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

Summary

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

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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.

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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.

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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]

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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]

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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]

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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).

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

Transcript

[A]

The Story of dialysis is an amazing case study of good intentions being thwarted.

[B]

By bad incentives, poor oversight and profiteering. When I was working at DaVita, the.

[A]

Priorities was to get them on dialysis and get the next patient on as soon as possible. It was all about numbers.

[B]

Tom Mueller is the author of how to Make a An Investigation of the Dialysis Industry. In America, patients on dialysis die one to two times faster than in any other developed country.

[A]

This is what now with Trevor Noah. This episode is presented by Whole Foods Market. Eat well for less. This message is brought to you by Apple Card. Did you know that Apple Card is designed to help you pay off your balance faster with smart payment suggestions? And because fees don't help you, Apple Card doesn't have any. That's right. No fees. So if your credit card isn't Apple Card, maybe it should be subject to credit approval. Apple Card issued by Goldman Sachs Bank USA, Salt Lake City Branch. Variable APRs for Apple Card range from 17.99% to 28.24% based on creditworthiness rates as of October 1, 2025. Existing customers can view their variable APR in the wallet app or card.apple.com terms and more at app. The 2026 Chevy Equinox is more than an SUV. It's your Sunday tailgate and your parking lot snack bar.

[B]

Your lucky jersey, your chairs and your big cooler fit perfectly in your even bigger cargo space. And when it's go time, your 11.3-inch diagonal touchscreen's got the playbook, the playlist.

[A]

And the tech to stay a step ahead.

[B]

It's more than an suv. It's your Equinox Chevrolet together.

[A]

Let's Dr. I've never known you without glasses. Now that I realize it, you actually have.

[C]

When half of our relationship was without glasses.

[A]

What? Take off your glasses.

[C]

Remember this guy?

[A]

No, actually, I know. You're right. You're right, Actually. Yeah, the beard. Now, it's like a flip.

[C]

It was no beard, more hair, no glasses.

[A]

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

[C]

Do you know this guy?

[A]

Eugene, where are you?

[C]

I'm here.

[A]

Oh, Eugene, you're back.

[B]

I think someone else is.

[A]

Where is he?

[B]

Well, I'm just saying welcome to.

[A]

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

[B]

Thank you very much, Eugene. I feel like I fit right in.

[A]

You do, actually. You do. If you want to. You do, man. You do indeed. Actually, you know why I feel like you fit right in is because you've got, like, one of the most beautiful, weird Stories of how you've lived your life. You know, and when I read your books, I can't help but wonder if the way you write and the way you've thought of writing comes from how you've lived your life. Like, just take us through some of this, so. Cause a lot of people are fans of your books, but I don't think a lot of people know a bit of your life. It's like, where were you born?

[B]

I was born in New York City.

[A]

Okay.

[B]

Left six months later, went to London and Paris.

[A]

I like how you say that. Like, you left, you were like, I'm out.

[B]

I was left. You were like, I'm out.

[A]

I'm out. Parents.

[B]

That's right.

[A]

I can't do this anymore.

[B]

Yeah. When I say I was born in Columbia Presbyterian, my New Yorker friends say, yeah, but you're not a New Yorker. So I try to make that clear at the outset. And we moved around a lot in the United States, California, upstate New York, Texas. I did my high school in Houston, Texas, which I do not recommend, but was an experience. I learned about football, which is something. And then, yep, I went east for college and then went to England for grad school and have really not lived in the United States since Ronald Reagan was president.

[A]

That is wild.

[B]

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

[C]

Do you.

[A]

Do you think that some of that has affected how you're able? Like, maybe I'm projecting here, but I. I sometimes feel, regardless of nationality, one of the best things you can do is remove yourself from a situation to be able to see it better. Doesn't matter who you are in the world, spend time away from your family, come back to them. You'll see them slightly differently than when you're always in it. And I feel like you've done that with America, with the corporations, with the way we see, you know, the way things just work. Is that. Do you think that's partially because of just, like, how you've lived, where you've been?

[B]

I think. No question. Stepping back and looking at the way in which. For instance, you mentioned the corporations, the way in which, in America, corporations and money are regarded with a certain religious awe, whereas in other places it's, you know, they are welcome and they are sometimes very powerful, but they're not the be all and the end all. And again, stepping back into a place where you've been born and raised, you realize, my gosh, Things really have changed here. And the last 30 plus years, things in America have changed at an accelerating pace and an alarming pace really. But you can see that better if you're outside the bubble for a while and then you pop back in.

[A]

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

[B]

Yes, I did a PhD in history and love history, but realized I was not cut out for academia. So I thought, well, I know languages. Europe, 1992 is happening, let's try. There were recruiters on campus checking for people who are interested in banking and consultancies and various others. And I ended up at Goldman Sachs in London doing mergers and acquisitions, which for two years, which was a remarkably good experience from a business point of view. 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. I mean, it was big money.

[A]

What do you mean by that?

[B]

They were indentured servants to this company and simply their lifestyles were terrible. Their incomes were very good, but terrible, terrible lifestyles. And, and that was well before, you know, the run up to 2008 and all the massive crime. I was in a business where still the relationship was important. And, and if you screwed up with a client, you were done. I mean, you were finished. And then later clients became sock puppets and traders replaced relationship bankers and you got 2008. So, you know, one of my closest collaborators were bosses and collaborators at the bank was on the one NDB indict. I mean, he was investment bank.

[A]

We're talking about like the, this is the 2008 Wall Street Crash, financial collapse.

[B]

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

[C]

Wait, wait, Tom, that was an actual term?

[B]

The actual term sock puppets? Yes.

[C]

Was it used within your circles or.

[B]

Just not within my circles, but you know, the folks that I worked with who stayed at the bank, that's what they were talking about. Yeah, and the. And again, trading is very, very different from relationships. Trading is one day at a time. I win, you lose. I mean, there's a, it's a zero sum game. So trading is, at the end of my day, I close out my position and you are my counterparty. You're not my client at all. And that means I can take advantage of you. And that's what happened in the run up 2008. Goldman was in particular, I mean, involved in all sorts of bad stuff, but they were basically building financial vehicles to fail and then selling them to unsuspecting pension funds and various other, you know, innocent parties as a good investment. Yeah. And then betting against them.

[A]

That's insane, man. I still can't believe that that happened.

[B]

Yeah.

[A]

And then I. You know what shocks me even more is that the ramifications were barely felt. Did you get what I'm saying?

[C]

Yeah, yeah.

[A]

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

[C]

But I think that's why a lot of people have sympathy and sometimes admire people who do. White collar crime. Right. Cause it almost feels like it's a victimless crime. If someone is bleeding on the side of the road and someone has a firearm in their hand, that's a crime. If someone says, I lost millions of dollars and people go, how much do you still have? A couple of million more. There's no crime here. No farm. You see what I'm saying? Yeah.

[B]

I mean, you look at Mike Milken. I mean, he was actually prosecuted and sent to jail for multiple felonies. Comes out, he's the toast of the Nobel Prize community. He's got billions still in his, in his foundation. It's. No, I mean, white collar crime is vastly more. It's the cancer of society. It's vastly more damaging. It causes massive amounts of, of harm. But as you say, it's, it's almost lionized in, in the business school community as something. Hey, you know, he really is a risk taker. Right. He's a real heart. You know, you talk about killers in business, you talk about making a killing. Yeah, yeah, yeah, yeah. That's a good thing. That's supposed to be a positive attribute.

[A]

They see it different than we do.

[B]

Yeah. And if you're flying, you know, close to the, to the wind in legal terms or beyond, that's. It's viewed as an incentive. There's no normative quality to a law. You break the law, it's wrong. What do you they say? What are you talking about? I mean, how much do I have to pay here? What's the settlement? I'll pay it. Put all that checkbook, write it. And while you're at it, individuals don't go to jail anymore. It's corporations, Right. So it's the perfect crime. I mean, you, you are lionized as a killer on Wall Street. You are covered by your corporation, so you individually aren't prosecuted at all. And when the time comes to write a check, you can write a check instead of going to jail and your corporation writes it for you, and you keep your beach house. It's beautiful.

[C]

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

[B]

Yeah.

[A]

Where?

[C]

Base. Did you read about it?

[B]

I did.

[C]

For those who don't know, it was an inquiry headed by a constitutional judge who's now retired, that was based in South Africa to hear about widespread corruption in the government with private actors, so who were involved in having government contracts that went on for, I think, almost two years. A billion rand later, not a single prosecution. Everyone got away with everything. But when I was having conversations with my friends, even I would always say, why is it that whenever we talk about corruption, we speak about the person whose hand is caught in the cookie jar? So if you and I steal, we make a billion dollars, we still have to go buy Ferraris, Maseratis, Lamborghinis. Who's selling us those cars? We have to go buy mansions. Who's selling us those mansions? Who's investing our monies? Where are those funds kept? Where are we making the transaction? And the withdrawals? And I always think to myself, I would love to meet someone who can make me understand why is it that even when corruption is thwarted, it doesn't go further than when people exchange the same money for goods.

