money.
And if you're in that culture where you say,

Speaker 1 Look at that. I got 5 million bucks.
That's very tangible. And now it's 5.2 and the stock markets are growing, and growing.

Speaker 1 The wealthy people that I know, the ones that have 100 million, they only talk about the people who have 200 and 300 million. The ones who have 300 million, they talk about the billionaires.

Speaker 1 The ones who have a billion, they talk about the two billion. It's never enough.
It's like the shark that can never get full. And that's where I think that's the ultimate problem.

Speaker 1 It becomes, especially when the society worships these people and condones all of their actions. It becomes this sort of

Speaker 1 endless, endless hunt for

Speaker 1 for more money at the end of the day. And it's a status thing.

Speaker 1 But how can you possibly live? How can you possibly use even a million dollars, let alone a billion dollars?

Speaker 1 I mean, how can you, it's just, it's just a score, it's a counter for the quality of your life because the quality of your life, I don't know.

Speaker 1 I mean, again, working in banking for a brief time, I saw some amazing people, incredibly smart people, doing incredibly dumb things with their life, throwing away their time in order to have a metric ton of money.

Speaker 1 They didn't have cars, they didn't travel, they didn't live,

Speaker 1 but they felt successful. And for me, after two years, I was like, you were losers, you guys.
I mean, I'm sorry. And now they think I'm sure that I'm a loser because I have not made any money.

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Speaker 4 We had an episode of the podcast with Rutger Bregman, right? And some people might not know his name, but he was the guy who rose to a little bit of infamy by he went to Davos.

Speaker 4 And at Davos, he basically said to everyone in the room, he's like, hey, hey, why is everyone here trying to solve the problems of the world as if you are not causing the problems of the world?

Speaker 4 And he said to everyone in that room, just pay your taxes. Everyone here is avoiding, you flew in on private jets and you're like, what should we do? He's like, pay your taxes.

Speaker 4 And then they were like, who invited this guy? Don't invite him back again.

Speaker 4 But one of the things he talks about, and that's what he's working on now, is he said, we've created a society, a society where the smartest, brightest minds go into fields where...

Speaker 4 they're just trying to extract from society.

Speaker 4 There was a time when the most brilliant scientist tried to work on the science that would change the world in the most positive way, invent a light bulb, create an aeroplane, find a new type of health solution.

Speaker 4 You know what I mean?

Speaker 4 And then now that person goes, go to a company that can make as much money as possible, as quickly as possible.

Speaker 4 Mathematicians were trying to solve going to space or, you know, trying to figure out the circumference of the globe, whatever.

Speaker 4 And then they were just like, go to this company, make as much money as possible, get the trading.

Speaker 4 But what you said, I think, is key. It's the reverence.

Speaker 4 You turn on the news and they go, Larry Ellison, now the richest man.

Speaker 4 But why? Like, if society, like, and I mean that on like a media level, not the people on the ground, because I think the people are oftentimes sort of not victim to it, but

Speaker 4 you're experiencing it.

Speaker 4 If the news tells you that this is good and important, and the media tells you it's good and important, then you think it's good and important.

Speaker 1 And not by accident, half the media is owned by those very people. If you look at the oligarchs that are owning the big news outlets, they're Legion and

Speaker 1 try to tell Jeff Bezos that he really shouldn't be a monopsony in

Speaker 1 all

Speaker 1 goods sold in the United States. You will not last very long, right? There is a lot of self-editing.
So I think that's no, that's absolutely right.

Speaker 1 This reverence, a sense that they are gods. And it builds into this sense, too, that there is an Übermensch society, and then there are underlings.

Speaker 1 And those underlings, if they're homeless, well, they're not human, really. It's not my problem.
I mean, that's a a sense that I get. It's horrible to say, but there are people who

Speaker 1 the haves and the have-nots have always existed since ancient Greece, since Rome, since whenever. But this is a sort of an institutionalized

Speaker 1 form of

Speaker 1 superior being, judged by your net worth, and then everybody else is really expendable.

Speaker 4 To talk about expendable,

Speaker 4 you can look at one of the examples you give in the book, and you go through

Speaker 4 multiple hospitals and healthcare systems

Speaker 4 i i i i was reading about the dialysis and and and

Speaker 4 how each system doles it out

Speaker 4 and to what you're saying in some of these stories man it it it sounded less like healthcare and more like a fast food drive-through chain it felt like they're trying to get people on and off a machine as quickly as possible, use as few nurses as possible, make as much time work as possible, look after the patient for the least possible.

Speaker 4 And I went, I mean, I guess this is great if you're trying to get fries out quickly, but these are human beings. You know what I mean?

Speaker 4 It feels like the business model isn't, it's not about health care, it's about health profits.

Speaker 1 100%.

Speaker 1 It's fast food medicine, and it's a model that wasn't invented by dialysis. It was invented in the 60s by

Speaker 1 people who actually

Speaker 1 ran Kentucky Fried Chicken franchises and Wendy's. Literally.
Literally. Who then started buying up,

Speaker 1 you know, started privatizing hospital systems and putting together. So they literally were the people with this branding experience and this mass fat.

Speaker 1 You know, and in theory, I mean, you know, Atul Goande wrote the Cheesecake Factory article in the New Yorker, which got a lot of attention. I don't like it, but he's a smart guy.
He's a doctor. And

Speaker 1 the idea of focusing in on a specific medical procedure, making it as efficient as possible, and delivering it in as low-cost a way as possible, that's

Speaker 1 potentially a useful idea. The important thing here is that it not become

Speaker 1 turning patients into widgets on an assembly line, which is precisely what the fast food model or the cheesecake factory does.

Speaker 1 You're not... tailoring your care to the individual needs of your patient.
You are looking, and once again, this is a finance person's view.

Speaker 1 The person who brought this into dialysis or popularized it, Kemp Theory, he was a former CEO and the founder of DeVita, one of the two big companies. He made his bones at Bain Capital.

Speaker 1 That's a private equity firm.

Speaker 1 He was a finance guy, the kind of guys that I worked with.

Speaker 1 And he basically, and he said, speaking to a business school audience,

Speaker 1 he said, you know, if I were running Taco Bell with, I forget the exact numbers, 23,000 outlets, and I would be doing all the same things as I'm doing. No.

Speaker 1 It's not about the patients, is what he said. And some doctors hate it when I say this.
These are quotes, right, from his speech.

Speaker 4 This is an actual quote.

Speaker 1 Actual quote. Yeah.
Yeah, I can show you the video. It's quite striking.
But again, it fits in a business situation in which you are Wall Street facing and you're talking about return on assets.

Speaker 1 If you have 2,000 dialysis clinics around the country and your main focus is shareholder value, and I'm getting paid in stock as a CEO, so my shareholder value is pretty important to me too, right?

Speaker 1 It's a conflict of interest on a massive scale.

Speaker 1 Anyway, if that's your aim, you want to run as many patients through every single one of those facilities as you can because your asset base, your buildings, your machines, and so on, the more units you shoot through them, and it is just like Taco Bell, except people are not burritos, right?

Speaker 1 Every single person who goes into that facility needs, should have a treatment that is tailored to their individual problems, their individual biology, their individual size and everything.

Speaker 1 And if you're running it as a fast food, you know, assembly alignment model, you're not going to do that. One size fits all.
One size fits all.

Speaker 1 And you're going to penalize the people who slow things down, who say, Oh, actually, you know, Tom here, he should be getting five hours. No way, no way.
And they're violently pushed back.

Speaker 1 And the doctors, some of the doctors I've talked with who work in these facilities are not best pleased.

Speaker 1 And some of them, some of the workers are also suffering from serious moral harm because they realize it's like soldiers forced to commit, you you know.

Speaker 1 Yeah, yeah, yeah, yeah. That's the perfect analogy, actually.
It is. I think they're perfectly.

Speaker 1 Literally, they know what's wrong and they are not able to fulfill their Hippocratic oath to their patients and take care of their patients because the structure they're working in doesn't permit it.

Speaker 4 Yeah, I think that's the perfect analogy because we take for granted how much an overlord and a system can then oppress even the people within it.

Speaker 4 And then what happens is in a society, we start fighting amongst ourselves

Speaker 4 as if there's not one central thing that we should be looking at. So you have leaders and governments who send soldiers to do things that are despicable.
Those soldiers return home to their countries.

Speaker 4 They get spat on in the streets.

