1336: Dialysis | Skeptical Sunday

Summary

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The Jordan Harbinger Show: Skeptical Sunday – Dialysis (Ep. 1336, May 31, 2026)

Episode Overview

In this Skeptical Sunday episode, Jordan Harbinger and co-host Jessica Wynn take a hard look at dialysis—a life-saving but often invisible treatment that becomes all-consuming for those who need it. They unpack the medical, economic, and ethical dimensions of dialysis in America: how it works, who needs it, why it’s so grueling, and how the business model prioritizes profit over patient outcomes. The discussion exposes a system where miracles of science coexist with grim industry realities, and where the U.S. lags behind in patient-focused innovation, prevention, and care.

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Key Discussion Points & Insights

1. What Is Dialysis and Why Is It Needed?

• The kidney’s critical role: Kidneys are “your body's water treatment plant” (06:51, Jessica Wynn), filtering blood non-stop to remove waste and excess fluid.
• Kidney failure is serious and fast: Without intervention, “you die, usually within weeks” (07:26, Jessica Wynn), as toxins build up rapidly.
• Dialysis as artificial kidney: The most common dialysis, hemodialysis, “involves two needles in your arm, usually in a surgically created fistula” (08:11, Jessica Wynn), connecting your circulatory system to a machine that filters your blood.
• Intensity and permanence: Typical regimen is “three to five hours per session... three times a week, forever—unless you get a transplant or die” (09:43, Jessica Wynn).

Memorable Quote

"You're getting a part-time job filtering your blood... this is just keeping you alive. You're not curing anything. You're treading water."
—Jordan Harbinger (09:51)

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2. Life on Dialysis: Physical & Emotional Toll

• Sawtooth survival: Dialysis is not continuous, so “after treatment, it's perfect. Then increasingly toxic by day three. It's like instead of your heart beating constantly, it just beat really, really hard three times a week” (10:56, Jessica Wynn).
• Grim mortality: “Fewer than 40% of dialysis patients survive more than five years” (12:19, Jessica Wynn) — akin to cancer outcomes.
• Common causes: Main triggers are diabetes and hypertension, unevenly hitting poor, older, and minority Americans.

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3. The Hidden Dangers: Infections & Deaths

• Infections are rampant: “Sepsis mortality in dialysis patients is 100 to 300 times higher than in the general population” (15:06, Jessica Wynn).
• Industry variation: Infection rates “vary wildly between clinics”—some are “infection factories” (15:29, Jessica Wynn), but patients rarely know clinic quality.
• Psychological burden: Many patients “say, ‘I'm not living, I'm just not dying’” (13:52, Jessica Wynn), with some choosing to withdraw from treatment, resulting in 21% of patient deaths.

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4. The American Dialysis Industry: Big Business

• Massive cost and concentration: Dialysis is a "$50 billion a year industry" (28:19, Jessica Wynn). Two companies, DaVita and Fresenius, control about 70% of all U.S. clinics (29:01, Jessica Wynn).
• Perverse incentives: In-clinic dialysis pays $90,000/year per patient, while home dialysis is reimbursed less (about $60,000). “Home dialysis... is gentler, more flexible and cheaper,” but the business model discourages it (18:56, Jessica Wynn).
• Stagnant prevention: “We won’t pay for the thing that would have prevented this... but we will pay forever for the extremely expensive treatment” (27:31, Jordan Harbinger).

Memorable Quote

“If something in America is tragic enough, somebody will eventually franchise it.”
—Jordan Harbinger (39:19)

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5. Why Home Dialysis and Transplants Lag in the U.S.

• Low adoption: Only 12% of patients use home dialysis, vs. 40% in the Netherlands and 70%+ in Hong Kong (63:40, Jessica Wynn).
• Disincentivization: High recurring payments for in-center treatments, logistical hurdles, and lack of support keep patients in clinics.
• Transplant roadblocks: “Clinics aren’t always aggressive about pushing people through [the transplant] process,” as losing a dialysis patient also means losing revenue (38:00, Jessica Wynn).
• Profit vs. outcomes: In nonprofit clinics, transplant referrals are 64% higher; in for-profits, patients are seen “as entries in a spreadsheet” (41:47, Jessica Wynn).

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6. Exploitative Practices & Regulatory Capture

• Fraud and upselling: Clinics have engaged in overprescribing drugs for profit, performed unnecessary surgeries, and paid kickbacks to doctors (47:06, 48:50, Jessica Wynn).
• Regulatory failure: “Regulations focus on compliance, not outcomes” (51:00, Jessica Wynn), leading to clinics passing checks while patients suffer.
• Soft capture: Industry shapes its own oversight via lobbying, consulting, and funding patient advocacy groups that oppose reforms (52:21, Jessica Wynn).

Memorable Quote

“There’s a massive lobby for dialysis. Spending millions on political campaigns, funding patient groups, shaping the conversation.”
—Jessica Wynn (69:04)

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7. The Human Experience: Stories from the Inside

• Day-to-day grind: Patients spend “a full month per year sitting in a chair hooked up to a machine” (10:11, Jessica Wynn).
• Isolation and stigma: Many hide their condition due to exhaustion or shame; the treatment “reorganizes your entire existence” (55:39, Jessica Wynn).
• Life interrupted: One patient missed his daughter’s wedding due to inability to arrange out-of-town treatment (55:15, Jessica Wynn).

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8. Prevention and Global Perspectives

• Most kidney failure is preventable: Aggressive diabetes/hypertension management can “slow progression dramatically” (66:49, Jessica Wynn).
• The U.S. lags: Poor prevention, underpaid nephrologists, and lack of early screening drive up the need for dialysis.
• International success: Countries like Hong Kong and the Netherlands provide more home care with better outcomes, simply by making it the default and supporting patients (63:40, Jessica Wynn).

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9. Fixing the System: What Would Real Reform Look Like?

• Aggressive prevention: Early screening, better diabetes/hypertension care, healthier food access.
• Shifting incentives: Rewarding home dialysis and transplant, breaking industry duopoly.
• Focus on outcomes: Regulation based on patient survival and well-being, not just compliance.
• Invest in innovation: More funding for artificial kidneys and alternative treatments.
• Visibility and advocacy: Public pressure for reform begins with awareness.

Action Points for Listeners

• If you have diabetes/hypertension: Manage closely, get kidneys checked, seek a nephrologist.
• Support loved ones on dialysis: Encourage discussions on transplants and home options.
• Politically: Back prevention funding, better transplant programs, and outcome-focused policies. Be skeptical of advocates funded by industry.

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Notable Quotes & Timestamps

• “Fewer than 40% of dialysis patients survive more than five years.” —Jessica Wynn (12:19)
• “Sepsis mortality in dialysis patients is 100 to 300 times higher than in the general population.” —Jessica Wynn (15:06)
• “A patient on dialysis is worth $90,000 a year, every year, indefinitely. A patient who gets a kidney transplant... is off dialysis permanently.” —Jessica Wynn (36:00)
• “The system is optimized for corporate revenue instead of patient outcomes or fiscal efficiency.” —Jessica Wynn (43:55)
• “It doesn't have to be this way... We built this system through policy choices. We can unbuild it the same way.” —Jessica Wynn (73:22)

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Memorable Moments

• Jordan’s visceral reaction to the grim statistics: “This is psycho nonsense” (43:21) and “If you weren't angry before, you should be now” (61:13).
• Example patient stories: The teacher forced onto dialysis after years of insulin rationing; Marcus, the construction worker who described dialysis as “the worst hangover you’ve ever had... brain fog, nausea... I feel almost human, then the cycle starts again” (54:04–54:46).
• Discussion of food deserts and privilege: “Let them go to Whole Foods. Why don't they just go to Erewhon and buy… an organic bean burrito?” (25:09–25:18)
• The Black Mirror comparison: “This is Black Mirror, without the cool technology.” (41:54)

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Critical Timestamps

• [05:32] — Dialysis is “simultaneously a miracle and a massive industry.”
• [10:24] — The illusion that dialysis is a solution: “You're treading water.”
• [12:19] — Five-year survival rate under 40%.
• [15:06] — Infection rates up to 300x higher for dialysis patients.
• [18:56] — Only 12% of U.S. patients use home dialysis.
• [29:01] — Industry duopoly: DaVita and Fresenius control 70%.
• [38:43] — For-profit clinics refer transplant patients 64% less.
• [51:29] — Some clinics have 50% higher mortality rates.
• [63:40] — In Hong Kong, 70%+ use home dialysis.
• [66:49] — Prevention can keep many off dialysis entirely.
• [69:44] — Patients blame themselves, but system is at fault.

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Final Takeaway

Dialysis is a technological marvel and a lifeline for many, but the way it’s organized and financed in the U.S. has made it a story of profit trumping health. Many lives could be improved—or saved—by prevention, better incentives for home care and transplants, and a regulatory environment focused on results, not compliance. The invisible suffering of hundreds of thousands could become a driver for change, but only if people learn what’s really happening behind the curtain.

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Transcript

[Jordan Harbinger]

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[Jessica Wynn]

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[Jordan Harbinger]

Cause pools are cool.

[Jessica Wynn]

I feel the love book of VRBO that's loved by guests. If you know you vrbove

[Jordan Harbinger]

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[Jessica Wynn]

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[Jordan Harbinger]

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[Jessica Wynn]

Liberty. Liberty. Liberty. Liberty.

[Jordan Harbinger]

This episode is brought to you by Lufthansa. Lufthansa Allegris is an innovative elevated travel experience across all classes, focusing on each person with their own individual and situational needs. Look forward to your own feel good moment above the clouds. Visit lufthansa.com and search for Allegris to learn more. Lufthansa Allegris all it takes is a yes. Welcome to Skeptical Sunday. I'm your host, Jordan Harbinger. Today I'm here with Skeptical Sunday co host, writer and researcher Jessica Wynn on the Jordan Harbinger Show. You know it's funny, Jessica. I was doing comments on Spotify. You can look at people's comments and stuff and I like to engage there. I like to engage wherever people come in about the show and people were like, I don't know what it is with Jordan, but He just sucks up to this guest, Jessica. And I was like, you do you know what a weird thing to say about somebody that you work with that you've known for a long time? Like, I would get it if it was like a celebrity. No offense. I would get it if it was like a celebrity or something like that. Like, oh, look at this guy. And I'm like, is it weird to get along with people that you. I don't know. That's the age of the intern that we're in right now where it's actually weird, right?

[Jessica Wynn]

Be mean to me.

[Jordan Harbinger]

Yeah, you shut up, Jessica. Who said you could talk on this episode of the show where I pay you to talk? I mean, what am I, what am I supposed to do? Like I'm supposed to talk down to you and make you look stupid on this show? That's.