[B]

Those enablers. I mean, there is one whistleblower in finance who revealed that a certain bank, Wells Fargo bought it, was laundering money for the Sinaloa Cartel. He said those enablers, those bankers, had their finger on the trigger every time the Sinaloa cartel fired. And that's true. I mean, we cannot look at enablers, bankers, real estate people, corporate. Corporate foundations, all the other folks that make their lives possible. Tax advisors, all these offshore. Those are fundamental figures in the crime syndicate. And they are as responsible for every bullet that hits as the actual person who pulls the trigger. As I would argue that they're more responsible. I mean, I would argue that people who do it just for the money, as opposed to a hired killer. I mean, I don't know what that person's background is. I don't support hired killing, but somehow it's even more sinister when you're making a killing by doing a killing. I mean, those people are not making a lot of money. Right? The hitmen and women of this world.

[C]

In the food chain, yeah, they're just.

[B]

Tools in the hands of these other people. But we admire the lawyers, the white shoe lawyers, and the big bankers and so on, we admire them. They get their names written on New York Public Library, all sorts of very special perks for them.

[A]

You know what's amazing? Even when we think about our thinking of it, it's amazing that if you shoot somebody in the street or if you rob somebody, or if you shoplift one of those, you have committed a crime, you are a criminal. But if you defraud millions of people's pensions, if you get millions of people addicted to opioids, and you know, now they're having overdoses, et cetera, this is white collar crime. It's amazing that we've given crime a different name. But why, do you know what I mean? Why is it a. No, no, this is a white collar crime. We've almost given it a respectability that it doesn't deserve.

[B]

It's like, what kind of collar do the people who define it wear? They wear white collars. They're judges, they're lawyers, or the folks who are making these rules, right? I mean, you know, they are the people who see this, they see someone bursting into their house and robbing them or shooting things as a major threat. They do not see someone who is defrauding a pension fund and having elderly teachers eat dog food for the rest of their lives, which is something that happens. They don't see that as a problem because they're not elderly teachers. They don't see at the ultimate analysis, they don't see the common good as a major concern. They just don't. It's a dog eat dog world. It's an Ayn Rand world, and it's I win, you lose, that's it. And that's ultimately why the heroes of finance, the heroes of the law and so on are so, so clubbish and so in agreement along with the judges when it comes to defining the social damage by certain kinds of crime. And as you said, white collar crime causes infinitely more damage and just erosion of trust, erosion of respect and erosion of this social fabric than any blue collar crime.

[A]

People don't realize how much the things they're experiencing in the world every single day are a byproduct of those crimes. And while we'll never dismiss a murder or a robbery, those crimes have far less of a ripple effect out into the world. Do you know what I mean? So when you see your town dilapidated, when you see your parents sick or a family member who is dying and can't get treatment, when you see your retirement fund disappear, when you, those types of things have such a widespread Effect. You know what I mean? They're more likely to create more of the thing.

[C]

Yes.

[A]

That you don't want to see. And it's so crazy to see this. I actually wonder, like, how you had this, because your life is really. It almost feels like a series of trapdoors. When I think of your life, you know, you're studying history, and then you fall down this trapdoor, and then all of a sudden you're in London, you fall down a trapdoor, and then at some point, you were studying music, you know, and then it's like you fall down another trapdoor. Another trapdoor. And then you stumble into this world that, honestly, I think everyone should be grateful for. And for me, it was like, you know, when you were writing about the corruption in the olive oil industry, which seems like such a, like, light topic, you know, so when I saw that, I was like, huh, Corruption in olive oil. Well, this is like a cute world to be in, you know, but you expose so many of the layers. And then your next book, you talk about whistleblowers and the role they play in society and how we don't protect them enough and what they've done to expose what we're experiencing. And, man, I feel like your latest book, I hate to say it, is more and more applicable every single day.

[C]

Right.

[A]

You know, how to Make a Killing in healthcare in America is like, you know, you look at all the stories that popped up, the Luigi Mangioni story, you know, you look at people, you know, going on strike or rioting in certain parts of the world, you look at. Because they're losing their health benefits. You look at people just losing faith in the societies that they live in, in the system.

[B]

Yeah.

[A]

And when I read your book, I went, this guy, you didn't just critique it. You. You break it down on the. On. On the, like, the most minute levels. And I wanted to know, like, why you started with dialysis, because that's. That's like the, you know, the.

[C]

The.

[A]

The real crux of your book, but it exposes everything. You went. You go into dialysis.

[C]

Why.

[A]

Why that topic? Help me understand.

[B]

Yeah, well, I, as you mentioned, I wrote a book about whistleblowing, and I was interviewing a bunch of different whistleblower classes. So there's, you know, the big pharma whistleblowers and the defense contractor whistleblowers, the big bank whistleblowers, all these. And there was this weird outlier. Dialysis whistleblowers, the finance people in dialysis who were. Who were bringing false claims Suits, whistleblower, lawsuits against the big dialysis companies. And, like, what's going on here? And they were. The dialysis companies were signing 400 and $500 million settlements at a pop. Their stock price was going through the roof. Warren Buffett owned 40% of one of them. And I'm like, okay, what's going on here? My. My bank, inner banker was like, the board is going off. Yeah. What is going on here? And so I looked into. Well, first I started with the finance people. Then I worked my way back into nephrologists, kidney doctors who were working for these companies, and then gradually back down to the blood floor where dialysis is actually delivered. And that's when I realized this is not a chapter in a whistleblower book. This is its own book. Because as you said, Trevor, I mean, it is a perfect microcosm of what can go horribly wrong when you put profits before patient care.

[A]

It's also a terrible story of. Of how a miracle can be turned into a curse. Right. Because you look at when this technology is invented, you know, and I only learned this from your book. It's not like I knew this before reading the book.

[B]

I didn't either.

[A]

You look at this world where it's like, dialysis is this miracle.

[C]

Yeah.

[A]

It's like, wow, we've invented this way to basically, you know, an extra kidney. Yeah. An external mechanical kidney. What have we done?

[C]

Yeah.

[A]

And in such a short amount of time, it goes from miracle to, oh, no, this is a curse on people's lives, on their finances, on their futures and on their families. And I was like, when you. When you. When you stepped into it, what made it the perfect place to start? Like, what. What would people not understand about dialysis? Like, they might be like, oh, yeah, what. What makes dialysis so big or so unique? Or why dialysis versus everything else? What was it about this specific topic?

[B]

Well, first of all, as you say, it was a miracle. And it's such a miracle, such a breakthrough, the first replacement organ that it. That had the potential to save millions of lives. And it was such a miracle that the U.S. congress got involved. I mean, they were. This was 1972, the early 70s, 1972, the actual law was passed. Congress got involved at a time when. And this is going to take you back at a time when the Republicans, the Democrats, the insurance companies, the ama, everybody had their plan for national health. The US Was going to have national health. And they viewed dialysis, this breakthrough cure, which had hit the news in a way that made it Very difficult for them to ignore. There was who decides who lives and who dies. There was, you know, Life magazine cover stories about this. There's Edward Newman doing NBC reporting on it. And it's pretty blunt that, you know, the folks who were chosen for the very few chairs that were available survived and lived pretty well for decades, and the rest were dead. I mean, they had no chance at all. They were condemned to death. So Congress got involved and they made it the one and only Medicare for all program in 1972, signed by Richard Nixon. And that is at a time literally where everyone is thinking, we're going to have national Health. Everybody else, I mean, most other countries around that same time adopted National Health Australia, which is the counterpart that I compare the US to a lot in 1972. But then Watergate consumed Nixon, the Vietnam War went ballistic. You know, the OPEC oil embargo, stagflation, and the entire government pivoted from build a Great Society to cost cutting and Reaganomics very soon after. And government's the problem, not the solution.

[A]

Damn.

[B]

And we've never looked back. We've never gone back. So dialysis, from a historian's point of view, is a really interesting sort of rally point of a different era where the government felt and the people felt the government had a role in taking care of human beings. That's an important part of being a citizen, is getting health care. So we once thought. And then the dialysis, the fascination to me of this treatment which is done wrong, it's a sort of an incarceration. I mean, you need dialysis three times a week, minimum, minimum, minimum, three, three and a half hours each treatment, or you die.

[C]

It's as simple as that.

[B]

They own you. If it's a good organization, they are looking out for you. They're saving your life every single time. If it's a bad organization, that's run like Taco Bell, which one of the former CEOs actually bragged about. This is how we're going to run this company. Then they own you. They actually possess your body. So it reminded me one of the lawyers who got in order to help a lot of patients who have contacted me. I've been contacted by over 3,000 patients and family members since this book came out and long before. One of the lawyers who really got it was a former Innocence Project lawyer. So people unjustly incarcerated, people on death row, mostly black and brown, and he said, oh, I get it. He had just retired from the Innocence Project because Illinois had done away with the death penalty. And it was a major success for him. And I said, you've got to get involved with this involuntary discharge from the Dallas of facilities. And he said, said, I get it, I get it. You're trying to bring me back onto death row. Oh, damn. Punch in the gut. That's exactly what it is. Suddenly saw what he meant about this combination of health care and incarceration. So to come back to your question, this is, let's say, one of the most extreme cases of health care delivery where you need it and if you don't get it, you're going to die. At the same time, you have to follow the rules that whatever organization is taking care of you is laying down or you don't get it. Yeah. And if those. And there are good organizations and there are good facilities and there are wonderful people and they do a good job about focusing on the individual and their individual needs, as with all medicine. But there are big companies that are running things on an assembly line, one size fits all basis. And they're really looking much more at Wall street than they are at their individual patients. I mean, they are hedge funds with an exposure to healthcare. That's not an overstatement. They are financial vehicles with exposure to healthcare.