Speaker 4 The defense company doesn't get spat on. The people who lied about weapons of mass destruction, they don't get spat on.
Do you know what I mean? And the same thing happens here.

Speaker 4 People go, my doctor is trash.

Speaker 4 But it's when you delve into it that you go like, oh man, my doctor's victimized by the same system.

Speaker 1 The doctor is called a provider now or even a vendor. I mean, you know,

Speaker 1 he or she is a cog in a wheel. And again, certain things, maybe, maybe burritos should be made that way.
I'm game for that.

Speaker 1 But healthcare, there are other things. I mean, you know, are we good with private prison systems? Are we good with private warfighting?

Speaker 1 Are we good with, you know, there are certain things that should not be primarily profit-facing? Yeah. And healthcare is one of them.
But there are a lot of others.

Speaker 1 And we just, in America, we've lost that discourse.

Speaker 4 Aaron Powell, Jr.: When you look at other countries, what did you find? Because I think there's a perspective that you bring in this book and in your work that I think is really important.

Speaker 4 Because oftentimes people will go, well, I mean, show me a better way to do it. And you're like, oh, yeah, I can.

Speaker 1 And you actually go to other countries and you show a better way.

Speaker 4 But talk us through some of that because, like, Australia, Japan, like a wealth of other wealthy countries show that this is not the normal way that it needs to be.

Speaker 1 No, precisely. I mean, we've gotten so caught up in American exceptionalism that we lose sight of the fact that there are a lot of places

Speaker 1 where things in general and healthcare in particular are done a lot better. And the example and the most brutal example is: how long do patients on dialysis survive in the U.S.
versus other countries?

Speaker 1 What are the stats? They die two to three times faster than any other developed world, and many lesser developed countries as well.

Speaker 1 I mean, you know, we're talking 20% to 22% per year death rate, whereas mortality in Europe is anywhere 12 to 15 percent percent

Speaker 1 and more on the 12 side, Japan 6%.

Speaker 1 I mean, we're talking the most,

Speaker 1 and that's just how soon do you die. Quality of life is another big issue.
But I mean, the central premise that everything has to be for profit

Speaker 1 is preposterous because every other country in the world does it better, does it cheaper?

Speaker 1 I mean, the basic promise of the Reaganomics era and ever since is we will do it better because government's the problem, and we will do it cheaper because we are so efficient. Now,

Speaker 1 in America, we do it worse and we do it vastly more expensively at the same time. So something's rotten in the state of Denmark.
Not Denmark.

Speaker 1 We know what it is. Yeah, I know exactly what's going on.

Speaker 1 So in most countries,

Speaker 1 you have the Fisk, you have the Treasury that collects... taxpayer dollars, and you have, I don't know, patients in hospitals where patients go.
And the money goes from the treasury

Speaker 1 to the hospitals, pays the doctors, pays the staff, and pays for the treatments. In America, you have the treasury and you have the hospitals or the dialysis facilities in this case.

Speaker 1 In the middle, you have these twin towers

Speaker 1 of massive corporate

Speaker 1 absorption. You talk about

Speaker 1 middleman and the cost to healthcare. This is a classic example.
You have these two twin towers that are that are soaking up a lot of the billions and billions. And we're talking roughly.

Speaker 4 I wouldn't do twin towers in the hands like that. It might be the, it looks like the wrong thing.

Speaker 1 Yeah, yeah, you went twin towers and you used hands, and I was like, it's just a little bit of a hand.

Speaker 1 Tom, Tom, Tom, Tom, wrong hands. Let's fight.

Speaker 4 Different analogy.

Speaker 1 Different analogy.

Speaker 4 Let's go with something.

Speaker 1 Two large. Yeah, two large.

Speaker 4 You know what?

Speaker 1 Sinkholes.

Speaker 4 Sinkholes. That's better.

Speaker 1 Two sinkholes. And all the money goes in.
And sucking everything in. That's way better.
Looks nice. Nothing went towers, and then your hands did this.
That's nice.

Speaker 4 And yo, man, we from another country.

Speaker 1 Tom, don't be doing that to us. Yeah, yeah.

Speaker 1 Look at the calendar, man. Look at the calendar.
That was yesterday. Yeah.

Speaker 1 No, no, you're absolutely right. These are the twin sinkholes

Speaker 1 of money absorption. And the money goes into the sinkhole and not so much comes out.
And this is, again, this is not unique to dialysis. It's particularly...

Speaker 1 in my view, obscene in dialysis. But it happens, you know, what is United Healthcare's model? It's to take as much money as they can and give as little as they can away.
That's it.

Speaker 1 And the rest goes into the sinkhole.

Speaker 4 I feel like it's the Rosetta Stone of healthcare.

Speaker 4 That's what you've shown us with the dialysis model: you've gone, let me show you this example, show it to you so clearly that you can then understand every different language of what's going wrong in American healthcare and how to actually look at it.

Speaker 4 You know what I mean? And when you look at these other countries, what would you say is the biggest thing, like just on one level, that they're doing differently?

Speaker 4 I mean, I can understand the government is paying and, you know, it's a different, but what would you say is like something that they're practically doing differently than in the U.S.

Speaker 1 Well, they're following universally accepted medical guidelines, which have to do with how long, how gently you treat, at what values you treat. Do you do it at home or not?

Speaker 1 I mean, if you look at Australia, the majority of, they push patients to home dialysis. Wow.

Speaker 1 And ever since the 1960s, ever since this miracle cure was invented, the people who are not trying to make money off of it said, home dialysis is the way to go. You get to control your destiny.

Speaker 1 You get a feeling of, I mean, in any chronic disease, a sense of agency is critical to getting well or to feeling better, right? And being a passive recipient of care. Lie down, put your arm out.

Speaker 1 I'm going to take your blood. I've heard this, I've heard patients tell me this from, you know, in dialysis facilities.

Speaker 1 You need to have control of your destiny, and doing that at home is the way to do it. Also, again, you can tailor your care to, and it's doable.
So Australia pushes people home.

Speaker 1 But just to faith, that is another of the fundamental, widely, universally accepted accepted laws of dialysis. It's being broken in the United States.

Speaker 1 It's being broken because it's, you know, there are companies that make a lot more money doing it elsewhere, but it's also being broken because CMS, well, the

Speaker 1 Health and Human Services, doesn't enforce best practices on their, you know,

Speaker 1 I beat up in my book, I beat up a lot on corporations, I think they deserve it, but I didn't give sufficient time to the silent partner in the crime, and that is the CMS, That is the National Health Administration in America that is simply in bed with or complicit with or toothless to do anything about major corporate wrongdoing.

Speaker 4 What is CMS?

Speaker 1 It's the Center for Medicare and Medicaid Services. Okay, the ones that administer Medicare and Medicaid funds.
And they know what good dialysis is. They know what the metrics are.

Speaker 1 They're just not counting them. So they don't count treatment time.

Speaker 1 They don't penalize people who don't treat longer.

Speaker 1 They don't count UFR or ultrafiltration rate, which is the speed with which you remove liquid from someone's blood and their body, which are critical to survival.

Speaker 1 They don't count those things.

Speaker 1 What are you counting exactly? They don't count septicemia, which is one of the major causes of death.

Speaker 1 If you're not counting that shit, what are you counting? I mean, you know, it's putting the ladder up against the wrong wall.

Speaker 4 Yeah, but the question is, who's telling them what to count and how to count?

Speaker 1 I guarantee you the answer is the revolving door. I mean, in my book,

Speaker 1 I cite several examples of people from the White House who have gone to the board of the big pharma companies. Yeah, man.
Same thing. Indians' companies.
And vice versa. People

Speaker 1 from

Speaker 1 the boardrooms of the big... healthcare companies who go straight into government and are making these policies.
And I cite examples of ways in which the policies got softer when these people arrived.

Speaker 1 I wonder why that is.

Speaker 1 And again, it's the notion that a corporation is going to do it better because we have been penetrated and taken over by this mentality to this point where we don't even recognize that there is common good anymore.

Speaker 1 It's just, let's grab as much as you can before, you know, while it's your turn to eat.

Speaker 4 You know why they've done a great job of tricking us. You know?

Speaker 4 It's one of the greatest scams that has ever been pulled on people collectively. What they did was governments were providing a good.

Speaker 4 It doesn't mean that they were perfect, but the good was being provided by the governments. In this case, it's the 1970s when Medicare says they're going to cover dialysis.
This is revolutionary.