[Jessica Wynn]

Yeah, please. Yes, that's entertainment, Jordan.

[Jordan Harbinger]

It is that. Well, that's what passes for entertainment. And the other thing that's weird about it is it's like if I were rude to you, I would like to think, I would hope that I would get more comments about how I'm not treating you well, but treating someone too well, I don't know. And people like, someone's like, I agree with Tod or whatever. Nick. I agree with Nick said, that sucked. And I'm just, I was thinking, because of course, me being the neurotic podcast host that I am, I'm like, well, now I have to think about every single thing I've ever said to you and what it might the vibe of that might be. I don't know, I just thought that was such a funny. I meant to share that with you earlier, but I think it's a funny thing to share with the audience as well because I don't know, I guess we're not supposed to get along. I don't know.

[Jessica Wynn]

Okay, let's be more combative today.

[Jordan Harbinger]

Yeah, let's do that. Huh? That's a good idea. Finally, you've had a good idea. On the Jordan Harbinger show, we decode the stories, secrets and skills of the world's most fascinating people and turn their wisdom into practical advice that you can use to impact your own life and those around you. Our mission is to help you become a better informed, more critical thinker. During the week, we have long form conversations with a variety of amazing folks. Spies, CEOs, athletes, authors, thinkers and performers. On Sundays, though, it's Skeptical Sunday, a rotating guest co host and I will break down a topic you may have never thought about and debunk common misconceptions about that topic, such as recycling chemtrails, which are not a thing. Astrology, which is a thing, but also not a thing. Well, that's the theme of the show, right? It's a thing, but it's. It's not what you think. Diet supplements, the lottery, Reiki healing and more. If you're new to the show or you're looking for a handy way to tell your friends about the show, we've got starter packs. They're collections of our favorite episodes on persuasion, negotiation, psychology, disinformation, junk science, crime and cults and more that'll help new listeners get a taste of everything we do here on the show. Just visit jordan harbinger.com start or search for us in your Spotify app to get started. Today on the show, we're talking about something most people never think about until it becomes everything they think about. Dialysis. It's one of those words that lives somewhere in the back of your brain. You kind of know, maybe it's kidney related. You know, it sounds serious. You hope you never need to know more than that. And then one day it's your life on the line or that of somebody you love. And suddenly that word isn't medical trivia. It's a machine you're hooked up to three times a week. There's something about this that feels very American. Look, we can build a device that keeps you alive and also quietly bankrupts you. I mean, it's just a miracle of modern science. Here to help us filter the stream of info on dialysis is writer and researcher Jessica Wynn. So quick heads up, by the way. We're going to be discussing some medical stuff that's going to make some people squeamish. So if you're one of those people who's like, I'm listening while I'm eating, and if it's going to be gross, you got to tell me. This might be one of those. Jess. Dialysis. I'll be honest, I kind of know that it has to do with kidneys and blood cleaning and there's a machine involved and there's franchises. That's kind of where my knowledge ends, which I think that puts me in with about 99% of Americans.

[Jessica Wynn]

Yeah, definitely. And the invisibility is the whole story. So I didn't know much about dialysis until a good friend's entire life changed after their diagnosis.

[Jordan Harbinger]

Wow.

[Jessica Wynn]

Yeah. Dialysis operates in this weird space where it's simultaneously a genuine medical miracle and a massive industry but you don't see it until you're inside it. And by then, you know, you're not in a position to really ask hard questions.

[Jordan Harbinger]

Right. Yeah. I would imagine you are not shopping around or reading reviews online. You're just trying not to die.

[Jessica Wynn]

Right. And that ignorance matters because dialysis affects hundreds of thousands of people. It costs tens of billions of dollars, and it shapes how long and how well people live.

[Jordan Harbinger]

Okay, so bring me up to speed. What are we actually talking about here?

[Jessica Wynn]

Okay, so let's start with what kidneys do. You know, they're incredible organs. They're about the size of your fist, and they filter your blood every day. They process about 200 quarts of blood to remove waste and extra water, which becomes urine. They balance electrolytes, regulate blood pressure. They even help make red blood cells. So they're basically like your body's water

[Jordan Harbinger]

treatment plant, and they run 24. 7 in the background. I don't. You know, whenever I learn about organs, I'm always like this. This is amazing. Every. Every single thing in our body. Yeah. First of all, they're busy. They never take breaks. Really. They're just. You think like, oh, I'm. I'm so hard on whatever. Like, my stomach or whatever. Your stomach has it easy. Your stomach's hanging out most of the time. Yeah. You put some food in it, it holds acid. That's not an easy job. But your kidneys, they're just running a marathon all day, every day in the background and. Yeah. Making you pee.

[Jessica Wynn]

Right. It's nice to take it for granted.

[Jordan Harbinger]

It is nice to take it for granted. And I guess that's why when they fail, you got a big problem.

[Jessica Wynn]

Right. And when they do fail, and that's about 800,000Americans that are living with kidney failure right now, so your body can't clean itself. Waste builds up, fluid accumulates, and without intervention, you die, usually within weeks.

[Jordan Harbinger]

Yeah, I was going to ask how long that took. I'm going to imagine that the last few weeks are really bad. How many days do you need where you're not cleaning the thing that you're usually cleaning? 24. 7 before you start feeling terrible?

[Jessica Wynn]

It's awful. It's horror movie awful. Yeah.

[Jordan Harbinger]

Okay, so this is not like, I don't feel good. I should probably make a doctor's appointment. Okay. It's next week on Wednesday. This is a ticking health time bomb, so. All right, let me slow this down just a little bit more for a second here. When we say dialysis, what are we actually talking about?

[Jessica Wynn]

Well, so dialysis is an external version of that filtration system. So the most common type is hemodialysis. You go to a clinic, they stick two needles in your arm, usually in a surgically created, like, fistula.

[Jordan Harbinger]

Okay, that's a really gross word. It's a really gross word that makes my stomach turn. And I don't know what it means. What is that? It sounds like something. Oh, God, I don't know. Tell me what that means before I dry heat.

[Jessica Wynn]

So fistula is just the passage between, like, your organ and the body surface. It's just the name for that hollow, you know, surgically made passage.

[Jordan Harbinger]

That sounds way grosser than it is. Okay, I know it sounds like pustule or something, right? Yeah.

[Jessica Wynn]

Like, it would be gross and oozy, but it's not. It's just. It's literally the.

[Jordan Harbinger]

The passageway that makes me feel a little bit better. I think I'm probably not alone there. Okay, that's.

[Jessica Wynn]

So we can say the surgically created passageway.

[Jordan Harbinger]

If you want, you can say fistula. Now that I know what it means, it's not as gross as it was when it was in my head. It was like something out of Alien.

[Jessica Wynn]

Right. Okay, so that's where, you know, they've connected an artery to a vein to make it strong enough to handle repeated punctures. And then your blood flows out through one tube, through a machine with a special filter, and back into you through the other tube.

[Jordan Harbinger]

How long does this take? How long are you sitting there when you do this?

[Jessica Wynn]

Yeah, it's a long time. Typically three to five hours per session.

[Jordan Harbinger]

Oh, my God.

[Jessica Wynn]

And that's three times a week? Oh, every week. Forever. Or until you get a transplant or, you know, you die.

[Jordan Harbinger]

Wow. Okay. Three to five hours, three times a week. So this is. You're getting a part time job filtering your blood. Oh, my God. So when you say forever, I. Well, you mean forever. Unless you get a transplant or die. That's not hyperbole because you can't just stop doing this. And you. Yeah. Wow.

[Jessica Wynn]

Yeah. Welcome to dialysis.

[Jordan Harbinger]

Yikes.

[Jessica Wynn]

Yeah. 15 hours a week, and that's minimum. And that's 52 weeks a year. So after a year, that adds up to. You've spent a full month of your life sitting in a chair hooked up to a machine.

[Jordan Harbinger]

Wow, man, that's a lot of Candy crush. Or perhaps listening to this podcast. And this is. This is just keeping you alive. This. You're not curing anything. This is. You're treading water when you do this. That's pretty much it.

[Jessica Wynn]

Right. Your kidneys are still out of commission. So the machine does the kidney's job, but it's not even doing it that well. You know, natural kidneys work continuously and are perfectly calibrated. So dialysis happens three times a week. So you get this sawtooth patterns in your blood chemistry.

[Jordan Harbinger]

Oh, yeah, sure.

[Jessica Wynn]

Right. After treatment, it's perfect. Then increasingly toxic by day three. So it's like instead of your heart beating constantly, it just beat really, really hard. Three times a week.

[Jordan Harbinger]

Yeah. Yeah. And by the time it's ready to beat again, your blood is slowed to a crawl. Sl is not moving. Yeah, this makes sense. Yeah, you're right. I never thought about it. When I'm sleeping, you know, if I get up in the morning, I have to go to the bathroom. And I probably have to go to the bathroom even in the middle of the night. Right. Because I'm a well hydrated guy. Tmi. But my kidneys are working that whole time, so I don't have to go anywhere and do it because it's working while I'm watching To Ron on my iPad or whatever. Right, exactly. It's just going while I'm asleep. Wow. So this whole go to a place and do it manually sounds profoundly suboptimal. So I mean medically, emotionally, existentially suboptimal. Okay, before we go further, who ends up needing dialysis? Do your kidneys randomly fail because your luck is bad? How does. Who does this happen to?

[Jessica Wynn]

It's absolutely not random. So the two biggest causes are diabetes and hypertension. And together they account for about 70% of kidney failure cases. The rest are caused by a variation of sort of rare conditions or maybe addictions. And here's the really sobering part. Fewer than 40% of dialysis patients survive more than five years.

[Jordan Harbinger]

What? Wait a minute. Yeah, that's like a cancer statistic. That's not something people think of as a routine treatment. Okay, so, wow. So by the time you're on dialysis, your health is not good at all.

[Jessica Wynn]

You're not okay.

[Jordan Harbinger]

Yeah, you're not okay.

[Jessica Wynn]

I mean, being on dialysis is that serious, yet most people have no idea.

[Jordan Harbinger]

So what is actually killing these people?

[Jessica Wynn]

So it's lack lots of things. You know, it's heart disease, it's a lot of complications from diabetes. But here's the one that really stopped me. Infections are responsible for 36% of all dialysis deaths. And the most common cause of death after that, withdraw from dialysis.

[Jordan Harbinger]

So this isn't the disease and Stuff killing them. This is people saying, I can't do this anymore. I don't want to do this anymore. And they just stop doing dialysis and let the illness take its course?

[Jessica Wynn]

Yes.