[C]

How complicit or how complicit is the average person who buys stock in the.

[A]

U.S. why did you look at me when you said that? That was weird.

[C]

Complicit is ours.

[A]

No, no, no.

[C]

Complicit is Tom's world.

[A]

No, no, no. But what you. You went, how complicit are you, the average person? And you looked at me, you looked directly at me as if I've bought stock in any of these.

[C]

Complicit.

[A]

Yeah. A friend of yours that was really.

[C]

Wearing a tan spider.

[A]

Ask your question and look away from me. Don't be looking at me like that.

[B]

Look the other way when you say.

[A]

I've never bought any stock in a health career. You look the other way.

[C]

Don't.

[A]

Don't do that.

[B]

No, take that back.

[C]

I take it back. You feel better now? People like to wash their hands off of something that is innately horrible. When people say, if there's insider trading and you give me a tip off and I put a million dollars in something and I make a lot of money, but If I put $5 because my banker said I should, and this company ends up blowing up like it does, and it does the things that you say it does, how complicit am I?

[A]

Yeah, it's an interesting thought of, like, how far away do we get the blame for. Because, yeah, like, do you. If I'd expand on that. It is a difficult question, but do you think people know when they're investing in these companies, like the average person? Do you think they know what they're investing into?

[B]

No idea. No. I think they have no clue what they're investing in. And all of the signaling, all of the PR is about health and wellness and thriving United Health, just to take one example. But for me, the individual investor, you should probably do your homework because that's part of your responsibility as a citizen. But the people who are really complicit to me are people like Warren Buffett. I mean, you own 40% of a company. You have owned it for a long time. You yourself have made a killing in this investment. You should be kicking the tires on what's going on. I think that's very important, and I think people should be able to call folks on that. Now, he might argue that this is a good investment and what I'm doing is investing. And that is precisely the argument that there is zero social, you know, obligation on my part. I am an investor. And that's the sort of the Ayn Rand approach. Right. Or the, you know, the Reaganomics approach is ultimately, it means that you don't have a social responsibility. And in fact, there's. There's an argument that says social responsibility in running a company is actually. Should be illegal. I mean, your only legal obligation is to shareholder value. Yeah, that's another of those insane things like corporations are people and money is speech. One of those complete idiotic, insane things.

[C]

Corporations are people.

[B]

This is united Citizens United. Corporations are people as a legal entity and their money and any money is speech. Those are two things.

[A]

Yeah, that's one of the worst decisions America ever made.

[B]

It's preposterous. I mean, if you think about it, what is. That's crazy. It's crazy talk. But we've been fed it so many times, you know, with our pablum, that we ultimately say, oh, well, it must be true. I got those really smart people are saying it. Not only is it insane, it's also hugely damaging because of course, then the corporations with their speech are going to go in and buy politicians. That's what our. I mean, the US campaign system, campaign finance system is illegal in most countries. Yeah, I don't know how it is in South Africa.

[A]

No, no, no.

[B]

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

[A]

So ours is. You can, in South Africa. They make these big donations. But, but I was Shocked. When I first came to the US I was shocked at how many things are legal here and just full on bribery. Where we're from and in other parts of the world, it's just like, it's just bribery. They were just called. This is bribery. Half the stories that make the headlines in South Africa, politician got a private jet flight to this place and was put up in a hotel for a weekend and went out for. And then spent this much and got. And then you come here and they're like, no, that's lobbying. What are you talking about? That's not bribery.

[B]

Speech. Free speech, First Amendment.

[A]

Yeah. They're expressing themselves. This poor company needs to speak. Are you going to silence the company? Oh, poor company.

[C]

We, we're going through that actually right now. Where officials from our version of the DMV went to France.

[B]

Oh, yeah.

[C]

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

[A]

They have the exclusive contract essentially forever. It's massive amounts of money. But it's exactly what you're saying. And when you, you know, when we talk about complicit, I love that you use that word. Because when we talk about somebody like Warren Buffett, I go, I will not call Warren Buffett good or bad or whatever. But it is interesting. It is interesting that we would never accept that excuse, let's say, from another person, if they, if it turned out they funded the Sinaloa cartel. You know, if they owned 40% of it, like, imagine if you said to somebody, I own 40% of the Sinaloa cartel. They'd go, you're a criminal. And you're like, no, no, no, no, no. I just invest in the Mexican drug cartels. I don't engage in it.

[C]

They're a good investment.

[A]

They're a great investment.

[B]

Rapidly growing, good market share, all of the return on assets is awesome.

[A]

It's a great.

[B]

But I.

[A]

Look, do I condone everything? Of course I don't. But I'm not. I'm not there for the murder. I'm just there for the investment. There is a level of asking yourself, like, you know, like, who are. If everyone gets to say that they are not responsible, then who is responsible?

[C]

Yeah. I think it's also how things are phrased. You know, an inquiry, an inquisition, a, you know, white collar crime, corruption, bribery. It's theft. All of it is just theft. And I was asking you before we started that, what is it that makes people steal? I know what would motivate someone to tell the truth and blow the whistle. I can kind of figure it out. You get tired of how things are, you go, I have to make a change. I have to be the change that I want to see. But in your research, what makes someone go, here's a million dollars that's supposed to go to public good and I'm just gonna buy a nice car in a nice house?

[B]

Well, first of all, steal from necessity. I'm hungry, I gotta eat. My family has to eat. I get that. I'm not condoning it, but I get it. And a lot of that is caused by the white collar crime. We were talking, right? But second of all, if you ultimately, if you and your peers are an aggressive corporate culture and you talk about how you really got to push things, you really got to go for the, go for the throat, you know, all these sort of sports slash killing analogies of war. I mean, corporations as war fighting machines, that's kind of, you know, penetrate and take enemy territory, this sort of thing. Then you're going to naturally push hard and you're going to do things which are potentially illegal. But maybe, you know, there's this sort of nudge, nudge, wink, wink. The compliance department says we're doing everything just right. And we have a gold plated compliance department.

[C]

Plausible denial.

[B]

Go on, go on. Off camera, you can do, you know. But then there's this worship of money and the way in which people keep score in their lives. I mean, it's hard to figure out when you're doing the right thing. If you're saying, am I doing the right thing today by, I don't know, by writing a book, by doing a comedy show, by talking. It's hard at the end of the day or the end of a year to say I've done something really important. It's easy to count money. And if you're in that culture where you say, look, look at that, I got 5 million bucks, that's very tangible. And now it's 5.2. And on this, and the stock market is growing, growing. The wealthy people that I know, the ones that have 100 million, they only talk about the people who have 200 and 300 million. The ones who have 300 million, they talk about the billionaires. The ones who have a billion, they talk about the 2 billion. It's never enough. It's like the shark that can never get full. And that's where I think that's the ultimate problem. It becomes, especially when the society worships these people and condones all of their actions. It becomes this sort of endless hunt for more money at the end of the day. And it's a status thing. But how can you possibly live? How can you possibly use even a million dollars, let alone a billion dollars? I mean, how can you. It's just a score. It's a counter for the quality of your life. Because the quality of your life. I don't know. I mean, again, working in banking for a brief time, I saw some amazing people, incredibly smart people doing incredibly dumb things with their life, throwing away their time in order to have a metric ton of money. They didn't have cars, they didn't travel, they didn't live. But they felt successful. And for me, after two years, I was like, you are losers, you guys. I mean, I'm sorry. And now they think I'm sure that I'm a loser because I don't have any money.

[A]

Don't go anywhere because we got more.

[B]

What now?

[A]

After this. This episode is presented by Whole Foods Market. Eat well for less. You know how Thanksgiving always sneaks up on you. One minute you're eating leftover Halloween candy, and the next, everyone's arguing about who's making what for Thanksgiving dinner.

[C]

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[C]

Yo, why are you speaking like that?

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Is this an ad? Did you just teleport us into an ad?

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[C]

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[A]

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[C]

Can we go back to the episode?

[A]

Hi, everyone, I'm Ashley Flowers, creator and.

[B]

Host of Crime Junkie, the go to crime podcast for the biggest cases and.

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The stories you won't hear anywhere else. So whether on your commute, studying, or.