Speaker 4 You have this problem with your kidneys. They're going to come in.
The machine will be there. The government is going to help you out.
And because you can amortize the cost across a population,

Speaker 1 it will work. It will work.

Speaker 4 And then very quickly, companies who see a gap go, wait, wait, wait. If the government's paying for it, we can get that money.

Speaker 4 And then they go, if we can get that money, how do we get more of that money? And then they become part of the cycle.

Speaker 4 It's so crazy how you see this in every country, whether it's the UK, whether it's South Africa, whether it's the United States, wherever you're having these issues.

Speaker 4 The people who work in government work with the companies to make the government look inept.

Speaker 4 The people on the ground then go, the government is terrible. We should give this to the private companies.
The private companies then take the work.

Speaker 4 And then they provide a professional ineptness that not only doesn't do the job as well, but it extracts more wealth. So it's like before the government was going to be maybe not great,

Speaker 4 but they weren't going to be as expensive. And now you're getting a shit thing for an expensive price.

Speaker 4 But you then hate the government. You go, the government doesn't do anything.
It's like, yeah. And the companies that made that happen are the reason you keep coming.

Speaker 1 It's such a pernicious cycle. It's a big con job.
And exactly. And the government does become people in America, oh, big government.
It's really bad. I mean, you look at the Pentagon, trillion-dollar,

Speaker 1 and that is a bunch of sock puppets. I mean, they have Lockheed Martin up their butt with their hands going like this.
Right.

Speaker 1 I mean, and you see the revolving door between the generals who go onto Lockheed's board and I'm just speaking, Lockheed, even Raytheon, you name it, they've got it.

Speaker 1 The whole outsourcing government contracting thing is such a scam.

Speaker 1 Because it really corporatizes and at the same time is able, as you say, to push the blame onto government, big government, which never gets it right. And talk about socialism.

Speaker 1 I mean, if you look at warfighting in America, a trillion dollars a year to the Pentagon. Trillion dollars a year.
Trillion.

Speaker 1 Yeah, that's socialism, right? Oh, no, no, it can't be because it's America. Sorry.
My bad. Yeah.
And because it's war.

Speaker 1 It's because it's war.

Speaker 4 It's like, it's amazing how war. Yeah, war is always the thing where people are like, the government shouldn't be smaller there.

Speaker 1 You're like, why shouldn't the government be smaller there? We cut everything else, but 10% raise for the government.

Speaker 4 You know, they're like, smaller governments. And he's like, except for war.

Speaker 1 Oh, well, war. I mean, no, well, that's not.
And how successful have our wars been recently at producing security and national defense

Speaker 4 not so much actually you know if you think about it more importantly but i don't want to think about it sorry i want to more importantly this is the question i often ask people is i go

Speaker 4 you are so comfortable accepting the premise that america's job is to go out and fight wars why to protect americans that's offering that's what you say right we are willing to spend trillions of dollars to go out into the world to protect America.

Speaker 4 Why wouldn't you spend trillions inside the country to protect America?

Speaker 4 If Americans are dying from kidneys, dialysis machines that are too expensive, healthcare that's not being provided, you know, food on a basic level,

Speaker 4 that's a war that you could be fighting in your country without bombing anybody.

Speaker 1 And that's exactly the reason in the 1970s, a number of people, this is during the, you know, the Cold War, the coldest part of the Cold War, and the fight against Russia and everything else.

Speaker 1 And yet, at the same time, bipartisan congressional figures, Republicans and Democrats, are saying, We're spending billions.

Speaker 1 Back when a billion was a big number, billions to build these rockets, and we can't even take care of our own citizens.

Speaker 1 And they were pushing for dialysis in that way.

Speaker 1 And the other thing about war is, of course, and the trillion-dollar Pentagon, is that, you know, as one former general told me, when you get to be a big hammer, everything starts looking like a nail.

Speaker 1 Yeah. I mean, we got to go out there.
And I built all this kill. Cool.
You've got to find a way to use it. Highly trained in doing this stuff.
We've got to find a way to use it.

Speaker 6 And we have to get rid of it. Yeah.
Because we have to make more.

Speaker 1 Oh, you're not wrong. That's our inventory.
That's right. You're not wrong.
That's right. There's this new stuff coming on.
And some of it gets lost in these smaller third world countries.

Speaker 1 Oh, don't even get me started on that.

Speaker 6 It's almost like what you guys are explaining to me. It's almost like a shepherd that is not tending to the flock, but is out there hunting for wolves.

Speaker 1 That's a perfect analogy, actually.

Speaker 1 Yeah. That's a perfect analogy.
Yeah. The wolves are taking over in the shepherd's room.
Like, wolves are cooking dinner,

Speaker 1 having lounge.

Speaker 1 Okay, there, you can step.

Speaker 1 You know, you can take this, sit this one out. We'll take care of it.
You want to do something about that wolf? Whoa, whoa, whoa.

Speaker 4 Wolves have their rights too. You know, these poor, you do you know how the wolf feels about the sheep? You're the shepherd, though.

Speaker 1 Oh, yeah, yeah, yeah. But I mean, having a good time.
Come on.

Speaker 1 You know, that's that's you. You know,

Speaker 4 when you think of it, like, Alex, man, it's scary because you see this moving into everything. Yeah.

Speaker 4 People wonder why things are getting shittier and shittier in everything.

Speaker 1 Yeah.

Speaker 4 And when I looked at this dialysis story, I couldn't help but think of the analogy of it's almost what these healthcare companies did

Speaker 4 would be the equivalent of car companies realizing the value of a seat belt

Speaker 4 and then going, we're going to charge you every time you need to put it on. And now you have to gamble with your life and go,

Speaker 4 do I?

Speaker 4 Can I afford it? Can I not afford it? But you shouldn't, this shouldn't be a choice. We know that you need the seatbelt.
Put it on. And I was like, ah, but can I?

Speaker 4 And they're like, oh, do you want to play with your life? And they know, because to your point, it's a duopoly. It's what? Two companies.
Is it still two companies?

Speaker 1 The two major companies own and control 80% of the market.

Speaker 4 Yeah, but I mean, that's a duopoly. That's that you control everything.
No one can push you around. And then...

Speaker 4 And because it's your life, that's the craziest thing.

Speaker 6 I think corporations realize one thing. The minute a society, we said there are no holy cows or sacred cows, they thought to themselves, we will leave no sacred spaces.

Speaker 6 They've moved into an organized sport.

Speaker 4 Yeah, you're not wrong.

Speaker 6 Yeah, you're buying the soccer jersey. Yeah.
You're coming to the matches. Yeah, that's right.
They're paying your hero. They're controlling their life.

Speaker 6 Religion, they've made them miserable.

Speaker 1 So they've made us all complicit.

Speaker 6 And I worry a lot.

Speaker 6 Whenever I watch big organized sports, I'm like,

Speaker 6 The fact that people who love that sport assume that 90% of it is natural talent always amazes me.

Speaker 6 It's like when people have that debate thinking before steroids were illegal in sport, how great was sport?

Speaker 1 And I'm like, no, no.

Speaker 6 Before corporations were involved in sports, how fair was sport?

Speaker 1 Right, exactly. And the money aspect, again, you see sports betting now.
And to me, that is another thing where don't you think that's like the stock market versus the real economy.

Speaker 1 I mean, when you're putting a bet on something, you debase it inherently. And your focus, again, turns from the activity on the field to

Speaker 1 outcome. And you can have derivatives that are bets on bets.
And this is all stock market stuff.

Speaker 1 This is the way in which you think if you're not really engaging with the real world, and not only is it not helpful to what's going on in the field or what you're eating or what your healthcare, it's diametrically opposed.

Speaker 1 If you focus all your energies on making it into a money-making operation and betting on it, you're actually taking the energy away and the resources and

Speaker 1 the intelligent people and all the things who should be saying, How do we make a better dialysis machine? There hasn't been a better dialysis freaking machine in 40 years. No,

Speaker 1 Tom. Oh, no.
Absolutely. There have been tiny little adjustments there, but there's been no phase shift, major breakthrough.
Why is that? Because there's no freaking money in it.

Speaker 1 These two corporations, big corporations, before them, there were others,

Speaker 1 have locked in the market. They have their cash cow and they are milking it relentlessly.
They're not interested in a new milking machine.

Speaker 1 They're not interested in the cow. Yeah.

Speaker 6 You know what I've realized as well with the, I don't know how it is in this country, but in South Africa, when you get live cover now, you're not obligated to take an HIV test.