[Jordan Harbinger]

Oh, my God.

[Jessica Wynn]

About 21% of dialysis patients die after choosing to stop treatment. So it's most common in patients over 60. And to be clear, this usually happens with, you know, doctors and families involved. It's a huge end of life decision when the treatment itself has just become too burdensome.

[Jordan Harbinger]

Yeah, okay, I see. So I. By the way, I misspoke earlier because I said that this isn't the disease killing them. What I meant was, this isn't the disease over rides the treatment. They just stop getting treatment. So I should probably clarify that.

[Jessica Wynn]

They just fail.

[Jordan Harbinger]

But it sounds like the treatment can become harder than the disease, or at least it overrides your will to keep doing this nonsense. Right? Every week? Oh, God, yeah.

[Jessica Wynn]

For a lot of patients, absolutely. I mean, I don't want to romanticize any of this. You know, dialysis keeps people alive, but it can also mean hours in a clinic every week. There's exhaustion afterward, there's serious complications, not to mention the financial burden. And dialysis patients say, you know, I'm not living, I'm just not dying. And that calculation where death feels preferable to the machine, I mean, that tells you something really profound about what people are going through.

[Jordan Harbinger]

Okay, you mentioned infections. Break that down for me because again, that number is bananas. It's over. One third of people who die, die from an infection that seems like it shouldn't happen.

[Jessica Wynn]

Yeah, it's horrific. But dialysis requires vascular access, so either a fistula like we talked about, a graft, or a catheter is used. And every time you stick needles in someone or have a catheter line going into their bloodstream, you create an infection risk. And dialysis patients get this three times a week, week after week, year after year. I mean, the statistics are staggering. So sepsis mortality in dialysis patients is 1 to 300 times higher than in the general population.

[Jordan Harbinger]

Wait, wait, wait. 100 to 300 times higher or percent higher? Percent higher. Right.

[Jessica Wynn]

Like, times higher.

[Jordan Harbinger]

Oh, my God. That's horrific.

[Jessica Wynn]

It's hard to comprehend.

[Jordan Harbinger]

Yeah.

[Jessica Wynn]

And bloodstream infections from staph bacteria occur a hundred times more often in dialysis patients than in adults. Not on dialysis.

[Jordan Harbinger]

You're right. It's hard to wrap your mind around.

[Jessica Wynn]

Yeah.

[Jordan Harbinger]

300 times higher, that's like, oh, my God.

[Jessica Wynn]

Yeah, it's wild. And these aren't freak accidents. These are predictable consequences of the treatment model. And infection rates vary wildly between clinics. So some have excellent protocols and low infection rates. Other clinics are infection factories, but patients often have no way of knowing, you know, which kind of clinic they're walking into.

[Jordan Harbinger]

Yeah. Shouldn't there be ratings or something? Like, some kind of this place will not kill you scoreboard? Because right now it feels like dialysis clinics should have those big letter grades in the window, like restaurants in New York. You know, you get an A or a B or a C posted on the door and like, congratulations, this clinic is a solid B at keeping your blood infection free instead of. Except instead of dumplings, it's your bloodstream. I don't know. Just not knowing what you're gonna get and then being subject to a staph infection that kills you. The dice roll here is crazy. It's just terrible. Yeah.

[Jessica Wynn]

Plus, you have a lot of other things on your mind. You know, you're putting a lot of trust into these clinics, but there actually are ratings. You know, Medicare gives dialysis clinics star scores based on outcomes and safety measures.

[Jordan Harbinger]

And I'm guessing these are not posted on the window next to the inspirational happy kidney smiley face poster.

[Jessica Wynn]

They're not, but they do exist. They're just not prominently displayed. And the methodology is complicated. So most patients go to the closest clinic because, you know, logistics dictate it. You need treatment three times a week. You can't really shop around.

[Jordan Harbinger]

Yeah, if you need dialysis, you need dialysis. And you're probably not, like, you know what? That's it. I'm driving three hours away. Because it's cheaper and cleaner down in Modesto.

[Jessica Wynn]

Right, Exactly. Which brings us to the second type, peritoneal dialysis, where you do it at home. So you have a catheter in your abdomen, and you fill your belly with special fluid that draws out waste through the lining of your abdominal cavity. So you drain it out, you refill it, repeat. You know, some people do this manually several times a day. Others hook up to a machine at night that cycles the fluid while they sleep.

[Jordan Harbinger]

Okay, so that sounds better than the clinic, you know, immediately better. But again, it also makes me feel a little bit sick to my stomach. I feel bad saying that because these people have to live with it. And it's like, oh, Jordan's getting queasy hearing about it. But I think hopefully I'm coming across here as sympathetic, because, honestly, this just seems like such a terrible thing to have to go through. And I feel.

[Jessica Wynn]

Right.

[Jordan Harbinger]

I feel for anyone who has to deal with this. This is just a terrible way to live. And I'm, I mean, I just, I can't believe that. Well, one, the technology is amazing, but I'm also like, how do we not have everybody at home? I don't know. Maybe we'll talk about that in a bit.

[Jessica Wynn]

Yeah, I mean, it's wild. People are just live this way. And so the at home machines are better for many people. There's more freedom, it's gentler on the body, and you're not tied to a dialysis chair in one specific clinic every week. So some home dialysis systems are even portable, so people can travel with the equipment or ship supplies to where they're going and continue treatment there. But infection risk is also lower when it's done properly. But for some reason, only 12% of U.S. dialysis patients use it.

[Jordan Harbinger]

Yeah, I didn't, you know, I didn't even think about travel. How do you manage that? So why are only 12% of people using this if it's so much better?

[Jessica Wynn]

Well, now we're getting to the interesting part. So let me ask you something. If you were running a dialysis company, which would you prefer? Patients who come to your clinic three times a week, where you control everything and bill for every visit, or patients who do it themselves at home where you make less money? So home dialysis, particularly peritoneal dialysis, is gentler, it's more flexible and cheaper. And Medicare pays about $60,000 per year for home dialysis, but it pays $90,000 for in clinic.

[Jordan Harbinger]

After 15 straight minutes of kidney horror, even your anxiety needs a snack break. We'll be right back. This episode is sponsored in part by CookUnity. Jen and I have started doing this thing where we eat at home more often, partly because it saves us a ton of time. By the time you deal with traffic, parking, waiting for a table, getting home, the meal's a two hour event. We've also kind of exhausted our local restaurant rotation. You just hit that point where everything feels repetitive. That's why cookunity has been a nice charge for us. It keeps meals interesting without us having to leave the house. The food actually tastes chef made because it is real. Chefs, Michelin star, James Beard winners, Food network stars. They cook in small local kitchens, not mass produced factory meals. We've been trying all kinds of different stuff. Korean inspired dishes, Mediterranean meals, high protein options, pasta dishes. It genuinely feels like bringing new restaurant experiences home without the hassle or expense of constantly going out. And the biggest thing, it just saves us so much freaking time. Lunch or dinner is ready in minutes. The quality is great. There's no flavor fatigue because there are so many options available.

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[Jordan Harbinger]

this episode is also sponsored by Revolveman. One thing I'm trying very hard to avoid is accidentally drifting into full default dad wardrobe territory. You know what I'm talking about. I still want the stuff that feels effortless and comfortable, but I also like wearing pieces that feel a little more unique and intentional without looking. Try hard. I can find a lot of that on Revolve Man. It's curated in a way that makes shopping really easy. You're not scrolling endlessly through thousands of random products. They've got really solid, elevated basics, trend forward stuff, brands you actually want to wear, like Fear of God Essentials, Salomon and more. And what I like is the whole site helps you put together an actual look. You find one jacket or pair of shoes you like, suddenly you see exactly what works with it instead of guessing. I got a big haul from Revolve man recently, including these really clean on cloud sneakers that I've been wearing constantly. It's exactly the kind of stuff I like. Comfortable, easy, somehow still makes me look put together without feeling overly styled. That's basically the sweet spot I'm trying to go for here at age 46. And the shipping makes it easy too. Free two day shipping, easy returns. No hassle.

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[Jordan Harbinger]

Don't forget about our newsletter, Wee Bit Wiser. It is a gem from a past episode of the show from us to you. It's an under two minute read. Comes out every Wednesday. Jordanharbinger.com News is where you can find it. Now back to Skeptical Sunday. So this is not about what's best for the patients. Color me surprise. So okay are the diseases that lead to kidney failure? Are those Predictable?

[Jessica Wynn]

Yeah, very much so. So they cluster in commun with less access to healthy food, preventative care, and safe environments. There's a disproportionate impact on older adults, low income patients, black and brown communities, and people managing diabetes and hypertension without the resources to manage them.

[Jordan Harbinger]

Well, I know somebody who had to do dialysis, and I remember she had a lot of. She had diabetes and things like hypertension. I remember even just when I was younger, she had health problems. And then when she got older, she had to do this. So, okay, so by the time the machine shows up, these people had problems for years. The system has failed them in many ways, repeatedly. Right. If they live in a place where they can't get healthy food or, you know, health care, et cetera.

[Jessica Wynn]

Yeah, absolutely. And black Americans are three times more likely to develop kidney failure than white Americans.

[Jordan Harbinger]

Okay.

[Jessica Wynn]

Part of that might be genetic variant that's more common in people of West African descent. It's called APOL1. But genetics isn't destiny. So the bigger factors are things like living in food deserts where fresh produce is scarce, working jobs without health insurance, breathing air near industrial sites, drinking water with lead contamination. You know, by the time someone's on dialysis, they've usually been dealt a bad hand for decades.

[Jordan Harbinger]

Jess, I feel like we need to do an episode on food deserts because this is one of those things. And I know I'm going to sound like such a privileged POS right now, but I'm like, come on, man, like, is that real? You can't get healthy food. They sell chicken everywhere. But I don't know, like, I'm talking out of my ass, really. I don't know that there can be

[Jessica Wynn]

many square miles where there's not one regular grocery store. It's just bodegas.

[Jordan Harbinger]

You know what? Actually, now that you mention it, when I worked in downtown Detroit, I remember my boss was saying, you know, a lot of the people in this neighborhood, they do their shopping at the convenience store where they have no business doing all their shopping. And I was like, that's so silly. Why don't they go to the grocery store? And he's like, well, they either walk downstairs and walk into this convenience store and spend an extra $10 buying milk and Cheetos and microwave stuff because that's what they have at the convenience store, or they take the bus 15 minutes that way they go to the grocery store, they get a ton of bags, they get back on the bus with all of those bags, maybe they have to stand on the way home. And then they walk back up to their place with all the bags of stuff. And I was like, that does sound like a pain in the butt. Because I was thinking like, oh, you just drive to the store, man, what's the big deal? But like if you don't have a.