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[A]

We had an episode of the podcast with Ratka Bregman, right? And some people might not know his name, but he was the guy who rose to a little bit of infamy by. He went to Davos and at Davos he, he basically said to everyone in the room, he's like, hey, hey, why is everyone here trying to solve the problems of the world? As if you are not causing the problems of the world? And he said to everyone in that room, just pay your taxes. Everyone here is avoiding you flew in on private jets and you're like, what should we do? He's like, pay your taxes. And then they were like, who invited this guy? Don't invite him back again. But one of the things he talks about, and that's what he's working on now, is he said, we've created a society where the smartest, brightest minds go into fields where they're just trying to extract from society. There was a time when the most brilliant scientist tried to work on the science that would change the world in the most positive way. Invent a light bulb, create an airplane, find a new type of health solution. You know what I mean? And then now that person goes like, go to a company that can make as much money as possible as quickly as possible. Mathematicians were trying to solve, going to space or you know, trying to figure out the circumference of the globe, whatever. And then they were just like, go to this company, make as much money as possible, get the trading. But, but what you said I think is key. It's the reverence. You turn on the news and they go, larry Ellison, now the richest man. But why, like, if society, like, and I mean that on like a media level, not the people on the ground, Cause I think the people are oftentimes sort of not victim to it, but you're experiencing it. If the news tells you that this is good and important and the media tells you it's good and important, then you think it's good and important.

[B]

And not by accident. Half the media is owned by those very people. If you look at the oligarchs that are owning, you know, the big news outlets, their legion, and trying to tell Jeff Bezos that he really shouldn't be a monopsony and all goods sold in the United States, you will not last very long. Right. There's a lot of self editing. So I think that's. No, that's absolutely right. This reverence, a sense that they are gods. And it builds into this sense too that there is an ubermensch society and then there are underlings. And those underlings, if they're homeless, well, they're not human, really. It's not my problem. I mean, that's the sense that I get. It's horrible to say, but there are people who. The haves and the have nots have always existed since ancient Greece, since Rome, since whenever. But this is sort of an institutionalized form of superior being judged by your net worth. And then everybody else is really expendable.

[A]

To talk about expendable, you, you can look at one of the examples you give in the book and you go through multiple, multiple hospitals and healthcare systems. I was reading about the dialysis and how each system doles it out and to what you're saying in some of these stories, it sounded less like healthcare and more like a fast food drive through chain. It felt like they're trying to get people on and off a machine as quickly as possible, use as few nurses as possible, make as much time, work as possible, look after the patient for the least possible. And I went, I mean, I guess this is great if you're trying to get fries out quickly, but these are human beings, you know what I mean? It feels like the business model isn't. It's not about health care, it's about health profits 100%.

[B]

It's fast food medicine. And it's a model that wasn't invented by dialysis. It was invented in the 60s by people who actually ran Kentucky Fried Chicken franchises and Wendy's. Literally, literally, who then started buying up, started privatizing hospital systems and putting together. So they literally were the people with this branding experience and this mass. And in theory, I mean, you know, Atul Gawande wrote the Cheesecake Factory article in the New Yorker, which got a lot of attention. I don't like it, but he's a smart guy, he's a doctor and he. The idea of focusing in on A specific medical procedure, making it as efficient as possible and delivering it in as low cost a way as possible. That's potentially a useful idea. The important thing here is that it not become turning patients into widgets on an assembly line, which is precisely what the fast food model or the Cheesecake Factory does. You're not tailoring your care to the individual needs of your patient. You are looking. And once again, this is a finance version's view. The person who brought this into dialysis or popularized it, Kent Theory. He's a former CEO and the founder of DaVita, one of the two big companies. He made his bones at Bain Capital, that's a private equity firm. He was a. He was a finance guy, the kind of guys that I worked with. And he basically. And he said, speaking to a business school audience, he said, you know, if I were running Taco Bell with, I forget the exact numbers, 23,000 outlets, and I would be doing all the same things as I'm doing. No, it's not about the patients, is what he said. And some doctors hate it when I say this. These are quotes right? From his speech.

[A]

An actual quote.

[B]

Actual quote, yeah. Yeah. I can show you the video. It's quite striking, but again, it fits in a. Is this a situation in which you are Wall street facing and you're talking about return on assets? If you have 2000 dialysis clinics around the country and your main focus is shareholder value, and I'm getting paid in stock as a CEO, so my shareholder value is pretty important to me too. Right. It's a conflict of interest on a massive scale. Anyway, if that's your aim, you want to run as many patients through every single one of those facilities as you can, because your asset base, your buildings, your machines and so on, the more units you shoot through them, and it is just like Taco Bell. So people are not burritos. Right? Every single person who goes into that facility needs should have a treatment that is tailored to their individual problems, their individual biology, their individual size and everything. And if you're running it as a fast food assembly line model, you're not going to do that.

[C]

You're not size fits all, one side says.

[B]

And you're gonna penalize the people who slow things down who say, oh, actually, you know, Tom here, he should be getting five hours. No way, no way. And they're violently pushed back. And the doctors, some of the doctors I've talked with who work in these facilities are not best pleased. And some of them, some of the workers are also suffering from serious Moral harm, because they realize this. Like soldiers forced to commit, you know.

[A]

Yeah, yeah, yeah, that's the perfect analogy. Actually.

[B]

It is.

[A]

Actually.

[B]

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

[A]

Yeah, I think that's the perfect analogy because we take for granted how much an overlord and a system can then oppress even the people within it. And then what happens is in a society, we start fighting amongst ourselves as if there's not one central thing that we should be looking at. So you have leaders and governments who send soldiers to do things that are despicable. Those soldiers return home to their countries, they get spat on in the streets, right?

[C]

Yes.

[A]

The defense company doesn't get spat on. The people who lied about weapons of mass destruction, they don't get spat on. Do you know what I mean? And the same thing happens here. People go, my doctor is trash. My. This is. Yeah, but it's. When you delve into it, you go like, oh man, my doctor's victimized by the same system.

[B]

The doctor is called a provider now or even a vendor. I mean, you know, he or she is a. Is a cog in a wheel. And again, certain things, maybe burritos should be made that way. I'm game for that. But health care, there are other things. I mean, are we good with private prison systems? Are we good with private war fighting? Are we good with. There are certain things that should not be primarily profit facing. And healthcare is one of them, but there are a lot of others. And in America we've lost that discourse.

[A]

When you look at other countries, what did you find? Because I think there's a perspective that you bring in this book and in your work that I think's really important. Cause oftentimes people go, well, I mean, show me a better way to do it. And you're like, oh yeah, I can. And you actually go to other countries and you show a better. But talk us through some of that because like Australia, Japan, like a wealth of other wealthy countries, show that this is not the normal way that it needs to be.

[B]

No, precisely. I mean, we've gotten so caught up in American exceptionalism that we lose sight of the fact that there are a lot of places where things in general and healthcare in particular are done a lot better. And the example, and the most brutal example is how long do patients on dialysis survive in the US versus other countries?

[C]

What are the stats.

[B]

They die two to three times faster than any other developed world and many lesser developed countries as well. I mean, you know, we're talking 20% to 22% per year death rate, whereas mortality in Europe is anywhere 12 to 15% and more on the 12 side. Japan, 6%. I mean, we're talking the most. And that's just. How soon do you die? Quality of life is another big issue. But I mean, the central premise that everything has to be for profit is preposterous because every other country in the world does it better, does it cheaper. I mean, the basic promise of the Reaganomics era and ever since is we will do it better because government's the problem, and we will do it cheaper because we are so efficient. Now in America, we do it worse and we do it vastly more expensively at the same time. So something's rotten in the state of Denmark. Not Denmark. You know what I'm talking about?

[A]

Yeah, I know exactly how to.

[B]

And you have. So in most countries, you have. You have the fisc. You have the treasury that collects taxpayer dollars and you have, I don't know, patients in hospitals where patients go. And the money goes from the treasury to the hospitals, pays the doctors, pays the staff and pays for the treatments. In America, you have the treasury and you have the hospitals or the dialysis facilities. In this case, in the middle, you have this twin towers of massive corporate absorption. You talk about middleman and the cost to healthcare. This is a classic example. You have these two twin towers that are soaking up a lot of the billions and billions we're talking roughly.

[A]

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

[B]

Yeah, I'm using towers and you use hands. And I was like, it's just.

[A]

Wrong hands. Let's find different analogy. Different analogy.

[B]

Let's go with something too large.

[A]

Too large. You know what?

[B]

Sinkholes.

[A]

Sinkholes. That's better.

[B]

Two sinkholes and all the money goes.

[A]

In, sucking everything in.

[B]

That's way better. Looks nice.

[A]

Your hands did this. And, yo, man, we. We from another country, Tom. Don't be doing that to us.

[B]

Yeah, yeah. Look at the calendar, man. Look at the calendar. What was yesterday? Yeah, no, no, no, you're absolutely right. These are the twin sinkholes of money absorption. And the money goes into the sinkhole and not so much comes out. And this is, again, this is not unique to dialysis. It's particularly, in my view, obscene in dialysis. But it happens. You know, what is unitedhealthcare's model, it's to take as much money as they can and give as little as they can away. That's it. And the rest goes into the sinkhole.

[A]

I feel like it's the Rosetta Stone of healthcare. That's what you've shown us with the dialysis model is you've gone, let me show you this example, show it to you so clearly that you can then understand every different language of what's going wrong in American healthcare and how to actually look at it. You know what I mean? And when you look at these other countries, what would you say is the biggest thing, like just on one level that they're doing differently? I mean, I can understand the government is paying and, you know, it's a different. But what would you say is like something that they're practically doing differently than in the us?

