Podcast Summary: “The Most Dangerous Part of America’s Healthcare System Isn’t What You Think”

Podcast: What Now? with Trevor Noah
Guests: Tom Mueller (author, "How to Make a Killing")
Release Date: November 27, 2025

Overview

In this episode, Trevor Noah and co-host Eugene welcome investigative journalist and author Tom Mueller. They explore the hidden crisis in America’s healthcare system through the lens of the dialysis industry—a microcosm of broader systemic dysfunction. With humor, candor, and incisive questioning, the conversation weaves through corruption, white collar crime, institutional incentives, the corporatization of care, the outsized influence of profit, and the crucial role of whistleblowers, culminating in a call for urgent structural change.

Key Discussion Points & Insights

1. Tom Mueller’s Background and Perspective

• Grew up in the US, has lived in Europe for over 30 years, allowing for a ‘stepped-back’ perspective on American systems.
• Early stint at Goldman Sachs shaped his view on business, “I met some of the most fantastic people in the world and I came away with this amazement that some of the most fantastic people in the world were swindled into giving their lives away for a modest amount of money.” [06:10]

2. White Collar Crime as Societal Cancer

• The normalization and glamorization of white collar crime, contrasted with the demonization of ‘blue collar’ crime.
  • “White collar crime is vastly more… the cancer of society. It’s vastly more damaging. It causes massive amounts of harm. But as you say, it’s almost lionized in the business school community.” – Tom Mueller [08:38]
• Systemic failure to hold wealthy and powerful actors accountable.
  • “Individuals don’t go to jail anymore. It’s corporations… So it’s the perfect crime.” – Tom Mueller [09:21]

3. Enablers and Complicity

• The infrastructure supporting corruption: banks, lawyers, accountants, real estate, etc.
  • “Those enablers, those bankers, had their finger on the trigger every time the Sinaloa cartel fired.” – Mueller quoting a whistleblower [11:10]
• Challenging society’s double standard for penalizing “street crime” versus “boardroom crime.”

4. Dialysis: From Miracle to Cautionary Tale

• Dialysis began as a miracle technology, prompting Congress in 1972 to enact the only true Medicare-for-all program—originally a symbol of national solidarity and care.
• Over decades, the dialysis industry evolved into a “perfect microcosm of what can go horribly wrong when you put profits before patient care.” – Tom Mueller [18:00]
• Critical context:
  • US patients on dialysis die 2–3 times faster than in comparable developed nations.
  • “In America, patients on dialysis die one to two times faster than in any other developed country.” [00:16, intro]

The Transition: Government to Private Profit

• Private companies identified Medicare as a revenue stream and, through what Mueller terms “professional ineptness,” took over, prioritizing profit over outcomes.
  • “Now you’re getting a shit thing for an expensive price. But you then hate the government!” – Trevor Noah [51:54]
• Two major corporations control 80% of US dialysis—turning care into an assembly line akin to fast food:
  • “You are looking at Wall Street more than your patients. They are hedge funds with exposure to healthcare.” – Mueller [23:11]
  • “It’s fast food medicine.” – Mueller [38:17]

5. Systemic Failure and Accountability

• US regulators (CMS) know what good care looks like but do not enforce or measure the correct metrics—often due to regulatory capture via a “revolving door” with industry.
  • “The silent partner in the crime… is the National Health Administration in America, that is simply in bed with or complicit with or toothless to do anything about major corporate wrongdoing.” – Mueller [47:33]
• International comparisons highlight the US system’s unique dysfunction.
  • “They die two to three times faster than any other developed world and many lesser developed countries as well… The basic promise of the Reaganomics era… Now in America, we do it worse and we do it vastly more expensively at the same time.” – Mueller [43:42]

6. The Role of Language, Media, and Marketing

• Media, often owned by oligarchs or major corporations, fuels reverence for financial titans and shapes public opinion.
  • “Half the media is owned by those very people… There’s a lot of self-editing.” – Mueller [36:22]
• Terminology confers power or diminishes it: “white collar crime” vs. “crime,” “whistleblowers” vs. “snitches.”
  • “Why is it a… No, no, this is a white collar crime. We’ve almost given it a respectability it doesn’t deserve.” – Trevor Noah [12:31]
  • “When it’s corporate, it’s whistleblowing… When it’s violent crimes… informant. It’s just information.” – Eugene [67:59]

7. Personal Responsibility and Societal Complicity

• Trevor and Tom wrestle with the question of investor responsibility: “Do you think people know when they’re investing in these companies what they’re investing into?” – Trevor [24:22]
  • “No idea. No. All of the signaling, all of the PR is about health and wellness and thriving.” – Mueller [24:42]
  • Major investors like Warren Buffett face more complicity; “You should probably do your homework because that’s part of your responsibility as a citizen. But the people who are really complicit… are people like Warren Buffett.” – Mueller [24:42]
• Absence of accountability at scale: “If you do something on a big enough scale, it’s somehow not seen as the same issue multiplied, when in fact it is.” – Trevor Noah [78:07]