[Jessica Wynn]

And you live in a walk up without an elevator and yeah, you're doing it little at a time.

[Jordan Harbinger]

Yeah. Just stuff I never really think about anyway. So. Yeah. Because my knee jerk reaction is, okay, eat healthier, dummy. It's not that hard. But I guess, yeah, it's not that simple. Let them eat cake is what I sound like right now.

[Jessica Wynn]

Let them go to Whole Foods.

[Jordan Harbinger]

Yes. Why don't they just go to Erewhon and buy. Yes. An organic bean burrito? Yeah, that's. I know, I sound like $45.

[Jessica Wynn]

Yes.

[Jordan Harbinger]

That's exactly how I feel saying these things right now. But. But yeah, I just. Because food, desert sounds. It just sounds fake to me. And I can't be alone in that. I can't be the only person who's like, food, desert, come on.

[Jessica Wynn]

Of course. But the huge part of the population lives that way. And because you're living that way, and this is crucial, you know, the consequences don't go away. So let me give you a really typical case drawn from documented patient interviews. So I read about a 62 year old woman. She worked as a public teacher in Detroit for 30 years. She developed diabetes in her 40s. She struggled to afford her medications. She rationed her insulin a few times when money was tight.

[Jordan Harbinger]

Oh my God. You're not supposed to do that. For people who don't know.

[Jessica Wynn]

Not supposed to do that. And by her mid-50s, guess what?

[Jordan Harbinger]

Her kidneys were failing because she couldn't afford insulin. That makes me so sad and angry because that sentence should stop all of us cold. Insulin is not. It's not even expensive. Well, in most places. Like, it's. It's not. Not. This is one of the cheapest, easiest to obtain medications nowadays. I mean, it's just. No one should have to ration it. That is. That's disgusting.

[Jessica Wynn]

Yay, American healthcare.

[Jordan Harbinger]

Right? Yeah, that's.

[Jessica Wynn]

But now she's on dialysis and it's three days a week. She has to take a bus 40 minutes each way to the clinic. She sits in that chair for four hours. By the time she gets home, she's exhausted. You know, she's been interviewed saying, quote, the days I have dialysis, I don't have a life, I have a treatment.

[Jordan Harbinger]

Yeah. Geez. Yeah. What else are you gonna do when you take the bus? And it's basically an hour to get ready and go, and then you sit there for four hours, and then you come home? I mean, that's your whole productive day. Plus, you probably feel like crap after doing that. I can't imagine you feel good doing that.

[Jessica Wynn]

Yeah. And here's the thing. Medicare now pays for all of her dialysis, you know, every session. It's one of the only diseases where Medicare covers you regardless of age. The same system that wouldn't reliably help her afford insulin, which, as you mentioned, is not expensive, now spends about $90,000 a year keeping her on dialysis.

[Jordan Harbinger]

I had not thought of that. So we won't pay for the thing that would have prevented this, which is so cheap as to almost not incur cost at all.

[Jessica Wynn]

Right.

[Jordan Harbinger]

But we will pay forever for the extremely expensive treatment. Because I'm gonna go out on a limb here and say a public school teacher in Detroit does not make $90,000 a year. So we're actually paying 90,000 for her treatment instead of keeping her working for an extra 20 years for. I mean, the government cost of insulin per year has gotta be, I don't know, a couple hundred bucks at most. Probably not even. Yeah, that's crazy.

[Jessica Wynn]

Maybe we could pay our teachers more,

[Jordan Harbinger]

you know, or like, give them insulin so they don't die. I mean, come on, man.

[Jessica Wynn]

And better healthcare, right? Exactly.

[Jordan Harbinger]

O. Okay, how much are we talking about here total for the dialysis for everybody in America?

[Jessica Wynn]

It's a lot. You know, dialysis is about a $50 billion a year industry in the United States. Medicare spends about 36 billion a year on it. That's roughly 7% of the entire Medicare budget, and it's going to less than 1% of the population. So on a per patient basis is the single most expensive condition Medicare covers.

[Jordan Harbinger]

For sure. Yeah, I can. I mean, the numbers are staggering. $50 billion every year. That is. That is serious.

[Jessica Wynn]

Yeah. And follow that money. You know, two companies, DaVita and Fresenius, control about 70% of all dialysis clinics in America.

[Jordan Harbinger]

Two companies control 70%. That is not much of a market. I'm not going to say that they collude and make the prices higher, but I'm going to go ahead and imply that they collude and make the prices.

[Jessica Wynn]

Yeah, you're not wrong. I mean, it's effectively a duopoly.

[Jordan Harbinger]

Yeah.

[Jessica Wynn]

So DaVita has about 2800 clinics. Fresenius has about 2600, and together they treat roughly half a million dialysis patients. So this level of concentration is extraordinary even by American health care standards.

[Jordan Harbinger]

I want to be clear, for legal reasons, I have absolutely no facts or information whatsoever. And I don't have any reason to believe that they do that other than if I were running a duopoly of or half of a duopoly, I would probably be scummy enough to call the other guys and say, hey, you know what we should do? Right, because we'll all make more money. So, yeah, that just means I'm a terrible person. Moving on. How did it happen that there's only two companies? Because if there's this much money in it, how is this not like smoke shops where there's a zillion of these things?

[Jessica Wynn]

Yeah, I mean, it's consolidation over decades. So dialysis requires expensive equipment, trained staff, and regulatory compliance. So small independent clinics, they just, they got bought up and economics of scale kicked in. And once you're that big, you know, you have enormous power to shape regulation, negotiate with suppliers, and just influence payment rates.

[Jordan Harbinger]

And patients, again, can't shop around. You're just trying not to die. And you're. It's so long that you're just gonna go to the one that's near you kind of. Right?

[Jessica Wynn]

Yeah. I mean, that's the key. If you need dialysis, you need it three times a week on a schedule. So most people go to the clinic closest to them because like we said, anything else is logistically impossible. You know, you can't skip treatments to, you know, wait for that better deal. You know, you can't delay. It's not like choosing a gym or whatever.

[Jordan Harbinger]

Yes, this is life or death. Anytime I want to buy electronics, my brother in law's like, wait for Black Friday. And it doesn't matter if it's December, right? He's like, wait for Black Friday. And it's like, no, I kind of just want this thing like in the next 10 months, so I'm going to go ahead and buy it. But yeah, this is. So this is life or death. Yeah, you can't go like, oh, they usually offer a coupon. I'm going to hold off till Monday.

[Jessica Wynn]

Right. Waiting for that. Groupon doesn't happen. And that lack of choice matters when you look at who controls the industry. So DaVita's market cap is around 11 billion. And their longtime CEO, Kent Theory, who was known internally as mayor, he built this really intense corporate culture. You know, internally employees called themselves citizens of davita Village. And they did these company chants at meetings, all this weird stuff.

[Jordan Harbinger]

Chants okay, so I'm gonna withhold judgment because I don't know if you're doing something like this, maybe you need to be cheered up and feel good about it. But I think I saw this guy dressed up as a knight on John Oliver. Is that this guy?

[Jessica Wynn]

He did, yeah. David.

[Jordan Harbinger]

Yeah, that guy. Yeah, yeah, yeah. And he's like, I can't imagine doing that. But I guess, you know when you're making $100 million a year. Yeah, right.

[Jessica Wynn]

But it's David A Te. It's Italian for giving life. So there's a right sentiment there, I guess. But managers would lead these synchronized chants with everyone putting their hands in the air. It was meant to build unity and mission. But none of these people are on dialysis.

[Jordan Harbinger]

Well, we don't know that, but yeah, that's true. But also, I don't know, man. I'm on the fence because a lot of organizations do that. Sports teams do that, nonprofits do that, the Red Cross could chant and nobody would think twice. And also, I don't know, man, you're probably. It's a little bit depressing because you're seeing these people and they're not well. And then you're like, oh, where's Tom? Oh, I have to cancel Tom's appointment. He passed away. Like, that's sad. I don't know. You probably need a little bit of a morale boost to work in a place like this. I don't know.

[Jessica Wynn]

Yeah, I suppose. It just seems to me when I was reading about the corporate side of this, not what's going on in the clinics, but like, what's happening in this corporation. It seemed a little corporate culty to me.

[Jordan Harbinger]

I guess that's a good point. These. A lot of these people, they work in a building and they've never seen a dialysis patient in their life. They're not the nurses working. Because I'm always so. I'm so hesitant to crap on a healthcare worker or a nurse or a medical tech, like it's their job is hard enough.

[Jessica Wynn]

That's not exactly who I'm describing.

[Jordan Harbinger]

Okay, got it. No, that makes more sense. Yeah, you're right. When we think of these companies, we're thinking of the nurse who's like, you'll be fine. You know, do you want me to change the channel on the tv? We're not thinking of the person who's like, deny this person's coverage because I'm hungry and in a bad mood. Yeah. The issue, I suppose, is when chanting is happening inside a multi billion dollar company whose Primary customer is Medicare. That's a problem.

[Jessica Wynn]

That's the problem. Because when the rhetoric is about mission and community, you know, the economics are enormous. So theory made more than 17 million in his final year running the company, which is impressive for a company whose primary customer is Medicare.

[Jordan Harbinger]

Yeah, the government.

[Jessica Wynn]

Right. Funded by taxpayers.

[Jordan Harbinger]

Yes. So our government is cutting enormous, enormous checks to these companies, these two companies.

[Jessica Wynn]

And it's been happening since 1972. That's when Congress passed a law making kidney failure the only disease where Medicare covers everyone, regardless of age. Okay, you're 30 years old with kidney failure. Medicare pays. You know, it was seen as a moral imperative. We're not going to let people die because they can't afford dialysis.

[Jordan Harbinger]

Which in its face, I mean, that sounds great. I want people who have health problems to not die because they can't afford their medicine or their treatment.

[Jessica Wynn]

Right. It sounds great. It was great. But it also created something unique in American health care. Guaranteed indefinite payment. So this creates stable recurring revenue, and financial success becomes tied to keeping patients on dialysis, not necessarily getting them off it.

[Jordan Harbinger]

And to be clear, this isn't doctors and nurses wanting people to suffer. I have to go back to my earlier statement that I just. I don't want people to think like, how dare you? I work so hard in this dialysis clinic. We're not talking about you, we're talking about the pencil pushers.

[Jessica Wynn]

Of course not. I mean, it's important to remember doctors want to help patients, but this system quietly rewards stasis over resolution. So if you're a dialysis company, you have a customer base that cannot leave and a payer that cannot refuse. So you were right. That's not a market. That's a captive revenue stream. So the incentive is to keep people alive. Yes, but not necessarily to get them off dialysis.