[B]

Well, they're following universally accepted medical guidelines which have to do with how long, how gently you treat, at what, what values you treat. Do you do it at home or not? I mean, if you look at Australia, the majority of of they push patients to home dialysis. And ever since the 1960s, ever since this miracle cure was invented, the people who are not trying to make money off of it said home dialysis is the way to go. You get to control your destiny. You get a feeling of, I mean, any chronic disease, a sense of agency is critical to getting well or to feeling better.

[C]

Right.

[B]

And being a passive recipient of care. Lie down, put your arm out. I'm going to take your blood. I've heard the patients tell me this from, you know, in dialysis facilities, you need to have control of your destiny and doing that at home is the way to do it. Also, again, you can tailor your care to. And it's doable. So Australia pushes people home. But just that is another of the fundamental, widely universally accepted laws of dialysis is being broken in the United States. It's being broken because it's, you know, there are companies that make a lot more money doing it elsewhere, but it's also being broken because cms, well, the Health and Human Services doesn't enforce best practices on their. You know, I beat up in my book, I beat up a lot on corporations. I think they deserve it, but I didn't give sufficient time to the silent partner in the crime. And that is the cms, that is the National Health Administration in America, that is simply in bed with or complicit with or toothless to do anything about major corporate wrongdoing in what is cms. It's the center for Medicare and Medicaid Services.

[A]

Okay, got it.

[B]

Yeah, the ones that administer Medicare and Medicaid funds. And they know what good dialysis is. They know what the metrics are. They're just not counting them. So they don't count treatment time. They don't penalize people who don't treat longer. They don't count UFR or ultrafiltration rate, which is the speed with which you remove liquid from someone's blood and their body, which are critical to survival. Yeah, they don't count those things. Like, what are you counting exactly? They don't count septicemia, which is, you know, one of the major causes of death. Well, if you're not counting that shit, what are you counting? I mean, you know, it's putting the ladder up against the wrong wall.

[A]

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

[B]

I guarantee you the answer is the revolving door in my book. I cite several examples of people from the White House who have gone to the board of the big pharma companies. Same thing, dialysis companies, and vice versa. People from the boardrooms of the big healthcare companies that go straight into government and are making these policies. And I cite examples of ways in which the policies got softer when these people arrived. I wonder why that is. And again, it's the notion that, you know, a corporation is going to do it better because we've been penetrated and taken over by this mentality to this point where we don't even recognize that there is common good anymore. It's just, let's grab as much as you can before, you know, while it's your turn to eat.

[A]

You know why? They've done a great job of tricking us. You know, it's one of the greatest scams that has ever been pulled on people collectively. What they did was governments were providing a good. It doesn't mean that they were perfect, but the good was being provided by the governments. In this case, it's the 1970s, when Medicare says they're going to cover dialysis. This is revolutionary. You have this problem with your kidneys. They're gonna come in, the machine will be there. The government is going to help you out. And because you can amortize the cost across a population, it will work.

[C]

It'll work.

[A]

And then very quickly, companies who see a gap go, wait, wait, wait. If the government's paying for it, we can get that money. And then they go, if we can get that money, how do we get more of that money? And then they become Part of the cycle. It's so crazy how you see this in every country, whether it's the uk, whether it's South Africa, whether it's the United States, wherever you're having these issues, the people who work in government work with the companies to make the government look inept.

[B]

Yeah.

[A]

The people on the ground then go, the government is terrible. We should give this to the private companies. The private companies then take the work and then they provide a professional ineptness that not only doesn't do the job as well, but it extracts more wealth. So it's like before, the government was going to be, maybe not great, but they weren't going to be as expensive. And now you're getting a shit thing for an expensive price. But you then hate the government. You go, the government doesn't do anything. It's like, yeah. And the companies that made that happen are the reason you keep coming. It's such a pernicious cycle.

[B]

Con job and. Exactly. And the government does become people in America. Oh, big government. That's really bad. I mean, you look at the Pentagon, trillion dollar, and that is a bunch of sock puppets. I mean, they have Lockheed Martin up their butt with their hands going like this.

[A]

Right.

[B]

You know, I mean, and you see the revolving door between the generals who go onto Lockheed's board and I'm just speaking Lockheed, even Raytheon, you name it, they've got it. The whole outsourcing government contracting thing is such a scam because it corporatizes and at the same time is able, as you say, to, to. To push the blame onto. Onto government. Big government, which never gets it right. And talk about socialism. I mean, look at war fighting in America. A trillion dollars a year to the, to the Pentagon.

[C]

Trillion dollars a year.

[A]

Yeah.

[B]

That's socialism, right? Oh, no, no, it can't be because it's America. Sorry, My. My bad.

[A]

Yeah. And because it's war.

[B]

War.

[A]

That's because it's war. It's like, it's amazing how.

[B]

Yeah.

[A]

War is always the thing where people are like, the government shouldn't be smaller there. You're like, why shouldn't the government be smaller there?

[B]

We cut everything else but 10% raise for the government.

[A]

Smaller government. And he's like, except for war. War.

[B]

I mean, and how successful have our wars been recently at producing security and national defense? Not so much, actually, you know, if you think about it, more important. But I don't want to think about it. Sorry.

[A]

I want to. More importantly, this is the question I often ask people as I Go. You are so comfortable accepting the premise that America's job is to go out and fight wars. Why? To protect Americans far from America. That's what you say, right? We are willing to spend trillions of dollars to go out into the world to protect America. Why wouldn't you spend trillions inside the country to protect America? If Americans are dying from kidneys, dialysis machines that are too expensive, healthcare that's not being provided, you know, food on a basic level, that's a war that you could be fighting in your country without bombing anybody.

[B]

And that's exactly the reason in the 1970s, a number of people. This was during the, you know, the Cold War. The coldest part of the Cold War and the fight against Russia and everything else. And yet at the same time, bipartisan congressional figures, Republicans and Democrats are saying we're spending billions, back when a billion was a big number, billions to build these rockets. And we can't even take care of our own citizens. And they were pushing for dialysis in that way. And the other thing about war is, of course, and the trillion dollar Pentagon is that as one former general told me, when you got to be a big hammer, everything starts looking like a nail. Right. I mean, we gotta go out there and I built all this. Cool. You gotta find the user, highly trained in doing this stuff. Enough. Gotta find a way to use.

[C]

And we have to get rid of it.

[B]

Yeah.

[C]

Because we have to make more.

[A]

Ah, you're not wrong.

[B]

That's right.

[A]

You're not right.

[B]

That's right. There's this new stuff coming on and.

[C]

Some of it gets lost in the smaller third world countries.

[A]

Don't even get me started on that.

[C]

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

[A]

That's a perfect analogy, actually.

[B]

Good.

[C]

Yeah.

[A]

That's the perfect analogy.

[B]

Yeah. The wolves are taking over in the. In the shepherd's room, like wolves are cooking dinner. You know, you can sit this one out. We'll take care. You wanna.

[A]

You wanna do something about that wolf? Whoa, whoa, whoa. Wolves have their rights too, you know, These poor. You. Do you know how the wolf feels about the sheep? You're the shepherd, though. Oh, yeah, yeah, yeah. But I mean, have another beer.

[C]

Come on.

[A]

You know, that's. That's you.

[B]

When you.

[A]

When you think of it like, yikes, man, it's scary because you see this moving into everything.

[C]

Yeah.

[A]

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

[C]

Yeah.

[A]

And when I looked at this dialysis story, I couldn't help but think of the analogy of. It's almost what these healthcare companies did would be the equivalent of car companies realizing the value of a seat belt.

[C]

Yeah.

[A]

And then going, we're going to charge you every time you need to put it on.

[C]

Yeah.

[A]

And now you have to gamble with your life and go, do I, Can I afford it? Can I not afford it? But you shouldn't. This shouldn't be a choice. We know that you need the seat belt. Put it on. And I was like, ah, but. But can I can. They're like, oh, do you want to. Do you want to play with your life? And they know because to your point, it's. It's a duopoly. It's what, two companies. It's still two companies.

[B]

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

[A]

Yeah. But I mean, that's a duopoly. That's like you control everything. No one can push you around. And then. And because it's your life. That's the craziest thing.

[C]

I think corporations realize one thing. The minute as society we said there are no holy cows or sacred cows, they thought to themselves, we will leave no sacred spaces. They've moved into organized sport.

[B]

Yep.

[A]

You're not wrong.

[C]

Yeah. You're buying the, the soccer jersey.

[A]

Yeah.

[C]

You're coming to the matches. They're paying your hero. They're controlling their life.

[B]

Yeah.

[C]

Religion, they've made them miserable. So they've made us all complicit. And I worry a lot when I, whenever I watch big organized sports, I'm like, the fact that people who love that Sport assume that 90% of it is natural talent always amazes me. It's like when people have that debate thinking, before steroids were illegal in sport, how great was sport? And I'm like, no, no. Before corporations were involved in sports, how fair was sport?

[B]

Right. Exactly. And the money aspect, again, you see sports betting now. And to me, that is another thing where it's like the stock market versus the real economy. Ooh wee. When you, when you're putting a bet on something, you debase it inherently and your focus again turns from the activity on the field to outcome, outcome. And you can have derivatives that are bets on bets. And this is all stock market stuff. This is the way in which you think if you're not really engaging with the real world and not only is it not helpful to what's going on in the field or what you're eating or What? Your healthcare, it's diametrically opposed. If you focus all your energies on making it into a money making operation and betting on it, you're actually taking the energy away and the resources and the intelligent people and all the things who should be saying, how do we make a better dialysis machine? There hasn't been a better dialysis fricking machine in 40 years.