Speaker 6 Where else before, you were obligated to take an HIV test if they're going to ensure you for a certain amount of money.

Speaker 6 So you'd have to test or they have to know what your lifespan is, what your CD4 cell count is. But right now, they're like, no, just bring it and then we'll see when we get there.

Speaker 6 So I'm like, was HIV always that dangerous to the body and your longevity? Or they found a way to not profit from you having HIV anymore.

Speaker 4 Do you know what I'm saying? I wonder which one it'll be though.

Speaker 6 Because remember that before there was no home testing.

Speaker 1 Yeah, yeah, yeah. So they would have to send you to a facility.

Speaker 6 Yeah. Then you'd be.

Speaker 4 But I'm saying, I wonder which one it is. Because my brain goes, which one is it? Have they found a way to de-risk it? Or have they found a loophole on the other side?

Speaker 4 I'm saying I don't know which one it is. It's just interesting when I hear that.
I go like, huh, I wonder what changed. Do you know what I'm saying? Yeah, yeah.

Speaker 4 Like, like, what switches in a system that changes something? How do we look at it differently?

Speaker 4 I even think of, man, that, can I tell you, there are parts of your book where I was just like, I have to just meet this person.

Speaker 4 Because, no, there's books and there's thinkers that you encounter in life where you go who is this person and how are they so magical in the way they approach things

Speaker 1 or crazy

Speaker 1 no but crazy in a good way he takes naps yeah we teach at noon

Speaker 1 he's a noon

Speaker 4 but like there's there's a part of the book where man i was i was so impressed and like just like taken by how you stitched together even civil rights in in American healthcare and the way we think about how it's doled out to not doled out.

Speaker 4 Because you see, again, I didn't know and I would have never known how you can trace dialysis and Medicare and who gets treatment and who doesn't get treatment

Speaker 4 back to segregation and desegregation in the United States. No, literally, I mean, talk a little bit about that because that blew my mind.
I was just like, oh man,

Speaker 4 we really have to think holistically. And sometimes I don't think our brains are big enough.

Speaker 1 No, I, yeah, one of the most shocking things in my research for this book was the way in which dialysis

Speaker 1 impacts disproportionately black and brown communities.

Speaker 1 If you're black in America, you're 13% of the population, but you're 35% of the

Speaker 1 end-stage renal disease or kidney failure population. You're four times more likely to get dialysis than if you're white.

Speaker 1 And it's this death by zip code redlining, you know, that I've gradually begun to see. I mean, dialysis is a perfect map for it, but there are many other diseases.
You know, the incidence of

Speaker 1 hypertension, diabetes,

Speaker 1 and obesity, the way in which these communities,

Speaker 1 historically, the wrong side of the tracks, and I mean, I literally,

Speaker 1 I'm working in South Chicago

Speaker 1 where there's a disparity in life, in longevity between North and South Chicago of 30.1 years.

Speaker 6 In the same city.

Speaker 1 30 years in the same city. 30 years.
If you're in North Chicago, the wealthy areas, you live 30 years longer, 30.1 years longer than in South Chicago. That's insane.
It is insane.

Speaker 1 It is utterly, utterly unacceptable. And it has been going on.
I mean, as one,

Speaker 1 Majelle Nehanford, one of my great

Speaker 1 dialysis nurses, who was formerly an LAPD officer, as he said, it's got Jim Crow written all over it.

Speaker 1 This is absolutely, if you look at the maps of the impact of dialysis on communities, and that's kind of what I'm doing now. This book, I couldn't walk away from the book.

Speaker 1 Usually,

Speaker 1 with books,

Speaker 1 you know, I write it, I care about it. But six months before it comes out, I'm thinking, what's next? I don't have any next.
This is next.

Speaker 1 So I've gotten together with folks

Speaker 1 at the new school, the Institute for Race, Power, and Political Economy. And we're doing some research on these areas in Chicago, South South Chicago, and East LA,

Speaker 1 Boyle Heights, where the impact of dialysis is disproportionate. Trying to understand not just on individuals what bad dialysis does, but what does it do to a community?

Speaker 1 How do they start to see dialysis as sort of a part of their life's arc? You'll end up in the chair. Grand did, my uncle did, my kids are coming with me now to my treatments.
They'll probably end up.

Speaker 1 I mean, it's just, that's nightmarish.

Speaker 1 And especially when there are solutions that are in hand, that that are in you know again every other country does it better but there are very straightforward solutions to prevent this from happening in the first place so come back to your question i mean the it is absolutely dialysis in america is absolutely perfect um radiograph ct scan of what's wrong with racialized structural racism in america it is it is the poster child of what can go wrong

Speaker 1 And it is, for me, it's been quite a, I mean, a kind of a rediscovery of what America is. I'm going to places I haven't spent a lot of time in.
I can imagine.

Speaker 1 And I understand what the wrong side of the tracks means now. I mean, in Chicago, you literally walk underneath the tracks and you're in a different world.

Speaker 1 Everyone's a different color. I mean, you literally in the space of, it's the most segregated city in the country, but many, many, many areas are like that.
And

Speaker 1 it's an, yeah, I'm rediscovering my homeland in a way that is deeply, deeply disturbing.

Speaker 6 We had an episode where we spoke to

Speaker 6 one of the most interesting people we've spoken to in South Africa Dan, and we spoke about the remnants of apartheid and what people who say it's been 30 years, it's time to move on now.

Speaker 6 And I said, what the genius of that system was was to ensure that the longevity or the quality of life of a black person for generations will not be the same as the life quality of a white person.

Speaker 6 And I said, here's a typical example.

Speaker 6 Malnutrition within the black community is such a, you might have groceries in your cupboard but are they keeping you healthy yeah that is the question and what i did one day with a friend of mine is we drove to two schools we drove to a very private school wealthy black and white children then we went to a township school with only black children and we took a photo

Speaker 6 right that we just said you take this photo take this photo and we compared the photos at the end of the day and we saw the sizes of the kids yeah

Speaker 6 that's hard and they were not even 40 minutes apart from each other. Right.

Speaker 6 What they ate, what they did, you even see it when they do, they've even stopped doing it now in South Africa, where they do inter-schools.

Speaker 6 They never mix now schools that are doing well with schools that are not doing so well and doing sport because it becomes so glaringly obvious that there's size differences, that there's nutrition differences, and also there's concentration differences.

Speaker 6 I mean, the cues that will come up, I was, when I was growing up, they took us into this rugby clinic at one of the bigger stadiums. It was

Speaker 6 a program by the rugby club. The one thing that happened when all the township buses landed at the stadium or arrived at the stadium is all the township kids went to go queue for food.

Speaker 4 That's the first thing they did.

Speaker 6 First thing we did. Not they.
I was part of the kids that were in the bus from the township school. That was one of the first things that we did.
It was we left where we were.

Speaker 6 And the first thing we were like, we're going to eat something because clearly it's not going to be where we come from. And I'm thinking to myself.

Speaker 1 And malnutrition as a government, as a

Speaker 1 government agenda, as a weapon, yeah.

Speaker 6 Of oppression, and no, no one ever talks about that.

Speaker 6 And I always think whenever big companies expand and whenever corruption is going to take place, you can always see by how much hope they give to people about how many of them they'll employ.

Speaker 6 Yeah, yeah, that's right.

Speaker 4 They love that. Yeah.

Speaker 4 Bringing this many jobs, bringing, oh, they love that.

Speaker 1 The mining companies do. Yeah, yeah, they love that.
Yeah. Aren't they great?

Speaker 4 Oh, no, they love that. Yes.
Yes.

Speaker 6 In South Africa now, they're trying to clamp down on illegal mining, but they've discovered that the billions of rands in illegal gold lands in the mainstream.

Speaker 4 Yeah, because the gold needs to be sold into a market that is formalized. So at the end of the day, it all comes back.

Speaker 1 Back to the enablers. Yeah,

Speaker 4 it all comes back in a loop. And that's why, and I'm glad you really give them the credit they deserve.

Speaker 4 That's why whistleblowers are so important.

Speaker 4 Like you, I mean, I know you've got a whole book on it, but without these people, you just don't know.

Speaker 1 No, exactly.

Speaker 4 You literally just don't know.

Speaker 4 Without a whistleblower in FIFA, without a whistleblower in the banking system, without a whistleblower in the healthcare industry, without a whistleblower in the defense contractors, without a whistleblower, you just wouldn't know.