[Jordan Harbinger]

So nobody's saying this out loud, I suppose, but the system works best when people never leave. It's better. I'm not saying this, but in theory, it's better to never get off dialysis. You should not get better. You shouldn't get a transplant. You should just stay until you die. Like that's the ideal business. This is the ideal customer for them.

[Jessica Wynn]

Right. That math is undeniable. So a patient on dialysis is worth $90,000 a year, every year, indefinitely. A patient who gets a kidney transplant costs Medicare about $110,000 for the surgery. Then they get covered for their immunosuppressant drugs, but they're off dialysis permanently.

[Jordan Harbinger]

Huh. Okay, so from a business Perspective. Once again, transplants are actually bad.

[Jessica Wynn]

Yeah. From a pure revenue perspective, yes. A transplant means a dialysis provider loses a customer. So dialysis companies aren't actively preventing transplants. It's more subtle than that. The system simply doesn't incentivize them to prioritize getting patients off dialysis.

[Jordan Harbinger]

Okay, so how does that play out? What does that look like?

[Jessica Wynn]

So through the transplant wait list, about 90,000 people are on it. And so we discussed it at length in the episode on transplants, which was episode number 1253.

[Jordan Harbinger]

Yeah. Organ donation. Right?

[Jessica Wynn]

Organ donation. Right. The average wait time is three to five years. You know, some people can wait eight, 10 years and during that time they're on dialysis.

[Jordan Harbinger]

Wow. Because there aren't enough kidneys to go around to people who need them. Right? That's the idea.

[Jessica Wynn]

Right. That's partly it. We do have an organ shortage. About 17,000 kidney transplants happen each year. But demand far exceeds the supply. And here's what's sticky. The referral process to even get on the wait list is complicated.

[Jordan Harbinger]

How is it complicated? Remind me. I don't. I don't remember this.

[Jessica Wynn]

Right, so you need a referral from your dialysis clinic and you need extensive medical evaluations. You have to prove you can afford the anti rejection drugs.

[Jordan Harbinger]

Now that's some bullshit right there.

[Jessica Wynn]

That's some bullshit.

[Jordan Harbinger]

That is is insane to me. Oh, you're too poor to get this life treatment. I'm sorry, you're just going to have to stay here and do dialysis until you kill yourself.

[Jessica Wynn]

And remember, there's even a stipulation where you have to demonstrate you have social support.

[Jordan Harbinger]

Why?

[Jessica Wynn]

That's just part of the requirements to get on the transplant list.

[Jordan Harbinger]

I get it. But I hate that. Because it's like you don't have enough friends and family that care about you

[Jessica Wynn]

to live if you're a loner. Sorry, I get it.

[Jordan Harbinger]

Because I mean, here, the sad reality is though, they have to do that because they want to maximize the success of the transplant. Right. And the people who have more social support have better outcomes, I assume.

[Jessica Wynn]

Correct.

[Jordan Harbinger]

Oh, gosh, there's. This is some dystopian ish man.

[Jessica Wynn]

So it just ends up that clinics aren't always aggressive about pushing people through that process.

[Jordan Harbinger]

Okay, I'm going to say why not? Even though I already know the answer. But go ahead. Why not?

[Jessica Wynn]

There's no financial incentive.

[Jordan Harbinger]

Okay.

[Jessica Wynn]

So in fact, evidence suggests clinics are slower to refer patients for transplants.

[Jordan Harbinger]

Color me surprised.

[Jessica Wynn]

Yeah, right. There was a study in the Journal of the American Society of Nephrology, which found patients at for profit dialysis clinics were 64% less likely to get on the transplant wait list compared to the patients at nonprofit clinics.

[Jordan Harbinger]

Wow, 64% less likely. That's not subtle. That. That might not be an accident, Jess.

[Jessica Wynn]

Yeah, right. Even after controlling for patient health, demographics, everything. So the difference was profit motive. It's a system that just makes suffering profitable.

[Jordan Harbinger]

So far, the lesson is if something in America is tragic enough, somebody will eventually franchise it. We'll get back to that in a moment. First, our sponsors this episode is sponsored in part by Marathon At Marathon gas stations, every stop is the start of fun. Like the awesome fuel savings you can get with Marathon Rewards. Join Marathon Rewards today and start earning rewards on every gallon of gas. You can redeem rewards at any time, saving up to $1 per gallon. And don't forget, Marathon stations are packed with all the conveniences you need to stock up and live life on the Go Marathon, where fun runs on full Available at participating Marathon locations. Terms and conditions apply. See marathonrewards.com for details. This episode is brought to you in part by Lufthansa. When people talk about travel, they usually focus on the destination, the hotel, the restaurants, all the stuff that happens after you land. But the flight is part of the experience too. Just like a great hotel can shape an entire trip, so can a great flight. That's exactly what Lufthansa Allegris is built around. On a long haul route, comfort matters more than people realize. If you're cramped, tired and can't relax, you feel it the second you land. But when a flight is comfortable, you can actually stretch out, rest, work, or just enjoy the ride. It changes the whole trip. I was thinking about that on my recent Intercontinental Lufthansa flight. I got so comfortable I honestly didn't want the flight to end. Which is not something you say very often after a long international trip. That's why Lufthansa Allegris stands out. It's built around the idea that people travel differently. Lufthansa Allegris Business class has five seat options. You've got the suite, the privacy seat and the extra long bed, the extra space seat and the classic seat so you can choose what works for you. And that's what I like most. It feels elevated, but still practical. More privacy, more comfort, more thoughtful design for the way people actually travel. Now visit lufthansa.com and search for Allegris to learn more. Lufthansa Allegris all it takes is A yes. Limited availability on select routes. More routes coming soon. Don't forget about the Jordan Harbinger subreddit. If you are a Redditor, you can talk about episodes, sponsors. There's a meme thread in there. There's a lot of fun back and forth with listeners. Gabriel's in there. Bob's in there. There's a lot of great conversation with the crew and a lot of other show fans. So come join us in the Jordan Harbinger subreddit. Now back to Skeptical Sunday. Yeah, so if you're at a for profit clinic, they're just quietly not really wanting to help you leave. In a nonprofit clinic, it makes sense, right? We need as many people to get transplants as possible, because then we have a slot open and we can get another person in here. Cause their goal is theoretically helping as many people get through as possible. Whereas a for profit clinic, they don't really care if they're full, they're full. It's like a hotel. They don't really care. Like the. All guests are kind of created equal. Right, right, right.

[Jessica Wynn]

They're just numbers.

[Jordan Harbinger]

Yeah, they're an entry in a spreadsheet. This is so. Oh, gosh. This is black mirror without, like the cool, unique technology on screen.

[Jessica Wynn]

Exactly.

[Jordan Harbinger]

Well, I guess it does. A dialysis machine is pretty cool tech, so maybe it's just black mirror.

[Jessica Wynn]

It's pretty close. And you know, these for profit clinics, they're not. Not blocking you, but they're not exactly shepherding you through either. So remember, these clinics are often understaffed. They're stretched thin. Social workers who handle transplant referrals are juggling huge caseloads. Clinics are understaffed. And if the company's revenue depends on keeping chairs filled, you know what gets prioritized?

[Jordan Harbinger]

Yes, the chairs. That's what we were just sort of implying earlier.

[Jessica Wynn]

Right?

[Jordan Harbinger]

It's the chairs that get prioritized.

[Jessica Wynn]

Of course. You know, there was a whistleblower lawsuit filed in 2015. It was one of several, but where a former DaVita employee alleged the company systematically discouraged transplant referrals. So DaVita denied it and settled, but the allegation was that staff were told not to educate patients too much about transplants.

[Jordan Harbinger]

I'm fuming over here. Quietly. Don't tell them. There's a way out. That's so bleak, man. I can't believe what I'm hearing right now.

[Jessica Wynn]

I know it's subtle. You know, it's not a written policy.

[Jordan Harbinger]

No, because they would be sued into oblivion if it were written down anywhere.

[Jessica Wynn]

It's about what gets emphasized, what gets resources, you know, what gets rewarded. So if you're a clinic manager and your bonus depends on billed treatments, are you celebrating when patients leave?

[Jordan Harbinger]

No, but it's. This is psycho, Jessica. This is psycho nonsense.

[Jessica Wynn]

I know it's really hard to swallow, but it's systemic. And here's an even more maddening part. In the US Medicare system, transplants are actually cheaper. You know, Medicare saves about $270,000 over, you know, like, 10 years per transplant patient versus dialysis.

[Jordan Harbinger]

Wow. So even if you strip away morality, pure math says transplants win. But since they don't benefit the people currently making money.

[Jessica Wynn]

Correct.

[Guest Expert]

Yeah.

[Jessica Wynn]

The savings go to Medicare, meaning taxpayers. The losses go to dialysis companies. So the system is optimized for corporate revenue instead of patient outcomes or, you know, fiscal efficiency.

[Jordan Harbinger]

Are nonprofit clinics better? Because it seems to me. Right, like I said before, their outcome is like, get as many people out of here.

[Jessica Wynn]

Yeah.

[Jordan Harbinger]

Because they're.

[Jessica Wynn]

I mean, they seem to be. They seem to be for sure. So studies show nonprofit clinics have lower mortality rates, they have higher transplant rates, and just better patient satisfaction. But they make up a shrinking share of the industry. So for profit chains have been consolidating dialysis care for years, and nonprofits, they just don't have the capital to expand at the same pace. So the consolidation continues and the profit motive grows.

[Jordan Harbinger]

Yeah. So that reinforces why home dialysis isn't pushed.

[Jessica Wynn]

Yeah, right. It makes less money for clinics. And when patients dialyze at home, they're more independent. You're not coming to the clinic three times a week. The company has less control, less opportunity to bill you for add ons and, you know, and less ability to keep you just in their ecosystem.

[Jordan Harbinger]

By the way, you said add ons. What are add ons? This should not be add ons. This is a medical treatment thing. Don't tell me they're grifting these people in the clinic as well. I mean, why wouldn't they?

[Jessica Wynn]

I guess there's upselling at the dialysis clinic.

[Jordan Harbinger]

Oh, my God, I hate. I hate this. This episode is terrible.

[Jessica Wynn]

For medications, they want to sell you vitamin supplements, iron infusions, you know, things like that. And dialysis clinics have gotten very good at finding billable services for a while. There was a major issue with over prescribing a drug called Epigen, which is for anemia. So since dialysis patients often become anemic. Epigen makes sense. But Medicare used to pay for it separately on top of the dialysis payment.