[C]

No way, Tom.

[B]

Oh, no, absolutely. There have been tiny little adjustments there, but there's been no phase shift. Major breakthrough. Why is that? Because there's no fricking money in it. These two corporations, big corporations before them, there were others have locked in the market it. They have their cash cow and they are milking it relentlessly. They're not interested in a new milking machine.

[A]

Yeah.

[B]

They're not interested in the cow.

[A]

Yeah.

[C]

You know what I've realized as well with. I don't know how it is in this country, but in South Africa, when you get live cover now.

[A]

Yeah.

[C]

You're not obligated to take an HIV test. Where else before you're obligated to take an HIV test? If they're going to insure you for a certain amount of money. So you'd have to test or they have to know what your lifespan is, what your CD4 cell count is. But right now they're like, no, just bring it and then we'll, we'll see when we get there. So I'm like, was HIV always that dangerous to the body and your longevity or they found a way to not profit from you having HIV anymore? Do you know what I'm saying?

[A]

I wonder which one it'll be though.

[C]

Because remember that before there was no home testing.

[A]

Yeah, yeah, yeah.

[C]

So they would have to send you to a facility.

[A]

Yeah.

[C]

Then you'd.

[A]

But I'm saying, I wonder which one it is because my brain goes, which one is it? Have they found a way to de risk it or have they found a loophole on the other side? I'm saying I don't know which one it is. It's just interesting when I hear that, I go like, huh, I wonder what changed? Do you know what I'm saying?

[C]

Yeah, yeah.

[A]

Like, like what switches in a system that changes something? How do we look at it differently? I even think of man, that. Can I tell you, there are parts of your book where I was just like, I have to just meet this person. Because no, there's. There's books and there's thinkers that you encounter in life where you go, who is this person and how are they so magical in the way they approach things because nobody crazy.

[C]

In a good way. It takes naps. Yeah, we at noon.

[A]

He's a noon napper.

[C]

He's a noon.

[A]

But like, there's a part of the book where, man, I was so impressed and like, just like taken by how you stitched together even civil rights in American healthcare and the way we think about how it's doled out and not doled out. Because you see, again, I didn't know, and I would have never known how you can trace dialysis and Medicare and who gets treatment and who doesn't get treatment back to segregation and desegregation in the United States. No, literally, I mean, talk a little bit about that because that blew my mind. I was just like, oh, man. We really have to think holistically and sometimes I don't think our brains are big enough.

[B]

No. Yeah. One of the most shocking things in my research for this book was the way in which dialysis impact impacts disproportionately black and brown communities. 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. And it's this death by zip code redlining that I've gradually begun to see. I mean, dialysis is a perfect map for it, but there are many other diseases. The incidence of, of hypertension, diabetes and obesity. The way in which these communities historically the wrong side of the tracks. And I mean, I literally, I'm working in South Chicago where there's a disparity in life, in longevity between north and south Chicago of 30.1 years in the same. 30 years in the same city, 30 years. If you're in North Chicago, the wealthy areas, you live 30 years longer. 30.1 years longer than in South Carolina.

[A]

That's insane.

[B]

It is insane. It is utterly, utterly unacceptable. And it has been going on, I mean, as one Magellan Hanford, one of my great dialysis nurses, who was formerly an LAPD officer, as he said, it's got Jim Crow written all over it. This is absolutely. If you look at the maps of the impact of dialysis on communities, and that's kind of what I'm doing now, this book, I couldn't walk away from the book. Usually with books, I write it, I care about it, but six months before it comes out, I'm thinking, what's next? I don't have any next. This is next. So I've gotten together with folks at the New School, the Institute for Race, Power and Political Economy, and we're doing some research on these areas in Chicago, South Chicago and East la, Boyle Heights, where the impact of dialysis is disproportionate. Trying to understand, not just on individuals, what bad dialysis does, but what does it do to a community. How do they start to see dialysis as sort of part of their life's arc? You'll end up in the chair. Gran did, my uncle did, my kids are coming with me now to my treatments. They'll probably end up. I mean, it's just. That's nightmarish. And especially when there are solutions that are in hand that are, you know, again, every other country does it better, but there are very straightforward solutions to prevent this from happening in the first place. So come back to your question. I mean, it is absolutely. Dialysis in America is absolutely perfect. Radiograph CT scan of what's wrong with racialized structural racism in America. It is. It is the poster child of what can go wrong. And it is, for me, it's been quite a. I mean, a kind of a rediscovery of what America is. I'm going to places I haven't spent a lot of time in.

[A]

I can imagine.

[B]

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

[A]

Yeah.

[B]

I mean, literally in the space of. It's the most segregated city in the country, but many, many, many areas are like that. And it's. Yeah. I'm rediscovering my homeland in a way that is deeply, deeply disturbing.

[C]

We had an episode where we spoke to one of the most interesting people we've spoken to in South Africa, Dan. And we spoke about the remnants of apartheid and what people who say, it's been 30 years, it's time to move on now. And I said what the genius of that system was was to ensure that the longevity or the quality of life of a black person for generations will not be the same as the life quality of a white person.

[B]

Yeah.

[C]

And I said, here's a typical example. Malnutrition within the black community is such a. You might have groceries in your cupboard, but are they keeping you healthy?

[A]

Yeah.

[C]

That is the question. And what I did one day with a friend of mine is we drove to two schools. We drove to a very private school, wealthy black and white children. Then we went to a township school with only black children. And we took a photo, right. That we just said, you take this photo, take this photo. And we compared the photos at the end of the day and we saw the sizes of the kids.

[A]

Yeah.

[C]

And they were not even 40 minutes apart from each other.

[B]

Right.

[C]

What they ate, what they did. You even see it when they do. They've even stopped doing it now in South Africa where they do inter schools. Oh, they never mix now. Schools that are doing well with schools that are not doing so well.

[A]

Damn.

[C]

And doing sport because it becomes so glaringly obvious that the size differences, that there's nutrition differences and also there's concentration differences. I mean, the cues that will come up. I was. When I was growing up, they took us into this rugby clinic at one of the biggest stadiums. It was a program by the rugby club. The one thing that happened when all the township buses landed at the stadium or arrived at the stadium is all the township kids went to go queue for food.

[A]

That's the first thing they did.

[C]

First thing we, we did not. They. I was part of the. The kids that were in the bus from the township school. This was one of the first things that we did. It was. We left where we were. And the first thing we were like, we're gonna eat something because clearly it's not gonna be where we come from. And I'm thinking to myself, anger and.

[B]

Malnutrition as a government, as a. As a weapon. Agenda as a weapon. Yeah.

[C]

Of oppression and. No, no one ever talks about that. And I always think whenever big companies expand and whenever corruption is going to take place, you can always see by how much hope they give to people about how many of them they'll employ.

[A]

Yeah.

[B]

Yeah, that's right.

[A]

They love that.

[B]

Yeah.

[A]

Bringing. Bringing this many jobs. Bringing.

[B]

Oh, they love the mining companies.

[A]

Yeah. Yeah, they love that.

[B]

Yeah. Aren't they great?

[A]

Oh, no, they love that.

[C]

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

[A]

Yeah. Because. Because the gold needs to be sold into a market that is formalized. So at the end of the day, it, it all comes back to the enablers. Yeah. It all. It all comes back in a loop. And that's. That's why. And I'm glad you really give them the credit they deserve. Yeah. That's why whistleblowers are so important.

[B]

Yeah.

[A]

Like you. I mean, I know you've got a whole book on it, but without these people, you just don't know no, exactly. You, you literally just don't know. Without a whistleblower in FIFA, without a whistleblower in the banking system, without a whistleblower in the healthcare industry, without a whistleblower in the defense contractors, without a whistleblower, you just wouldn't know.

[B]

And it's fascinating to see the organizational reaction to a whistleblower. Oh, hell yeah. It's like this immune response and the T cells go out there fighting. I mean, people lose their minds. They're so angry and so frightened. Because at the end of the day, what you said is exactly right, that those whistleblowers really do have the kryptonite. Yeah. The question is whether they'll be able to give the kryptonite to someone who can use it before they are rubbed out. Literally or figuratively.

[A]

Yeah.

[B]

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

[C]

But this. You. You are making me realize there's so much power in words and phrasing. You start with a. With, with white collar crime, and now you're even speaking about whistleblowers. When it's corporate, it's whistleblowing.

[B]

Yeah, yeah.

[C]

When it's violent crimes, it's witness. It's. No. Besides, it's not a witness. It's a. It's an informant bringing information that's interesting.

[A]

That lead to something.

[C]

But when I'm telling the truth about how many people are losing lives and how much money. What are you doing? Why are you blowing? Who still blows a whistle? Information is timeless. But whistleblowing also makes.

[B]

Makes.

[C]

Makes it feel like you shouldn't be doing it in the first place.

[A]

It has an annoying connotation to it.

[B]

Where do you find the whistle?