Speaker 1 And it's fascinating to see the organizational reaction to a whistleblower. Oh, hell yeah.
It's like this immune response. The T cells go out there.

Speaker 1 I mean, people lose their minds. They're so angry and so

Speaker 1 frightened because at the end of the day, what you said is exactly right, that those whistleblowers really do have the kryptonite.

Speaker 1 The question is whether they'll be able to give the kryptonite to someone who can use it before they are rubbed out, literally or figuratively. Yeah.

Speaker 1 And but it is a really interesting thing to see this sort of organizational people, just perfectly sane professional people go completely off the rocker when a whistleblower stands up in their

Speaker 6 but the six you you are making me realize there's so much power in words and phrasing. You started with a with white-collar crime and now you're even speaking about whistleblowers.

Speaker 6 When it's corporate, it's whistleblowing.

Speaker 1 Yeah.

Speaker 6 when it's violent crimes, it's a witness.

Speaker 6 No, besides, it's not a witness, it's an informant.

Speaker 6 The person is bringing information.

Speaker 1 That's what it leads to something.

Speaker 6 But when I'm telling the truth about how many people are losing lives and how much money,

Speaker 6 what are you doing? Why are you blowing that?

Speaker 1 Who still blows a whistle? But the information is timeless.

Speaker 6 But whistleblowing also makes it feel like you shouldn't be doing it.

Speaker 4 It has an annoying connotation to it.

Speaker 1 Where do you find the one from? You had to have it found. There's a whistleblower.
You're a snitch. Yes, it's got a snitchy vibe.

Speaker 6 And there's always in whistleblowing, there's never plurality.

Speaker 1 No, no, no. That's right.
The individual.

Speaker 1 Oh, yes.

Speaker 6 It's always this shunt person who will generate as much noise as possible.

Speaker 4 Edward Snowden.

Speaker 1 Yes.

Speaker 6 But if you get rid of them, you almost feel like you've gotten rid of the problem. Yeah.

Speaker 1 Right? Exactly.

Speaker 1 That's exactly it. If you can't deal with a message, kill a messenger.

Speaker 1 I mean, that is literally the way in which you, the reason why there's scorched earth approach to whistleblowing is literally they can't deal with a message.

Speaker 1 Quite often, you know, a corporate informer will say that there's a trillion dollars in fraud here, or they've been dumping arsenic into the water, or they're Bhopal, or whatever.

Speaker 1 And so you can't actually say, oh, actually, not so much, or not too many people died.

Speaker 1 You go after the messenger, you totally destroy their credibility, you destroy them financially, you destroy their home life, you destabilize them psychologically.

Speaker 1 And all of a sudden, there's kind of a quirk or a disgruntled person. You can dismiss them.

Speaker 1 So that's the way you can't, when you can't actually face the facts and say, actually, no, he's wrong on this and this and this point, and we can prove it.

Speaker 1 Because you can't, because the person is right, the whistleblower is right. You just destroy their credibility and it goes away.

Speaker 1 And say, oh, you know, a disgruntled employee, you know, someone who's deeply or just psychologically not stable.

Speaker 4 Yeah, but what they don't realize is.

Speaker 4 They can only kill the messengers for so long. And then at some point, as we saw with Luigi Mangione, society turns around and goes, all right, I guess I'm also going to make my own rules.

Speaker 4 I'm not saying Luigi did or didn't do it, disclaimer. I'm just saying, like we saw in that trial, in that case,

Speaker 4 someone said,

Speaker 4 you know what? I don't agree with this. And I realize that I cannot beat you in the game because you have created the rules.
Precisely. So I will then play my game by a different set of rules.

Speaker 4 Precisely. And, you know, one of the reasons I think it's so important,

Speaker 4 we have these conversations. I try and talk to as many great authors as possible, particularly people who have done like all the real research.

Speaker 4 I always say this to Eugene: one of the things that I hate the most is how people will say something. They'll go, like, I'm going to do my own research.
And I'm like, no, you're not.

Speaker 1 You're not going to do your own research.

Speaker 4 You are going to go read an article that either affirms what you think.

Speaker 4 Yeah, you're going to go read someone's, you're not going to go do the research.

Speaker 1 And yes, you can argue on a semantic level.

Speaker 4 Yeah, on a semantic level, you can be like, but that is research. No, no, no, no, no.

Speaker 1 It's a cumulative effort.

Speaker 4 Yeah, I like to read the work of people who have done the work. Do you get what I'm saying? And that is how we should acquire knowledge in life.

Speaker 4 I don't think every one of us should go and test the principles of Newton to actually apply them in our lives. We can apply.

Speaker 1 I'm not going to run those

Speaker 1 process. Exactly.
You know what I mean?

Speaker 4 But

Speaker 4 when I look at that situation. where the United Healthcare CEO shot.
And then even that story that was like a weird one. You know, the gunmen in Manhattan went into that tower

Speaker 4 and then shot. And and then they said like they said they they were there to shoot the NFL person

Speaker 4 but then they shot uh a person who was in um I think they were a CEO or they they headed up a division that was specifically tasked with housing oh but I remember

Speaker 4 and everyone was like oh wait wait wait this is weird you're saying they went there to shoot someone in the NFL yes but they shot somebody who a lot of people don't like yes did they shoot anyone else not really

Speaker 1 and you sure they were going for that coincidence yeah and you're like wait

Speaker 4 and and

Speaker 4 what I found most interesting,

Speaker 4 just after the Luigi Mangioni story, what I found most interesting, and I'm not naive about this, is how the news and how these healthcare CEOs and all CEOs and jail came out on TV and they're like, why would people be celebrating this?

Speaker 1 Why, why? Then I was like, wait, wait.

Speaker 4 I'm not condoning any of this. Yeah.
But you're shocked.

Speaker 4 You really don't know why. People are cheering for this.
You're really going to act like you don't know why people are cheering for this. Exactly.

Speaker 4 But the reason I think we need to keep having these conversations, I'll talk to an author who's written a book 10 years ago, 20 years ago, like Robert Putnam. We had, I was like, because

Speaker 4 the thing about the book is it expands, it dives deep, it gives you concrete understandings of what the situation is. It's not glamorous.
It's not glossy. It's not quick.
It's not snappy.

Speaker 4 It doesn't catch you really quickly. But when you're done reading it, you really, really, really understand.

Speaker 4 And I wonder if it's a little frustrating for you. You go into this process, you write this whole book, you do this whole thing.
You see a moment like Luigi Mangione.

Speaker 4 Everyone was in on, like, everyone's like, healthcare, let me tell you what's wrong with them. And let me tell you, and then Sheen was selling t-shirts of Luigi Mangioni's face.

Speaker 4 And then there's like a movie. Emma Stone's going to be doing a movie about Luigi Mangione.
And then it just trickles out. And then you just see new headlines:

Speaker 4 United Healthcare buying this, United Healthcare announcing that, cutting these jobs, expanding on this, merging with that. And you go, huh?

Speaker 4 It's like people enjoy the flash of the moment, but not what the moment actually meant. Like, how do you keep yourself going?

Speaker 4 I'm assuming you might be, but maybe I'm wrong.

Speaker 1 No, no, it's deeply frustrating. And to see something with a sort of a lot of PR potential

Speaker 1 and an opportunity, a crisis gone wasted because you haven't changed the structure.

Speaker 1 You haven't basically asked the fundamental question, number one, are you really serious that you don't understand the outrage and the anger and the sense of

Speaker 1 powerlessness?

Speaker 1 And number two, are we really going to make sure that something called united healthcare is primarily focused on health and not primarily focused on their

Speaker 1 share price? We haven't done anything about that. We haven't gone upstream and said, is capitalism indeed the best way to organize our society?

Speaker 1 Or better, is profit motive the only way we should be focusing on our healthcare industry? Is it really an industry? You know, these are bigger questions that never get raised.

Speaker 1 And I had my own sort of Luigi Mangione moment. I was corresponding with,

Speaker 1 since my book came out, I have had countless contacts from people in the industry. And one of them was a young nephrologist, Dr.
Andrea Bua.

Speaker 1 who

Speaker 1 is and was very, very frustrated about

Speaker 1 the misuse of dialysis by certain nephrologists that he named.

Speaker 1 And he sent me a lot of data.