[Jordan Harbinger]

Oh, no. I know where this is going. Oh, gosh.

[Jessica Wynn]

So suddenly, Epigen doses, they skyrocketed. It became just a profit center. And these higher doses increased risks of heart attacks and strokes. Davita and Fresenius were among the biggest purchasers of Epigen in the world. And that manufacturer, Amgen was making billions.

[Jordan Harbinger]

This is crazy to man. And also the risk of heart attack and stroke. I don't want to sound unkind, but I'm going to go ahead and guess that somebody who's diabetic and on dialysis is already at sky high risk of heart attack and stroke.

[Jessica Wynn]

Yeah, exactly.

[Jordan Harbinger]

So giving them a drug that they don't need that increases that risk is. You're killing people doing this, period. I don't even need to know that that has happened as a fact to know that that has happened. Right. There's. I don't need a documented instance. Because if you're raising the risk profile of somebody who's high risk risk. Over the course of 800,000Americans doing this, three times a week, someone has died from this.

[Jessica Wynn]

Oh, yeah. It's incredibly depressing.

[Jordan Harbinger]

So the manufacturers making billions off of selling this drug to these clinics that are upselling it, slash giving it out when people don't necessarily need it because they can bill Medicaid for it.

[Jessica Wynn]

Right.

[Jordan Harbinger]

Or Medicare for it. So what, what happened?

[Jessica Wynn]

So Medicare changed how it paid for the drug, so they bundled it into the overall dialysis payment so there was no incentive to over prescribe. And Clin couldn't bill extra for higher doses. And guess what? Usage dropped immediately.

[Jordan Harbinger]

Funny how that works. That's disgusting. Yeah, that's disgusting.

[Jessica Wynn]

And at the same time, the FDA issued safety warnings because studies showed that higher doses increased the risks of all these health concerns, like the heart attacks, blood clots, and like you said, even death.

[Jordan Harbinger]

So when the financial incentive disappeared, suddenly patients didn't need as much of this drug.

[Jessica Wynn]

And Both companies have PA massive fraud settlements. Over the past 15 years, DaVita has paid around $1 billion for various allegations.

[Jordan Harbinger]

Wow. Imagine being that general counsel and your job is just to deal with fraud allegations. And you're like, okay, so we definitely did this. Let's negotiate the fine.

[Jessica Wynn]

Yeah, I'm sure they have a chant for that.

[Jordan Harbinger]

Oh, yeah. The legal department is. Those guys are busy. $1 billion in fraud settlements. Not wrongful death, not tax fraud. Like this is. You have. You are a bad actor. You have committed actual fraud. You're getting fined $1 billion. That is crazy. That is a crazy high settlement.

[Jessica Wynn]

I know. And crazy that they can afford it and stay in business. Right.

[Jordan Harbinger]

No. Cost of doing business is how. That's why they still exist. Otherwise, this would be. Oh, my gosh.

[Jessica Wynn]

Yeah. There was a $495 million in just one case for allegedly billing Medicare for drug waste.

[Jordan Harbinger]

Oh, my God.

[Jessica Wynn]

34 million just in 2025, last year for legal kickbacks to nephrologists. Fresenius has been sued for allegedly performing unnecessary vascular access surgeries to generate additional revenue. The lawsuit claimed these surgeries weren't medically necessary, but they were really profitable.

[Jordan Harbinger]

Oh, my gosh. So they're paying doctors. Nephrologist is a kidney doctor. So they're paying doctors, I don't know, probably to refer to a specific clinic or to get some treatment or something. And then they're giving people unnecessary surgeries. Again, not to beat this dead horse, but if you are already high risk for medical complications and you are, I don't know, a diabetic and you have high blood pressure, going into surgery unnecessarily could and will, in some instances, definitely kill. Like, again, someone has died from this.

[Jessica Wynn]

Absolutely.

[Jordan Harbinger]

Depending on how widespread that fake, or I should say unnecessary surgery. This is like some Nazi kind of crap. Like, we're just gonna do surgery on you because it makes us money. I mean, it's not quite the same thing, but it's up there. This is. That is up there.

[Jessica Wynn]

It's terrifying. Allegedly.

[Jordan Harbinger]

Yeah, allegedly. Sorry. Sorry. Sorry. Yes, Allegedly. Allegedly. They're doing this, but that case is

[Jessica Wynn]

ongoing, and this is the environment we're talking about. You know, when billing is the business model, pressure to maximize what you can bill for follows.

[Jordan Harbinger]

Who's regulating all this?

[Jessica Wynn]

So cms, the Centers for Medicare and Medicaid Services. They oversee dialysis clinic clinics, and there are standards for water quality, infection control, and staffing. The clinics do get inspected, but here's the. The regulatory burden has exploded, but outcomes haven't improved proportionally.

[Jordan Harbinger]

What do you mean?

[Jessica Wynn]

So there's a quality measures manual for dialysis clinics, and it doubled in size from 150 pages in 2016 to 280 pages in 2025. And the patient survey they're required to administer is 62 questions long. And so that's insane. And less than 30% of patients even respond to it.

[Jordan Harbinger]

And that doesn't actually help patients, of

[Jessica Wynn]

course not, because the standards focus on compliance, not outcomes. So a clinic can check every box and still have terrible outcomes. They can meet every technical requirement and still have patients who are miserable or dying at astonishingly high rates. Rates? There was an investigation by ProPublica a few years ago that found wide variation in mortality rates between clinics. And some had death rates 50% higher than the national average.

[Jordan Harbinger]

Oh, my gosh, that's significant. Okay, so how is that possible, though, if they're all regulated?

[Jessica Wynn]

Because the regulations don't measure quality of life or long term outcomes very well. They measure things like, is the water clean, are infections logged, are treatments happening on schedule? You know?

[Jordan Harbinger]

Yeah. Okay, this almost sounds like soft regulatory capture.

[Jessica Wynn]

Yeah, soft is right.

[Jordan Harbinger]

Meaning not like cartoon villain corruption, just regulators. Maybe slowly over time, getting too cozy with the industry they're supposed to oversee. Same language, same incentives. I mean, if there's. If it's a duopoly. So there's two companies and it's just this lucrative. There's kind of no way that you don't end up with big problems.

[Jessica Wynn]

And when these two giant companies with enormous resources are running the show, they have sway over how the rules are written.

[Jordan Harbinger]

Yeah, that's what I mean. Yeah.

[Jessica Wynn]

Yeah. So they submit comments on proposed regulations. They're the ones funding studies. They hire former CMS officials as consultants. They spend about $2 million each on federal lobbying. And so over time, the regulatory environment just becomes comfortable for them.

[Jordan Harbinger]

That is. Is bleak. That is complicated, but bleak also. I. I don't know. Side note here, but it is amazing how low that number is. $2 million each. It kind of sounds like a lot, but give me a break. You only need two or whatever, $4 million to get the government to let you charge the taxpayers billions of dollars. That is really great roi. Our Congress people are pathetically cheap dates. If that's really what this costs.

[Jessica Wynn]

Yeah, which shouldn't surprise anyone.

[Jordan Harbinger]

I would have thought you had a zero on the end to the amount that they had to lobby to get this stuff. I mean, I guess it's. Come on. Wow.

[Jessica Wynn]

And so they fund patient advocacy groups. You know, organizations that ostensibly represent patient interests but are financially supported by dialysis companies. So when legislation comes up that might hurt the industry, these groups will oppose it. You know, framed as protecting patient access.

[Jordan Harbinger]

Yeah, that's sinister. But it's also super common, so I don't even know if we can act surprised that that's happening.

[Jessica Wynn]

Right. I know, know, but lower reimbursement could cause some clinics to close, which would hurt access. But the framing is always about protecting the current system, never about redesigning it.

[Jordan Harbinger]

Okay, I need to understand the patient experience more. So let's come back to the human side here. What does this feel like? Do we know what this feels like? I can't imagine you feel great after dialysis, even though it's cleaned you up.

[Jessica Wynn]

Well, people try to discredit it. So I'll tell you about another patient. There was this guy I read about named Marcus. He was 54. He worked in construction, and he had kidney failure from untreated hypertension. He described dialysis as, quote, imagine the worst hangover you've ever had. That's how I feel when I wake up on treatment days because the toxins have built up. Then I sit in a chair for four hours while the machine sucks out my blood. Blood cleans it and pumps it back. Afterward, I'm wiped out. Not just tired, wiped, brain fog, nausea, muscle cramps. I go home and sleep. The next day, I feel almost human. Then the cycle starts again.

[Jordan Harbinger]

Wow. Three times a week.

[Jessica Wynn]

Three times a week, you go through that. And here's what people don't realize. You can't travel easily, right? You can't take a spontaneous trip. If you want to go somewhere, you need to arrange dialysis at a clinic near your destination. That's, you know, if they have an open chair. And it has to fit your schedule. So this man, Marcus, he missed his daughter's wedding because they just couldn't arrange dialysis where she lived.

[Jordan Harbinger]

Gee, that sucks. I'm sorry to hear that. That's awful. So he misses his daughter's wedding. I don't really know how that's. It seems like that shouldn't happen. I don't know. But I guess if they don't have enough chairs and appointments, like, that's it. You just can't go, right?

[Jessica Wynn]

And I think in his case case there was a lot of optimism, like, of course. Of course this is going to happen for you. And then at the last minute, it just. They couldn't make it work.

[Jordan Harbinger]

Oh, man.

[Jessica Wynn]

You know, and dialysis doesn't just replace your kidney function, right? It reorganizes your entire existence. Your job has to accommodate your schedule, which is what puts people into. Yes, Medicare covers it, but people go into financial hardship because you can't really work while you're doing this. Your social life revolves around it. Imagine trying to date while you're on dialysis. You know, who wants to date someone who's exhausted half the week? And big life events become logistical puzzles because clinics or machine rentals are just not available. So you might miss things like walking your daughter down the aisle.

[Jordan Harbinger]

I know someone's thinking it, so I'm just gonna say it. I guess if you Date somebody who's on dialysis. You should also maybe be on dialysis, Right?

[Jessica Wynn]

And then you just hang out at

[Jordan Harbinger]

the cliff, sync your appointments up, and you. Yeah, you go and you say, hey, we want two chair next to each other. And you bust out the sorry or trouble or some. Or Monopoly or something like that. And you just. You have four hours of uninterrupted. I don't know. I'm joking, but I. I'm gonna guess while you're doing this, maybe you don't feel like having a great time. You might just be sitting there with a slamming headache or something. I don't. I don't know.

[Jessica Wynn]

I didn't read about what it does to your libido, but it can't be good.