[C]

You have to have it first.

[A]

Whistleblower.

[B]

You're a snitch.

[A]

It's got a snitchy vibe. Whistleblower.

[C]

And why are you blowing it? Why is everyone keeping their whistles quiet? And, and there's always, in whistleblowing, there's never plurality.

[B]

No, no, no. That's right. The individual. Yes.

[C]

It's always this shunned person who will generate as much noise as possible.

[A]

Edward Snowden. Snow.

[C]

Yes. But if you get rid of them, you almost feel like you've gotten rid of the problem. Right?

[B]

Exactly. And that's exactly it. If you can't deal with a message, kill a messenger. I mean, that is literally the way in which you. The reason why there's a scorched earth approach to whistleblowing is literally they can't deal with a message. Quite often a corporate informer will say, there's a trillion dollars in fraud here, or they've been dumping arsenic into the water or the Bhopal or whatever. And so you can't actually say, oh, actually, not so much, or not too many people died. You go after the messenger, you totally destroy their credibility. You destroy them financially, you destroy their home, you destabilize them psychologically. And all of a sudden there's kind of a quirk or a disgruntled person, you can dismiss them. So that's the way you can't. When you can't actually face the facts and say, actually, no, he's wrong on this and this and this point, and we can prove it. Because you can't, because the person is right, the whistleblower is right, you just destroy their credibility and it goes away. And say a disgruntled employee, someone who's deeply or just psychologically not stiff.

[A]

Yeah. But what they don't realize is they can only kill the messengers for so long. And then at some point, as we saw with Luigi Mangione, society turns around and goes, all right, I guess I'm also gonna make my own rules. And I'm not saying Luigi did or didn't do it. Disclaimer. I'm just saying, like we saw in that trial, in that case, someone said, you know what, I don't agree with this. And I realized that I cannot beat you in the game because you have created the rules.

[B]

Precisely.

[A]

So I will then play my game by a different set of rules.

[B]

Precisely.

[A]

And, you know, one of the reasons I think it's so important we have these conversations, I try and talk to as many great authors as possible, particularly people who have done, like, all the real research. I always say this to Eugene. One of the things that I hate the most is how people will say something. They'll go like, I'm gonna do my own research. And I'm like, no, you're not. You're not gonna do your own research. You are going to go read an article that either affirms what someone's research. Yeah, you're going to go read someone's. You're not going to go do the research. And yes, you can argue on my own truth. Yeah. On a semantic level, you can be like, but that is research. No, no, no, no, no.

[B]

Cumulative effort.

[A]

Yeah, I like to read the. The work of people who have done the work. Do you get What I'm saying. And that is how we should acquire knowledge in life. I don't think every one of us should go and test the principles of Newton to actually apply them in our lives. We can apply.

[C]

We're not going to run those.

[B]

It's an exact cumulative process. Exactly.

[A]

You know what I mean? But, you know, but when I look at that situation where the United Healthcare CEO shot and then even that story, that was like a weird one, you know, the gunman in Manhattan went into that tower.

[C]

Oh, yes.

[A]

And then shot. And then they said, like, they said they were there to shoot the NFL person, but then they shot a person who was in. I think they were a CEO or they headed up a division that was specifically tasked with. With housing. But I remember. And everyone was like, oh, wait, wait, wait, this is weird. You're saying they went there to shoot someone in the NFL? Yes. But they shot somebody who a lot of people don't like? Yes. Did they shoot anyone else? Not really. And you sure they were going, what coincidence? Yeah. And you're like, wait. And what I found most interesting is just off the Luigi Mangione story, what I found most interesting, and I'm not naive about this, is how the news and how these healthcare CEOs and all CEOs and Joe came out on TV, and they're like, why would people be celebrating this?

[B]

Why?

[C]

Why?

[A]

Then I was like, wait, wait. I'm not condoning any of this. Yeah, but you're shocked. You really don't know why people are cheering for this. You're really gonna act like you don't know why people are cheering for this. But the reason. I think we need to keep having these conversations. I'll talk to an author who's written a book. Ten years ago, 20 years ago, like Robert Putnam, we had. I was like, because the thing about the book is it expands, it dives deep. It gives you concrete understandings of what the situation is. It's not glamorous, it's not glossy, it's not quick, it's not snappy. It doesn't catch you really quickly. But when you're done reading it, you really, really, really understand. And I wonder if, like, it's a little frustrating for you. You go into this process, you write this whole book, you do this whole thing, you see, like, Luigi Mangioni. Everyone was in on, like, everyone's like, healthcare. Let me tell you what's wrong with them. And let me tell. And then Sheen was selling T shirts of Luigi Mangion's face. And then there's like a movie, Emma Stone's going to be doing a movie about Luigi. And then it just trickles out and then, and then you just see new headlines. Healthcare, UnitedHealcare buying this. UnitedHealthcare announcing that, cutting these jobs, expanding on this, merging with that. And you go, huh? It's like people enjoy the flash of the moment, but not what the moment actually meant. Like, how do you keep yourself going despite. I'm assuming you might be, but maybe I'm wrong.

[B]

No, no. It's deeply frustrating and to see something with a sort of, a lot of PR potential, an opportunity, a crisis gone wasted, because you haven't changed the structure. You haven't basically asked the fundamental question, number one, are you really serious that you don't understand the outrage and the anger and the sense of powerlessness? And number two, are we really going to make sure that something called UnitedHealthcare is primarily focused on health and not primarily focused on their share price? We haven't done anything about that. We haven't gone upstream and said, is capitalism indeed the best way to organize our society? Or better, is profit motive the only way we should be focusing on, on our healthcare industry? Is it really an industry? You know, these are bigger questions that never get raised. And I had my own sort of Luigi Mangione moment I was corresponding with. Since my book came out, I have had countless contacts from people in the industry. And one of them was A young nephrologist, Dr. Andrea Bua, who was very, is and was very, very frustrated about the, about the misuse of dialysis by certain nephrologists that he named. And he sent me a lot of data. He showed me, he has a website, as a matter of fact, kidneykiller.com which alleges the use of certain drugs to knock out people's kidneys so they will be on dialysis sooner, all sorts of stuff like that. And he wrote, we corresponded for three months until January of this year. And then three days after his last email, which were data filled, really thoughtful. He gets in a car, he drives from Miami to Terre Haute, Indiana. He attempts to. Allegedly attempts to murder one of the nephrologists.

[C]

Wow.

[B]

That he had mentioned in his emails and was mentioned in other lawsuits. Now, of course, when I heard this, I was horrified and I went through those emails a million times saying, what could I have seen this coming? They were the absolute picture of data driven, thoughtful, measured. But at the very end of one of the last ones, he said, I just can't see a way to make this stop. I can't find a way to make change. And it's a horrifying thing to be in the middle of it. But I think that sense, as you said, Trevor, of pointlessness, of sense of hopelessness and of powerlessness to stop and just the obscenity of a situation of the Luigi Mangione situation, where you have one person who apparently allegedly murdered another Luigi murdered Brian Thompson. But you have Brian Thompson, who has been making a very successful career on, in part, denying care to people who claim, whose doctors claim they need it. Now, I don't know about you, but until we can talk about that second group of people making an enormous amount, making a killing, as they say, on denying care as a form of taking people's lives. If we can't say it out loud, we're not going to get anywhere. We're not going to ever get anywhere. And if we can't say it out loud, that making money, doing that, that makes it worse, we're really not going to get anywhere. And money may not be the root of all evil or love of money, but it's a pretty good proxy until you find it. And we really need to get off the money drug somehow find a way to reorganize our view of how life should be led so that money isn't the number one thing. And those folks can't come on and say, oh, I'm shocked, shocked. I can never condone violent acts against. But yes, you have two people. And how many. Again, how many people has the major healthcare CEO accounted for in his long career?

[A]

Yeah, but it's that old line, right? If you owe the bank $1,000, it's your problem. If you owe the bank a billion dollars, it's the bank's problem. If you do something on a big enough scale.

[B]

I was thinking Voltaire, the, you know, murder to the sound of trumpets by the thousands is called. Is good.

[A]

Yeah.

[B]

One murder is unacceptable.

[A]

Yeah. There's a weird thing that happens in society where if you get the scale great enough, it's somehow not seen as the same issue multiplied, when in fact it is. What is this?

[B]

Stalin's One murder's a tragedy. A million is a statistic.

[A]

Yes, exactly. But that's exactly what it is. And to your point, accountability is also doled out differently, Right. Because if Luigi Mangioni.

[B]

There it is.

[A]

If Luigi Magione is found guilty, he's gone. Gone for. Gone for. Gone like. Like life, death. What? Like gone, gone. Right. Not if. When healthcare CEOs and their companies are found guilty. There's no life sentence. You check, there's no death sentence. There's barely even a financial sentence. Right. The last I checked, the Sackler family, who are responsible for more deaths in the US Than most criminal organizations.

[B]

In all criminal organizations.

[A]

Best loud there. Think about how many families have lost a father, a mother, a brother, a sister, a child because of opioids that they were told were there to help them. Those people became addicted, died from pain, whatever, you name it. Sackler family, they didn't even lose all their wealth. Like, just, just think of this for a moment. Even if you said to me, okay, they're at zero. We took away everything. I know they're not in jail, but they had zero. I'd go, it's still not fair.