Speaker 1 He showed me, he has a website, as a matter of fact, kidneykiller.com,

Speaker 1 which alleges the use of certain drugs to knock out people's kidneys so they will be on dialysis sooner, all sorts of stuff like that. And he wrote, we corresponded for three months

Speaker 1 until January of this year. And then three days after his last email, which were data-filled, really thoughtful, he gets in a car, he drives from Miami to Terre Hood, Indiana, he attempts to,

Speaker 1 allegedly, attempts to murder one of the nephrologists

Speaker 1 that he had mentioned in his emails and were and was mentioned in other lawsuits. Now, I, of course, when I heard this, I was horrified.

Speaker 1 And I went through those emails a million times saying, what could I have seen this coming?

Speaker 1 They were the absolute picture of data-driven, thoughtful, measured.

Speaker 1 But at the very end of one of the last ones, he said, I just can't see a way to make this stop. I can't find a way to make change.
And, you know, it's a horrifying thing to

Speaker 1 be in the middle of it. But I think that sense, as you said, Trevor, of pointlessness, of sense of hopelessness and of powerlessness to stop

Speaker 1 and just the just the obscenity of a situation of the Luigi Mangione situation where you have one person who apparently allegedly murdered another. Luigi murdered Brian Thompson.

Speaker 1 But you have Brian Thompson who has been making

Speaker 1 a very successful career on,

Speaker 1 in part, denying care to people who claim they're whose doctors claim they need it.

Speaker 1 Now, I don't know about you, but until we can talk about that second group of people making an enormous amount making a killing, as I say,

Speaker 1 on denying care as a form of taking people's people's lives. If we can't say it out loud,

Speaker 1 we're not going to get anywhere.

Speaker 1 We're not going to ever get anywhere. And if we can't say it out loud that making money doing that makes it worse,

Speaker 1 we're really not going to get anywhere. And money may not be the root of all evil, the love of money, but it's a pretty good proxy until you find it.

Speaker 1 And we really need to get off the money drug, somehow, find a way to reorganize our view of how life should be led so that money isn't the number one thing.

Speaker 1 And those folks can't come on and say, oh, I'm shocked, shocked. I can never condone violent acts against, but yes, well, you have two people.

Speaker 1 And how many, again, how many people has the major healthcare

Speaker 1 CEO accounted for in his long career?

Speaker 4 Yeah, but it's that old line, right?

Speaker 4 If you owe the bank $1,000, it's your problem. If you owe the bank a billion dollars, it's the bank's problem.

Speaker 1 If you do something on a big enough scale, I was thinking voltaire the you know murder to the sound of trumpets by the thousands is called is good yeah one murder is not unacceptable yeah there's a there's a weird thing that happens in society where if you get the scale great enough yeah it's somehow not seen as the same issue multiplied when when in fact it is

Speaker 4 stalin's a one murder is a tragedy a million is a statistic yes exactly but that's that's exactly what it is and and and to your point accountability is also doled out differently yeah right because if luigi mangioni color yeah there it is if luigi mangion is found guilty he's gone gone for gone for gone like life death what like gone gone right

Speaker 4 not if when healthcare ceos and their companies are found guilty there's no life sentence you're ready to check there's no death sentence no there's barely even a financial sentence right

Speaker 4 the last i checked the sackler family who are responsible for more deaths in the U.S. than most criminal organizations.

Speaker 1 Than all criminal organizations.

Speaker 4 They're still out there. Think about how many families have lost a father, a mother, a brother, a sister, a child because of opioids that they were told were there to help them.

Speaker 4 Those people became addicted, died from pain, whatever, you name it.

Speaker 4 The Sackler family, they didn't even lose all their wealth. Like, just think of this for a moment.
Even if you said to me, okay, they're at zero. We took away everything.

Speaker 4 I know they're not in jail, but they're at zero. I'd go, it's still not fair, but they didn't even take all their wealth.
The people could still fly away in a helicopter.

Speaker 4 Like, my brain, do you know what I mean? It's like, wait, wait. Then are we living in a just society?

Speaker 4 And that's the thing that I think people at these levels either don't understand or either act like they don't understand.

Speaker 4 If a justice system is not just,

Speaker 4 then people stop believing in the system. Yeah.
Yeah.

Speaker 1 And we're seeing that more and more. I mean, the violent acts are because the safety valve is clogged and we're blowing.
You're like,

Speaker 4 why would you not see this? Do you not see that this is going to blow back on you?

Speaker 4 We're going to continue this conversation right after this short break.

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Speaker 6 I think what's going on in the world, you're absolutely making so much sense. What's going on in the world is what usually happens in the classic mafia movies.

Speaker 6 You know, no one, first part for me is no one ever talks about the marketers. People talk about the great CEO that came from this company that did this to this thing.

Speaker 6 But if you think about it before, when people trusted the government more, they would buy government bonds. And the government would be accountable.

Speaker 6 to the people that bought the bonds because the government would have to pay the bonds back.

Speaker 6 The same people that make the legislation, which is the guardrails, that is supposed to keep people safe, now go into private business.

Speaker 6 They get rid of the guardrails, but they still keep the government bonds system by saying you're selling people shares.

Speaker 6 But the marketers have realized, just like in that scene in The Godfather, where he walks around the square and he bites bites an apple and then later on the nana would come and complain yeah don't call you on it we'll take care of it everyone is wetting their beak yeah yeah if you are betting online if you are buying shares if you are watching the stock price go up if once in a while the thing that astonishes me more in this country is when you watch television these ads about you know you owe this much money if you call this and then this was up and then they always give the stat of how many people haven't versus the how many people should and all of a sudden i look at the drug companies different and go but if they care so so much, they're here buying ads.

Speaker 6 But are they advertising the product? Do they really want you? Which lawyers must you call to do this thing?

Speaker 1 Yeah, it's all, it all comes.

Speaker 6 Yes, everyone's beak is wet. Everyone is eating a little bit here and there with online betting, with buying shares, with working there, knowing someone who is in it.

Speaker 1 And no one's looking after the little guy, us, right? And no one is looking at the Consumer Financial Protection Bureau is

Speaker 1 constantly the target of attacks. It's been dismantled.
No one is out there saying, yeah, but what about, you know, Sally out there? What about Bob?

Speaker 1 I mean, what about, you know, there's no one after them.

Speaker 1 And that's the thing that, I mean, that's kind of what I saw in dialysis, but I see it everywhere is the sense of the most vulnerable people are taking it in the neck.

Speaker 1 And everyone's sort of, oh, well, you know, they're sort of vulnerable. It's maybe it's their fault.
Who knows?

Speaker 6 Blame the victim, yeah.

Speaker 6 Yeah, medical aid companies do that all the time in our countries. They'll co-opt you into going and using their app that monitors how many times you go to the gym, how much healthier you are.

Speaker 6 But I'm like, since when are we being lectured about living our lives when your job is to improve our quality of life?

Speaker 6 So now you've foisted me with the responsibility of not getting sick while I pay you to keep me from getting sick.

Speaker 1 And that's my data, too.

Speaker 6 But that's why I was even saying that I think as society, especially if you have a platform and a megaphone, we must be very careful not to use our privilege as a way to lecture people who are hopeless.

Speaker 1 Right.

Speaker 1 Yeah.

Speaker 1 Right. That's right.
Yeah.

Speaker 1 Yeah. The lecturing part is very

Speaker 1 tricky too when you helicopter into these situations. I'm working in Boyle Heights in Los Angeles, and it's in an area that's 95% Hispanic.
And,

Speaker 1 you know, I can't just sort of helicopter in and say, hey, guys, how's the dialysis working for you? And by the way, there's a way to fix this.

Speaker 1 So

Speaker 1 I hook up with local organizations. Homeboys Industries is the most.
If you haven't been, you got to go. Okay.
The coolest place I have maybe ever been, but it's certainly the most impressive.

Speaker 1 It's a gang rehabilitation organization. It was started in the 80s by Father Gregory Boyle, no relation to the neighborhood.

Speaker 1 But now they have this view of Boyle Heights that is all-inclusive and

Speaker 1 Boyle Heights-centric. Every business has to be in Boyle Heights.
They have urban gardening. They have all kinds of other things.
They have art, but they are.

Speaker 1 actually taking the people who are most at risk. So when I arrived, I mean, the people that everyone else fails to do and won't even take a chance at because their statistics might be skewed.

Speaker 1 When I arrived, I couldn't get anyone on the phone, but I wanted to talk with Father Gregory Boyle and I wanted to talk with, you know, the head of research and so on.

Speaker 1 So I just arrived and sat down and they have a wonderful homegirl cafe. I sat down.