8. Structural Racism, Health Inequality, & Redlining

• The disproportionate burden of dialysis and kidney disease maps directly onto America’s long legacy of segregation and redlining.
  • “If you’re black in America, you’re 13% of the population, but you’re 35% of the end stage renal disease or kidney failure population. You’re four times more likely to get dialysis than if you’re white.” – Mueller [60:24]
  • In Chicago, a 30-year disparity in life expectancy within the same city. [61:34]

9. The Essential Role—and Cost—of Whistleblowers

• Whistleblowers are the linchpin for exposing entrenched wrongdoing, but are often destroyed or discredited by their organizations.
  • “It’s like this immune response… They’re so angry and so frightened. Because at the end of the day, those whistleblowers really do have the kryptonite… The question is whether they’ll be able to give the kryptonite to someone who can use it before they are rubbed out.” – Mueller [67:11]
• The attack on whistleblowers is a reflection of deeper institutional rottenness.
  • “If you can’t deal with the message, kill the messenger.” – Mueller [68:52]

10. Paths Toward Reform and Hope

• Concrete reforms are possible: learn from international best practices, enforce evidence-based care, address regulatory capture, support community efforts.
• “It needs to start with information, good information… But it can, I think, in a pretty short space of time, you can turn something around by taking the small community view and building outwards…” – Mueller [88:11]
• Community initiatives like Homeboy Industries and local advocacy offer tangible hope when system-wide reform feels distant.

Notable Quotes & Memorable Moments

On Systemic, Invisible Harm

• “If you shoot somebody in the street… you are a criminal. But if you defraud millions of people’s pensions… this is white collar crime. It’s amazing that we’ve given crime a different name, but why…?” – Trevor Noah [12:31]

On Health as a Rosetta Stone for Dysfunction

• “That’s what you’ve shown us with the dialysis model… let me show you this example, show it to you so clearly that you can then understand every different language of what’s going wrong in American healthcare.” – Trevor Noah [46:29]

On Corporate Capture

• “The folks who are really complicit to me are people like Warren Buffett. I mean, you own 40% of a company… You should be kicking the tires on what’s going on.” – Mueller [24:42]

On Racial Disparities

• “It is absolutely… a perfect radiograph CT scan of what’s wrong with racialized structural racism in America. It is the poster child.” – Mueller [63:31]

On the Power (and Peril) of Whistleblowers

• “The scorched earth approach to whistleblowing is literally they can’t deal with the message… The person is right, the whistleblower is right, you just destroy their credibility and it goes away.” – Mueller [68:52]

On Urgency and Accountability

• “There’s an urgency to this that gets me, keeps me awake at night. Every day since we’ve been talking here, people are in harm’s way. This needs to stop. Like yesterday.” – Mueller [97:40]

Key Segment Timestamps

• Tom’s background & expatriate lens: [03:13–05:22]
• Banking & Wall Street culture: [05:27–09:19]
• White collar crime vs. street crime: [08:19–14:16]
• Origins of dialysis as social good: [16:46–20:39]
• Transformation of dialysis into a profit machine: [21:15–24:42]
• Assembly line medicine, fast food analogy: [38:17–41:44]
• International comparisons & mortality stats: [43:22–44:43]
• Exploration of systemic racism & health disparities: [60:24–64:34]
• Whistleblowers, language, and institutional response: [67:11–69:50]
• Personal motivation and community change: [88:11–99:04]
• Impact of book, lawsuits, and hope for reform: [89:22–91:37]

Closing Thoughts

The episode is a compelling, unflinching examination of how profit-seeking in healthcare erodes trust, worsens outcomes, and intensifies inequality. Through Tom Mueller’s research and storytelling, listeners come to see not just the dangerous incentives embedded in dialysis, but a template for understanding—and challenging—dysfunction across American institutions. The conversation ends in a plea for better information, bolder whistleblowers, empowered communities, and a return to the common good.

Memorable closing:

“It’s all up to all of us… There is no, you know, knight in shining armor… The cavalry is not coming.” – Tom Mueller [99:15]

Further Exploration

• Tom Mueller’s book: "How to Make a Killing: Blood, Death, and Dollars in American Medicine"
• Investigate whistleblower stories in other industries (finance, pharma, defense)
• Resources on racial health disparities (e.g., The Institute for Race, Power and Political Economy).

For full context and rich, candid storytelling, listen to the full episode on the What Now? with Trevor Noah podcast feed.