[Jordan Harbinger]

Yeah, I just. In just like you do, can you just lay there sort of like on an airplane, you're watching a movie and you feel dehydrated and gross? You know, that's kind of what I'm imag. It's sad that this is just accepted as normal for these people. This is just their life now. That's depressing.

[Jessica Wynn]

And dialysis is invisible. I mean, most patients, they don't talk about it because there's a stigma, there's exhaustion, and there's this constant emotional math of gratitude versus suffering.

[Jordan Harbinger]

Sure.

[Jessica Wynn]

Like, you're supposed to be grateful because the machine is keeping you alive, which it is. But that doesn't mean the system is okay.

[Jordan Harbinger]

Right? You can say, this keeps people alive and still say, hey, the way we've built this is insane.

[Jessica Wynn]

Exactly. Exactly. And that's where criticism gets shut down. Because if you say, hey, the dialysis industry has problems, someone will respond with, oh, so you want people to die? It's like, no, I want people to live. Well, there is a difference.

[Jordan Harbinger]

So what are the clinics like? What is a day of dialysis like in this place?

[Jessica Wynn]

Yeah. So, I mean, it varies, but the typical setup is a large room with maybe, you know, 20 to 30 reclining chairs arranged in rows. Each chair has a dialysis machine next to it. Patients come in, they get weighed, they get their blood pressure taken, the needles are inserted, and then they sit for four hours.

[Jordan Harbinger]

What do people do? Like I said, you bust out a game or you watch tv. I mean, I don't know. What do you. What do you do?

[Jessica Wynn]

Yeah, I mean, they watch tv, they sleep. If you can focus, I guess you could read. Some people bring their laptops, but a lot of patients, they just feel too crappy to concentrate.

[Jordan Harbinger]

That's what I'm thinking. Yeah. Yeah.

[Jessica Wynn]

I mean, there is a strange community that forms, and I think this happens with chemo patients, too. You know, you see the same people three times a week for years. So some people make friends, others just endure.

[Jordan Harbinger]

You know, statistically speaking, someone is almost certainly listening to this right now while undergoing dialysis. So if that's you, I hope it's going well for you. And we're thinking about you right now, thinking of you, and we hope you feel better soon and go find out how to get a transplant if you haven't done that already, because we want you to survive and not have to do this crap anymore. What about staffing at the clinics?

[Jessica Wynn]

So this is a major issue. Nurses and techs are often stretched thin. In some clinics, one nurse is managing six or seven patients simultaneously, and turnover is high because the work is really hard and the pay isn't great. And when staffing is thin, you know, that's when corners get cut and patients don't get as much attention. That's when the infection rates go up. And remember those infection statistics we Talked about? That's 36% of deaths of people on dialysis are from infection. So this isn't abstract. You know, understaffing kills people.

[Jordan Harbinger]

So people are dying because clinics save money on labor.

[Jessica Wynn]

I mean, that's the implication. So you maximize profit by minimizing labor costs, and in healthcare, that means worse outcomes.

[Jordan Harbinger]

Yeah, of course. There's kind of no way around that. I'm curious if you know what happened when Covid hit, because that must have just been like a bomb going off in this industry.

[Jessica Wynn]

Oh, my gosh.

[Guest Expert]

Yeah.

[Jessica Wynn]

Covid was catastrophic for dialysis patients. So even though dialysis was still available during lockdown, 25% of dialysis patients who got Covid, they died. That's one in four. So it exceeded death rates in the general population by a huge margin. And there was actually a decline in the US Dialysis patient census for the first time because of all these excess deaths.

[Jordan Harbinger]

One in four dialysis patients who got Covid died. Wow. Because of their super high risk for exactly this kind of thing. And also. Oh, man.

[Jessica Wynn]

Yeah. I mean, it was a perfect storm. So they're immunocompromised, they're in clinics with other sick people three times a week. They can't isolate the one positive outcome from it was that it accelerated the shift to home dialysis. So suddenly there was, you know, urgency around getting people out of clinics.

[Jordan Harbinger]

So a global pandemic with a lethality of 1 in 4 in the target population that we're talking about now had to happen for the system to prioritize the thing that was better and cheaper for patients all along. That's yeah, okay. If you weren't angry before, you should be now.

[Jessica Wynn]

Yeah. And Medicare started pushing harder for home dialysis, but progress is slow because the financial incentives, they haven't fundamentally changed.

[Jordan Harbinger]

Nothing says modern healthcare like we can keep you alive, but only in the most expensive and depressing way possible. More on that in just a moment. This episode is sponsored in part by LinkedIn. Running a small business means every hire matters. A bad hire can cost you time, money and momentum. A good hire that can help you grow your business. This gives me flashbacks to a nightmare hire in my previous company that really stunted the business, and even talking about it now makes my blood pressure go up. But the right hire is the exact opposite. Somebody who takes ownership, solves problems, and helps the business grow faster. And when you're small, that kind of impact is massive. But finding great talent isn't easy, especially when you don't have the time or resources to sift through piles of resumes to find the right fit. That's why LinkedIn built Hiring Pro, your new hiring partner that screens candidates for you. So instead of sorting through applications, you spend your time talking to candidates who are actually a good fit. With Hiring Pro, you can hire with confidence, knowing you're getting the best talent for your business business. In fact, Those hiring with LinkedIn are 24% less likely to need to reopen a role within 12 months compared to the leading competitor.

[Sponsor Voice]

Join the 2.7 million small businesses using LinkedIn to hire. Get started by posting your job for [e-mail] harbinger terms and conditions apply with verbo care.

[Jessica Wynn]

Help is always ready before, during and after your stay. We've planned for the plot twists, so support is always available because a great trip starts with peace of mind.

[Jordan Harbinger]

Thank you for listening to and supporting the show. Your support of our sponsors keeps the lights on around here. All of the deals, discount codes and ways to support the show are searchable and clickable on the [e-mail] deals please consider supporting those who support the show. Now for the rest of Skeptical Sunday. Tell me about other countries. Does anyone do this better? Denmark probably has a device that fits in the palm of your hand that you can walk around during the day doing this, right? It's free, right?

[Jessica Wynn]

They just have a kidney vending machine.

[Jordan Harbinger]

Yeah, but that's Japan. But yeah, go ahead, go ahead. And the problem is in Japan it's someone else's kidney.

[Jessica Wynn]

But several countries do it better. So in the Netherlands, about 40% of dialysis patients use home dialysis, compared to just 12%. Here in Hong Kong, it's over 70%.

[Jordan Harbinger]

Wow. 70%. That's incredible.

[Jessica Wynn]

Because they prioritize, they train patients, they provide support, and they make it the default option unless there's a reason not to.

[Jordan Harbinger]

Right. Okay.

[Jessica Wynn]

And their outcomes are better. They have lower mortality, they have better quality of life.

[Jordan Harbinger]

Yeah. Because you're at home with your family, chilling, watching It's a Wonderful Life or something, with this little thing beeping next to you. You don't have to schlep over someplace with a bunch of strangers and get an infection. Why can't we do that again in America? I don't understand what the. So is it really just. Hey, the clinics get. It's got to be incentives. Yeah, yeah.

[Jessica Wynn]

I mean, we could. Could do it, but it would require changing the incentives. So Medicare could pay more for home dialysis or pay bonuses to clinics that transition patients home. They've started doing this. Actually, there's a push to increase home dialysis rates, but it's slow because companies are resisting the shift when they see they're going to lose money.

[Jordan Harbinger]

What about transplants? Do other countries do that stuff better? I know that's a different episode.

[Jessica Wynn]

Yeah, we talked about that in the organ donation. And a lot of countries are much better at transplants. So Spain uses that opt out system. So you're a donor unless you say otherwise. We're in America, we're opt in. And their transplant rates are among the highest in the world.

[Jordan Harbinger]

We have opt in here. Yeah. You have to elect to do it.

[Jessica Wynn]

Right. We have opt in. And even then families can override that decision, which is a whole other issue. So we have chronic organ shortages as well. There are also innovations like paired kidney exchange programs, where incompatible donor recipient pairs, they swap kidneys with other pairs to make compatible matches.

[Jordan Harbinger]

Okay.

[Jessica Wynn]

There's all kinds of issues, and these are growing, but they're logistically complex and really underfunded.

[Jordan Harbinger]

What about artificial kidneys? Speaking of vending machines. Right. Is that science? I mean, this vending machine thing is fake. I obviously. But artificial kidneys, is that science fiction still at this point, or are we. How's that looking?

[Jessica Wynn]

It's actually real, but it's slow. So there are researchers working on implantable artificial kidneys, like some kinds of wearable devices. They're even talking about bioengineered kidneys that might be possible to grow from stem cells. The science is promising, but, you know, development is expensive. The path to FDA approval would be really long. We're just not there yet.

[Jordan Harbinger]

I see. And the dialysis industry, I'm guessing they're not involved in funding all this research, right?

[Jessica Wynn]

Why would they? If someone invents a portable artificial kidney that you wear like an insulin pump, that's the end of the dialysis clinic model. There's no incentive for incumbents to disrupt the system.

[Jordan Harbinger]

So innovation is happening despite the industry, not because.

[Jessica Wynn]

Because of it? Mostly, yes. You know, there are some companies exploring new technologies, but the big players are focused on optimizing the current model, not replacing it.

[Jordan Harbinger]

Okay, so. Because the quietest tragedy in all this is lack of prevention, right? Yeah.

[Jessica Wynn]

I mean, this is the part that makes me angriest, I think. I don't know. A lot of this makes me angry. But chronic kidney disease is often preventable or at least delayable. So if you catch it early, if you manage your diabetes well, control your blood pressure, you can slow progression dramatically. In fact, many people with early stage kidney disease never progress to kidney failure if it's caught early.

[Jordan Harbinger]

But we don't invest in that.

[Jessica Wynn]

We barely invest in that. Nephrologists, the kidney doctors, they're among the lowest paid specialists, and there's a shortage of of them. So primary care doctors are overworked and often don't catch kidney disease until it's advanced. The screening's really inconsistent. The education's really minimal. You know, we're back to patients like rationing insulin.

[Jordan Harbinger]

Because prevention doesn't really make money. And you can't bill Medicare for something that never happens.

[Jessica Wynn]

Right. Prevention means nothing dramatic happens. There's no emergency. There's no machine. There's no chair care. There's no $90,000 a year treatment. You know, it means someone stays healthy and never enters the system. And there's no billing code for that. So prevention pays society with fewer sick people and lower costs, but dialysis pays companies. So we have this perverse setup where the most profitable outcome is late intervention, indefinite treatment, and no cure.