Speaker 1 And I said, I'd love to talk with Father Boyle and Michael Aran and the other people. They said, oh, well, he's very busy today.
And I said, that's okay. I'll stay as long as it's necessary.

Speaker 1 And they said, well, you know, he may be busy all day. Oh, that's okay.
I'll stay today and I'll come back tomorrow and I'll come back the next day. And I went and sat down.

Speaker 1 And I really meant to go on my computer. I was perfectly happy and I wasn't, you know, and I really needed to meet these people.
And about five minutes later, someone

Speaker 1 went back.

Speaker 1 Remember, this is gang rehabilitation. These are some

Speaker 1 people with like tattoos over their faces and stuff. They read you in a heartbeat.
Yep. They can see, they know their territory.
They know who you are.

Speaker 1 And 20 minutes later, a couple guys came and sat down and had lunch, and one of them lifted her shoulder. Oh, that's a kidney guy.
Yeah. And so,

Speaker 1 by the third hour, I had already met with the people I needed to meet with, and

Speaker 1 we are off and running. But that feeling of entering this space where hope is in the air, they have been in a terrible place, and they're still facing incredible difficulties.

Speaker 1 But there is a sense of let's not let the state or the government, the federal government, or the let's do this in a community.

Speaker 1 That's, I think, part of the system that we need to employ to get back on our feet as a country. But, but that place is amazing.
And that's the sort of street-level

Speaker 1 person-to-person information that you really need to make a difference and to understand what dialysis or anything else is doing in a community is.

Speaker 1 find the people who know that community, who grew up there, who are really plugged in. Yeah.

Speaker 4 You know what I realized? Reading your book and then meeting you is you're that person from the movies.

Speaker 4 No, no, you know those movies we used to watch. They don't really make them anymore.
But remember you'd watch these movies. Maybe my problem.

Speaker 4 You'd watch these movies where there'd be like some random person. They'd be in like a suit that doesn't really fit too well.
And they've got their briefcase. Yes.

Speaker 4 And then they go to like an office and they'd be like, excuse me, I would like to meet thee. And they're like, I'm sorry.
He has no appointments. So it's like, okay, I'll just sit here.

Speaker 4 And then it's like, and then like two hours later, like, hey, he's not, he's not coming back. It's like, it's fine.
I'll just sit here. And I remember watching those movies and I'd go,

Speaker 4 there's no one like this.

Speaker 1 Now I've met one. You have a like a...

Speaker 4 It's a dogged and insatiable attitude towards finding the truth, the people,

Speaker 4 the story. It's

Speaker 4 like,

Speaker 4 is it conscience that's pushing you?

Speaker 4 What's motivating you beyond, don't get me wrong, I mean, it is, it is a noble

Speaker 4 cause, but beyond that, like, what, what is, what is making you sit down for that long? What's making you go talk where people don't want want to talk?

Speaker 4 What's making you investigate unbeatable, quote-unquote, corporations?

Speaker 1 Yeah, it's a really good question. And

Speaker 1 part of it is a sense of unfairness. I do have this sort of sense that

Speaker 1 bullies are one of the worst species, and hypocrites are also one of the worst. So you have a bully hypocrite.

Speaker 1 That's the worst of the worst. And I run into that a lot in corporate America.
So also just a sense that we can do better. We have to do better.
We must do better.

Speaker 1 And that it can start with, it needs to start with information, good information. So what is really going on in the dialysis industry.
But it can, it can,

Speaker 1 I think,

Speaker 1 in a pretty short space of time, you can turn something around by taking the small community view and building outwards rather than trying to fix it with a blanket. Everything needs to change.

Speaker 1 And besides which, there is no blanket anymore. So might as well do it in your own backyard because no one's going to be looking out for it.

Speaker 4 Yeah, but you've also done something that's pretty amazing because people would write books. People do,

Speaker 4 you know,

Speaker 4 it's so many stages. First of all, you hope someone will help you make the book.

Speaker 4 You hope somebody will publish it and put it out there. You then hope that people will read it.

Speaker 4 You hope that it'll connect. Yeah.
But the hardest step, after all of those hard steps, is you hope it'll make a difference. Yeah.

Speaker 4 And there's something that happened with your book that is, again, it's like a Hollywood movie that you hope would be written.

Speaker 4 there's a moment where the fda the head of the fda goes i i want to use your book to go after these two sinkhole companies that are you know scamming americans for their health care scamming the government essentially for all of the money that it's trying to provide to help people and i think your book if i remember correctly got cited 21 times and there was a lawsuit what's the latest on that is like

Speaker 4 is is this still moving forward are these companies still being held accountable because your book actually made a change on a level that people didn't think a change could be made.

Speaker 1 Well, it is work in progress. Nothing has been fixed yet.
But I will say that Marty McCary, who before he became FDA head, had read my book, when he became FDA head, he asked me for a memo.

Speaker 1 How do you fix dialysis? Wow. Give it to me.

Speaker 1 And he said

Speaker 1 he's spread it around

Speaker 1 to Dr. Oz and

Speaker 1 to RFK and others at the highest levels. Who knows what's going to come of that, but at least they asked.

Speaker 1 There has been a recent lawsuit that came out in May alleging antitrust violations of all kinds. They did cite my book 21 times and cited people.
I cited another 15.

Speaker 1 And they simply lay out,

Speaker 1 in my view,

Speaker 1 they're all allegations until proven, but in my view, a pretty good case for why you have two huge corporations that control 80% of the market.

Speaker 1 That's harming patients, that's harming workers, and that's harming taxpayers. I think they made a pretty good point.

Speaker 1 So, yeah, I mean, Robert Wood Johnson Foundation is funding some of the work that I'm doing. There is forward motion on this.

Speaker 1 And there is a sense, I think I've received thousands of emails from people inside the industry, whether they're patients or families or whatever. And I would say it's bipartisan.
There is a sense of.

Speaker 1 enough is enough. Some of them are Trumpists.
Some of them are, some of them are voted for Kamala Harris. Some of them are who knows? They didn't vote.
It doesn't matter.

Speaker 1 It's health. It is a fundamental thing that goes beyond politics.

Speaker 4 politics your kidneys don't vote bro

Speaker 1 they don't

Speaker 1 they do not they just and those babies

Speaker 1 i never had such a warm and fuzzy feeling for my kidneys you don't think about your kidneys right

Speaker 1 they are the they are the they are the conductor of the whole orchestra of your body without those kidneys you know people want to talk about renal fortitude they talk about guts and brains and heart but they don't talk about kidney power.

Speaker 1 They should. They should.

Speaker 4 Renal power is one part of you. You know the analogy I used? There was someone I was having this discussion with, like after reading your book, and they said, I don't know.

Speaker 4 I think, you know, the market, this, and the, and I don't think you should get, the government shouldn't get involved in what's happening here. And I think private companies,

Speaker 4 and I was trying to figure this out because I was like, wait, okay, how would I

Speaker 4 explain this? And I was struck. And then, and then it struck me.
I went,

Speaker 4 I would never deny. that there are many private companies that have done an amazing job providing us with products that we love and use.
We're using a bunch of them now, right?

Speaker 4 But But there are certain aspects of life where you have to ask yourself: who should be in charge of this?

Speaker 4 And the reason you need to ask yourself is because of the ramifications on the other side. Yeah.

Speaker 1 Right?

Speaker 4 If a private company is in charge of making these microphones and then they don't make them, I guess we'll talk without microphones. You know what I mean?

Speaker 4 It's inconvenient, but we'll have to find another way.

Speaker 4 If a private company is in charge of your health, which is your life, what are the ramifications on the other side if they screw you over? And then someone will go, oh, but who says government?

Speaker 4 You know, then I'm, again, I come back to this. Remember what a government is supposed to be? It is a collective force of the people.

Speaker 1 Yeah. Common good.
Yeah.

Speaker 4 We've made it seem like it's this foreign entity. No, no, no.
It's our collective force that's acting. It's your friend.
It's almost like having one friend where you go. They go to the bar.

Speaker 4 Hey, what do you guys want for drinks? Yeah, that's government. Yeah.
You go get us drinks. And then you hold them accountable and be like, yo, where's my drink? That's what it's supposed to be.

Speaker 4 But now we've made it seem like your friend at the bar goes to the bar. And then all of a sudden you're like, that bar guy, man, let me tell you about Barry.

Speaker 1 It's took my money. Yeah, it's like, no, no, this isn't.
He took my money.

Speaker 4 Yeah, it's like, took my money. Yeah, yeah.
But was supposed to take your money to buy you the drink that you wanted them to buy.

Speaker 4 And when you think about like healthcare and these types of industries,

Speaker 4 I keep thinking, and this was the analogy I use with this person. I said, so you think it's fine? They're like, yeah, well, they made money.
They found a way to make money on these things.

Speaker 4 I said, okay,

Speaker 4 what if I found a way to make a technology that could suck the oxygen out of the air?

Speaker 4 What if I found a way to do that? And you lived next door to me. If I sucked the oxygen out of the air, you know, there's no law that like stops this right now, right?

Speaker 4 And now I say to you, oh, no, no, no, no, no. Please, I'm not saying you shouldn't breathe.
I'm just saying you should pay me to breathe.

Speaker 1 Would you?

Speaker 4 accept that and would you live in that society? Right now, even someone would be like, that's a crazy, that's a, that's a ridiculous analogy. Is it though?

Speaker 1 AI, what's happening with AI right now? It's sucking the oxygen out of you.

Speaker 4 If somebody has a machine that decides whether you live or die and you have to pay them in order, like a crazy amount of money to stay alive, and then your government doesn't really cover you the way they should because that same company has convinced them to not.

Speaker 4 How is it any different?

Speaker 6 I think you said the keyword, they're convinced. I think

Speaker 6 we have a lot of whistleblowers.

Speaker 6 We have a lot of researchers but i think the fight back from these corporations and these companies and these institutions is how much they invest in marketing yeah they do and the language that they put out there you're not wrong for example i i think even body organs are not given priority based on what the the language the common colloquial language is for that for that organ for example a kidney as essential as it is marketing and language has made it seem like you can do without it.

Speaker 6 And also, marketing has also made it feel like it's something that someone will give begrudgingly if you need to, but they're going to be fine with it.

Speaker 1 There's a kid, get a kidney transpire.

Speaker 1 Get a kid.

Speaker 1 The doctor has not called the kids.

Speaker 6 Kidneologist. Yeah, nephrologist.
That's interesting. There's also this shroud of mystery that's put around things.
And sometimes, if it's not mysterious, it's trivialized.

Speaker 6 So you don't take it as seriously as it should be. You know, the biggest example for me is Department of Defense versus Department of War.

Speaker 6 And I say to people whenever they talk to me about self-defense, I'm like, why don't you maybe go to a self-offense class?

Speaker 1 Yes.

Speaker 6 Because that will help you more.

Speaker 6 Because self-defense means we're blocking, right? Or we're getting away from the thing. So it's the language that people use.

Speaker 6 But I think the fight back right now, after people like you have done the job that they've done, is for marketers to reinvent how people see a subject or how people even speak about a body organ for it to become as prolific as it should be in people's lives.

Speaker 6 And people go, when you talk about kidneys, I I know what you're talking about. Yeah,

Speaker 1 but it's like it's basically on us in these forums, essentially.

Speaker 4 That's what I feel like. Absolutely.
Because there's no money in that marketing. If we're honest, there's no money in that marketing.
Yes, you know what I mean.

Speaker 4 You're not going to make money from that part of it.

Speaker 4 But the man, the one thing I really love and I appreciate about your work, and that's why I really appreciate your time. Not you.
Oh, not you. I do love your work, but not right now.

Speaker 4 One thing I appreciate about your work, Tom, is like

Speaker 4 it reminds us

Speaker 4 that we are the ones who are supposed to make it matter? You know, we are the ones who are supposed to give it a voice. We are the ones who are supposed to speak out about it.

Speaker 4 And we don't know who will read the books. That's the ironic thing.
You didn't know when you wrote that book that the head of, that the person would become the head of the FDA.

Speaker 1 Right. Wow.

Speaker 4 Did you get what I'm saying?

Speaker 1 Yes.

Speaker 4 That's like such a crazy thing.

Speaker 4 They were not in that position. They read your book.
They go into that position.

Speaker 6 They put a message in a bottle.

Speaker 4 No, and to your point, Eugene, it's like we take for granted what those messages, you know, where those messages land up.

Speaker 1 like where those bottles wash up on shore where they you know yeah it's just that there's an urgency to this that gets me keeps me awake at night because every time you know um

Speaker 1 i took a lot of people's patients stories um and convinced them to tell me their stories despite the fact that they were putting themselves at risk i mean there's a real risk of retaliation yeah

Speaker 1 and and a couple of them use the same kind of language they said okay i'll tell you my story but when i'm gone you have to promise that this won't happen to somebody else. Wow.

Speaker 1 And I, you know, you don't, it's not the kind of promise you make lightly, and it's not one I take lightly. Every day since we've been talking here, people are in harm's way.

Speaker 1 This needs to stop like yesterday. So that's kind of what,

Speaker 1 at the same time, there are positive movements and positive, positive symptoms, and a very clear game plan for what needs to happen. It's hard, but very clear.
10-point plan.

Speaker 1 There's an urgency here that just

Speaker 1 I can't let go of.

Speaker 4 Does it make you interact with the healthcare industry on a personal level differently?

Speaker 1 It does.

Speaker 1 Yeah, it does. And

Speaker 1 yeah, with

Speaker 1 my brother who is

Speaker 1 undergoing some real, real health challenges right now,

Speaker 1 I see a lot of what I've reported on in a way that

Speaker 1 hits home very hard. So, yeah, I mean, we're all in this, and it's up to all of us.

Speaker 1 That's the other thing that I think you brought up, but that I think is really really important for people to remember. It's on you.
It's on us.

Speaker 1 There is no, you know, the knight in shining armor who's going to arrive. The cavalry is not coming.

Speaker 6 You are it. Yeah.
Yeah.

Speaker 1 And, and, but we can. I mean, we definitely can.

Speaker 1 And I've seen, you know, these small groups and larger groups, people's lobby in Chicago and the homeboys in LA and a bunch of others who are just saying, okay, let's just do this.

Speaker 1 You know, let's just do this right here among us. And then we see how it goes.
And I think

Speaker 1 that's kind of my model until I see a better one. Hey, man.

Speaker 4 I'll tell you now. You've put forward one of the best models.
I hope as many people as possible read your book because one of them might become the next head of the FDA.

Speaker 4 One of them might become the next something of something.

Speaker 4 And yeah, wherever we can help, let us know, man.

Speaker 4 It's really worthwhile. Thank you for taking the time.

Speaker 1 Thank you very, very much, Trevor and Eugene. It's been a pleasure.

Speaker 4 This is really great, man. Thank you so much.

Speaker 1 Tom.

Speaker 4 For real, man.

Speaker 1 Thanks.

Speaker 1 We've got to stay in touch. Tell her about your brother.
Yeah. Yeah, it's tough.
Yeah, it's tough. Tell her about your brother.
It happens, but you don't think it's going to happen.

Speaker 1 Yeah, no, it happens.

Speaker 4 But can I tell you, it's,

Speaker 4 you know, my mom is more prophetic in the family, but

Speaker 4 she would say something to the effect of

Speaker 4 we don't know. what wars life is preparing us to fight.

Speaker 4 We just experience the battles.

Speaker 4 You know, and I I almost feel like

Speaker 4 in a weird way, it's almost come around where you go, like, damn,

Speaker 4 it's put you in the front seat to fight the thing that you're already fighting in an even more energizing way.

Speaker 1 That's true.

Speaker 6 You already had perspective, you needed urgency.

Speaker 1 Yeah, that's right.

Speaker 4 That's exactly that.

Speaker 4 That's a more eloquent way to say it. Thank you.

Speaker 4 This episode is presented by Whole Foods Market. Whole Foods Market is the place to get everything you need for Thanksgiving.

Speaker 4 With great prices on turkey, quality organic produce, grab-and-go sides and everyday low prices from 365 brand, you can prep for the holiday with big savings.

Speaker 4 Shop everything you need for Thanksgiving now at Whole Foods Market.

Speaker 4 What Now with Trevor Noah is produced by Day Zero Productions in partnership with Sirius XM. The show is executive produced by Trevor Noah, Sanaz Yamin and Jess Hackle.
Rebecca Chain is our producer.

Speaker 4 Our development researcher is Marcia Robiu. Music, Mixing and Mastering by Hannes Brown.
Random Other Stuff by Ryan Harduth. Thank you so much for listening.

Speaker 4 Join me next week for another episode of What Now?

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