[Jordan Harbinger]

By the way, I want to say real quick, I know someone's going to be like, no, Medicaid also pays for part of dial I. No, we're saying Medicare. It does. That is what pays for the bulk of it. And it's just easier than saying both of those things at once. So for people who are ready to fire that off in an email, we know. It's just. We're trying to keep it simple. Okay, what would proper prevention look like

[Jessica Wynn]

here, it would just be aggressive screening for high risk populations. You know, better diabetes management. Access to healthy food would help treatment for hypertension. So nephrology consultations for anyone with early stage kidney disease would stop a lot of people from going into dialysis. You know, it's not some exotic idea. We know how to do this.

[Jordan Harbinger]

Right. We just don't.

[Jessica Wynn]

Right. We don't fund it. There's no lobby for prevention, but there's a massive lobby for dialysis. Spending millions on political campaigns, funding patient groups, groups shaping the conversation.

[Jordan Harbinger]

You've spent a lot of time on this. When you talk to patients, what do they want?

[Jessica Wynn]

And they want their lives back. You know, that's the consistent theme with people. They're grateful for dialysis. Most of them would be dead without it. But they also don't want to live this way. They want to travel. They want to work full time. They don't want to feel like shit half the week. And they want to feel like the system is trying to get them off dialysis, not keep them on it.

[Jordan Harbinger]

Well, do they feel like the system is trying mostly?

[Jessica Wynn]

No, they feel like they're in a holding pattern. And here's what's really hard. Many patients blame themselves. You know, they think if I just managed my diabetes better, if I'd just gone to the doctor sooner, if I'd eaten better. All of these things you would say to yourself. And sure, personal choices matter, but these are people who often didn't have good options available to begin with with. You know, they couldn't afford medications. They couldn't get doctors appointments or insurance even if they were working two jobs or they lived in neighborhoods where the only nearby food was fast food.

[Jordan Harbinger]

So the system failed them. And then they blame themselves. That's right. It's heartbreaking. Yeah.

[Jessica Wynn]

And then the system locks them into these. This permanent treatment while profiting from it. So it's hard not to see it as exploitation.

[Jordan Harbinger]

I'm sympathetic to the whole, like, personal choice thing, but I don't know, when you talk about, like, the food desert thing and the medical thing, and then there's also the genetic thing, it's like, it's a bad hand. Like you said earlier in the episode, I suppose somebody could say, hey, you guys are being anti medicine, or you're being extreme, saying it's exploitation, like, come on, guys.

[Jessica Wynn]

I know, but we don't want to look at it. But the industry hides behind the fact that it's providing necessary care, which it absolutely is. But the dialysis system, it's not optimal. And it's certainly not ethical. So we can acknowledge that dialysis saves lives. Lives. While also demanding it does better.

[Jordan Harbinger]

Okay, and what does better look like?

[Jessica Wynn]

So it looks like this aggressive prevention, so fewer people need the dialysis. It looks like incentivizing home dialysis and transplants. You know, let's break up this duopoly so there's actual competition. It would look like regulation that focuses on outcomes, not just compliance. Better staffing ratios to reduce those horrific infection rates. And it looks like funding research into alternatives into those portable kidneys, those bioengineered organs, whatever works.

[Jordan Harbinger]

All of which would reduce revenue for the current players.

[Jessica Wynn]

Exactly. So it won't happen without political will. No. Medicare could change payment structures tomorrow. Congress could fund prevention programs. The FDA could fast track artificial kidney research. But all of that requires overcoming industry resistance.

[Jordan Harbinger]

And industry has money and lobbyists and patient groups that they fund.

[Jessica Wynn]

Yeah, right. And nobody wants to be accused of rationing care or letting people die. So the conversation doesn't happen. We just keep writing checks and the system continues.

[Jordan Harbinger]

How do we change that?

[Jessica Wynn]

I mean, honestly, visibility. Podcasts like this, you know, most people don't know this is happening. Happening. Dialysis is invisible until it's personal. And if people understood the scale of this, that half a million Americans trapped in a system optimized for profit, not outcomes where 60% won't survive five years, where infections kill more than a third of the patients, where people are choosing death over continuing treatment. You know, maybe if people realize that, there'd be pressure for reform.

[Jordan Harbinger]

But it requires people to care about something that maybe doesn't affect them directly at the moment.

[Jessica Wynn]

I know. For now. But kidney disease is growing. Diabetes is growing, hypertension is growing. So more people are going to face this. But the system isn't designed for them. You know, it's designed for shareholders.

[Jordan Harbinger]

Yeah, that's bleak, man.

[Jessica Wynn]

Yeah, but it's realistic. And here's the thing. It doesn't have to be this way. You know, we built this system through policy choices. We can unbuild it the same way. Way. So we just need to decide that keeping people alive isn't enough. You know, we should want them to live.

[Jordan Harbinger]

Well, you would think that would be part of the baseline, but I. I get it. There's numbers involved, but it's like, man, we are really focused on those numbers.

[Jessica Wynn]

Yeah, I mean, you'd think. But when profit is the organizing principle, alive becomes the acceptable outcome, everything else seems optional.

[Jordan Harbinger]

So what do we tell people? What's the action item here? The take, Takeaway.

[Jessica Wynn]

I mean, you know, if you have diabetes or hypertension, manage it aggressively. Get your kidney checked regularly. It's just a blood test and a urine test. If you have chronic kidney disease, see a nephrologist early. You know, don't wait until you're in crisis. And if someone you care about is on dialysis, support them. Encourage them to talk with their doctor about transplant eligibility or whether home dialysis might be an option. Option. Sometimes patients just don't realize those conversations are available to them. And politically, I mean, politically, we have to support policies that fund prevention and expand transplant programs. We could demand that Medicare reward outcomes, not just volume. And we have to be skeptical when patient advocacy groups oppose reforms. You know, look at who's funding that and address those infection rates. I mean, 36% of dialysis death deaths involving infection. It's unacceptable.

[Jordan Harbinger]

Yeah, that's insane to me. And that's where we are. We've built a system that rewards keeping people alive, but not really necessarily helping them live well at all. That's just not. That's an afterthought, right?

[Jessica Wynn]

I mean, I want to emphasize here, dialysis saves lives, but the business model was built for permanence, not prevention, mobility, or cure.

[Jordan Harbinger]

Yeah, that's a strange place for medicine to help end up.

[Jessica Wynn]

Yeah, and it doesn't have to stay this way. The system was built through policy choices. It can be rebuilt the same way. Ethical medicine requires asking how people live, not just whether they live. You know, dialysis isn't a scam. It's not malicious. It's a necessary medical intervention. It's just trapped inside a system that puts profit first.

[Jordan Harbinger]

Thank you, Jess. I feel depressed discovering kidneys have a $50 billion industry built around the them or failed kidneys.

[Jessica Wynn]

Yeah, you're welcome. You know, I'm happy to contribute to the existential dread here, but people do

[Jordan Harbinger]

need to know about this. And to anyone listening who's on dialysis or loves someone who is. This system is hard. It's complicated. So filter the facts as carefully as your kidneys are supposed to. And if you haven't, maybe go get your kidneys checked by a doctor, hopefully who's not being paid under the table by one of the dialysis companies. Maybe get a second to be opinion. I really feel for you if you're dealing with this. I hope this episode was enlightening for everyone else as well. Jess, this is a really good episode. Oh, shoot. That's not what I want to say. Jess, terrible work today. Terrible. I'm ashamed of you.

[Jessica Wynn]

I'm sorry to disappoint you and thank

[Jordan Harbinger]

you all so much for listening. Topic suggestions for future episodes of Skeptical Sunday to me jordanordanharbinger.com advertisers, deals, discounts, ways to support the show [e-mail] deals I'm @jordan Harbinger on Twitter and Instagram. You can also connect with me on link LinkedIn. You can find Jessica on her multiple substacks between the lines and where shadows linger. We'll of course link to those in the show notes. Her work is also on instagram @nevermet. Jessica's that's plural for some reason. This show is created in association with Podcast One. My team is Jen Harbinger, Jace Sanderson, Tata Savaskis, Robert Fogarty, Ian Baird, Gabriel Mizrahi in the house as well. Our advice and opinions are our own. And yeah, I'm a lawyer, but I'm not your lawyer. Of course we try to get these as right as we can. Not everything is gospel, even if it is fun. Fact checked. So consult a qualified professional before applying anything you hear on the show, especially if it's about your health and well being. Remember, we rise by lifting others. Share the show with those you love. If you found this episode useful, please share it with somebody else who could use a good dose of the skepticism and knowledge that we doled out today. In the meantime, I hope you apply what you hear on the show so you can live what you learn. And we'll see you next time. You're about to hear a preview about the biggest threats to your health that most people never see coming. From microplastics in the brain to everyday habits that quietly chip away at your

[Guest Expert]

energy, focus and longevity, I think microplastics are a problem. Most people know generally what they are. I mean, these are like small pieces of plastic that come off larger pieces and they get into our bodies mostly through what we're ingesting. And they're in the air as well. And so they get smaller and smaller and smaller. They're called nanoplastic. And the smaller they get, they become more dangerous in a way because we can absorb them easier. It's in our water sources. It's on the plants that we eat. So vegetables and fruits, because it's in the soil and they get on the plants. It's in the plants, it's in meat, it's in every. It's all over the place. Air is a big source of microplastic pollution as well. It's getting everywhere in our organs. But dietary fiber seems to prevent absorption in a couple different ways. Particularly soluble fiber fibers, fermentable fiber, prebiotics. Right. Those are all sort of interchangeable ways of saying soluble fiber. Fruits, fruits is a big one. The skins of fruits, some vegetables as well. But you can supplement with it, like inulin. You know, there's a lot of these prebiotic fibers people take as well. Beta glucans is another one. The point is, is that if there's something you can do to prevent your body from absorbing it, that's the best. And try to eliminate these microplastics as much as they can. And the number one thing you can do is get a water filter for sure. Air filters in your house, water filters in your house. Those are the two top things that you can do. The reality is, is that microplastics, it's just everywhere.

[Jordan Harbinger]

Catch the full conversation with Dr. Rhonda Patrick for the science behind it all and the practical changes that can actually make a difference on episode 1267 of the Jordan Harbinger Show. Suffering from dry, tired, irritated eyes. Don't let dry eyes win. Use Sustain Pro. It hydrates, restores and protects dry eyes for up to 12 hours. Sustain Pro Triple action Dry eye relief.

[Jessica Wynn]

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[Jordan Harbinger]

Classic group chat move.

[Jessica Wynn]

Don't walk into a surprise. Book a top rated VRBO stay with a premier host if you know you. VRBO support is available 247 with VRBOcare. We're here day or night, ready whenever you need need help Because a great trip starts with the right support.