[B]

But.

[A]

But they didn't even take all their wealth. The people could still fly away in a helicopter. Like my brain. Do you know what I mean? It's like, wait, wait, wait. Then are we living in a just society? And that's the thing that I think people at these levels either don't understand or either act like they don't understand. If a justice system is not just, then people stop believing in the system.

[C]

Yeah, yeah.

[B]

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

[A]

You're like, why would you, why would you not see this? Do you not see that this is going to blow back on you? We're going to continue this conversation right after this short break.

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[C]

I think what's going on in the world, you're absolutely making so much sense. What's going on in the world is what usually happens in the classic mafia movies. You know, no one first part for me is no one ever talks about the marketers. People talk about the great CEO that came from this company that did this to this thing. But if you think about it before, when people trusted a government more, they would buy government bonds and the government would be accountable to the people that bought the bonds because the government would have to pay the bonds back. The same people that make the legislation, which is the guardrails that are supposed to keep people safe now go into private business. They get rid of the guardrails, but they still keep the government bonds system by saying you're selling people shares. But the marketers have realized just like in that scene in the Godfather where he walks around the square and he bites an apple and then later on the nana would come and complain. Don Kolioni will take care of it. It everyone is wetting their beak. Yeah, if you are betting online, if you are buying shares, if you are watching the stock price go up if once in a while. The thing that astonishes me more in this country is when you watch television, these ads about, you know, you owe this much money, if you call this. And then this was happening and then they always give the stat of how many people haven't versus the how many people should. And all of a sudden I look at the drug companies different and go, but if they care so much, they're here buying ads, but they are they advertising the product? Are they. Do they really want you? Which lawyers must you call to do this thing?

[A]

Yeah, it's.

[C]

It all becomes yes, everyone's beak is wet. Everyone is eating a little bit here and there with online betting, with buying shares, with working there knowing someone who is in it.

[B]

And no one's looking after the little guy us. Right? And no one is looking at the Consumer Financial Protection Bureau is constantly the target of attacks has been dismantled. No one is out there saying, yeah, but what about, you know, Sally out there? What about Bob? I mean, what about, you know, there's no one after them. And that's the thing that, I mean, that's kind of what I saw in dialysis, but I see it everywhere is a sense of the most vulnerable people are taking it in the neck and everyone's sort of, oh well, you know, they're sort of vulnerable. Maybe it's their fault, who knows?

[C]

Blame the victim. Yeah, yeah. Medical aid companies do that all the time in our country. They'll co opt you into going and using their app that monitors how many times you go to the gym, how much healthier you are. But I'm like, since when? When are we being lectured about living our lives? When your job is to improve our quality of life. So now you've foisted me with the responsibility of not getting sick while I pay you to keep me from getting.

[B]

Sick and give you my data too.

[C]

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

[B]

Right? Yeah, right, that's right. Yeah, yeah. The lecturing part is very. Is tricky too when you, you'd helicopter into these situations. I'm working in Boyle Heights in Los Angeles and it's in an area that's 95% Hispanic. And I can't just sort of helicopter in and say, hey guys, how's the dialysis working for you? And by the way, there's a way to fix this. So I hook up with local organizations. Homeboys Industries is the most. If you haven't been, you gotta go.

[A]

Okay.

[B]

The coolest place I have maybe ever been, but it's certainly the most impressive. It's a gang rehabilitation organization. It was started in the 80s by Father Gregory Boyle, no relation to the neighborhood. But now they have this view of Boyle Heights that is all inclusive and Boyle Heights centric. Every business has to be in Boyle Heights. They have urban gardening, they have all kinds of other things. They have art, but they are actually taking the people who are most at risk. So when I arrived, I mean, the people that everyone else fails to do and won't even take a chance at because their statistics might be skewed. When I arrived, I couldn't get anyone on the phone, but I wanted to talk with Father Gregory Boyle and I wanted to talk with the head of research and so on. So I just arrived and sat down and they have a wonderful homegirl Cafe Satan down. And I said, I'd love to talk with Father Bole and Mike lan. And these are the people. Oh, well, he's very busy today. And I said, that's okay. I'll stay as long as it's necessary. And they said, well, you know, he may be busy all day. Oh, that's okay. I'll stay today, and I'm coming back tomorrow, and I'm coming back the next day. And I went and sat down and I really meant to guy my computer. I was perfectly happy and I wasn't, you know, and I really needed to meet these people. And. And about five minutes later, someone and I went back, remember, this is gang rehabilitation. These are some. The people with tattoos over their faces and stuff. They read you in a heartbeat. They can see, they know their territory, they know who you are. And 20 minutes later, a couple guys came and sat down and had lunch, and one of them left over. Oh, that's a kidney guy. Yeah. And so by the third hour, I had already met with the people I needed to meet with, and we were already. We are off and running. But that feeling of entering this space where hope is in the air. They have been in a terrible place, and they're still facing incredible difficulties. But there is a sense of, let's not let the state or the government, the federal government or let's do this in a community that's, I think, part of the system that we need to employ to get back on our feet as a country. But that place is amazing. And that's sort of of street level, person to person information that you really need to make a difference and to understand what dialysis or anything else is doing in a community is find the people who know that community who grew up there, who were really plugged in. Yeah.

[A]

You know what I realized reading your book and then meeting you is you're that person from the movies. You know, those movies we used to watch, they don't really make them anymore. But remember, you'd watch these movies.

[B]

That may be my problem.

[A]

You'd watch these movies where they'd be like. Like some random person. They'd be in like a. A suit that doesn't really fit too well, and they've got their briefcase.

[B]

Yes.

[A]

And then they go to, like, an office and they'll be like, excuse me, I would like to meet the. And they're like, I'm sorry, he has no appointments. It's like, okay, I'll. I'll just sit here. And then it's like. And then like two hours later, like, hey, he's not. He's not coming back. It's like, it's fine. I'll just sit here. And I. I remember watching those movies and I'd go, there's no one like this?

[C]

Yep.

[A]

Now I've met one.

[B]

You.

[A]

You have it like a. It's a dogged and insatiable attitude towards, like, finding the truth, the people, the story. It's like, is it conscience that's pushing you? Is it, like, what's motivating you? Beyond. Don't get me wrong, I mean, it is a noble cause, but beyond that, like, what is making you sit down for that long? What's making you go talk where people don't want to talk? What's making you investigate unbeatable quote, unquote, corporations?

[B]

Yeah, it's a really good question. And part of it is a sense of unfairness. I do have this sort of sense that bullies are one of the worst species and hypocrites are also one of the worst. So you have a bully hypocrite feeding you a line. That's the worst of the worst. And I run into that a lot in corporate America. So. Also just a sense that we can do better, we have to do better, we must do better, and that it can start with. It needs to start with information, good information. So what is really going on in the dialysis industry? But it can, I think, in a pretty short space of time, you can turn something around by taking the small community view and building outwards rather than trying to fix it with a blanket. Everything needs to change. And besides which, there is no blanket anymore, so you might as well do it in your own backyard because no one's gonna be looking out for it.

[A]

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

[B]

You, You.

[A]

You know, it's. It's. It's so many stages. First of all, you hope someone will help you make the book. You hope somebody will publish it and put it out there. You then hope that people will read it. You hope that it'll connect.

[C]

Yeah.

[A]

But the hardest step, after all of those hard steps is you hope it'll make a difference.

[B]

Yeah, that's.

[A]

And. And there's something that happened with your book that is, again, it's like a Hollywood movie that you. You hope would be written. There's a moment where the fda, the head of the fda, goes, I. I want to use your book to go after these two sinkhole companies that are, you know, scamming Americans for their healthcare, scamming the government, essentially for all of the money that is trying to provide to help people. And I think your book, if I remember correctly, got cited 21 times and there was a lawsuit. What's the latest on that is like, is this still moving forward? Are these companies still being held accountable? Because your book actually made a change on a level that people didn't think a change could be made.

[B]

Well, it is work in progress. Nothing has been fixed yet. But I will say that Marty Makary, who, before he became FDA head, had read my book. When he became FDA head, he asked me for a memo. How do you fix dialysis? Yeah.

[A]

Wow.

[B]

Give it to me. And he said he's spread it around to Dr. Oz and to RFK and others at the highest levels. Who knows what's going to come of that? But at least they asked. There has been a recent lawsuit came out in May alleging antitrust violations of all kinds. They did cite my book 21 times and cited people. I cited another 15. And. And they simply lay out. In my view, they're all allegations until proven. But in my view, a pretty good case for why you have two huge corporations that control 80% of the market that's harming patients, that's harming workers, and that's harming taxpayers. I think they made a pretty good point. So, yeah, I mean, Robert Wood Johnson foundation is funding some of the work that I'm doing. There is forward motion on this, and there is a sense, I think, and I've received thousands of emails from people inside the industry, whether they're patients or families or whatever, and I would say it's bipartisan. There is a sense of enough is enough. Some of them are Trumpists. Some of them are. Some of them voted for Kamala Harris. Some of them. Who knows? They didn't vote.

[A]

It doesn't matter.

[B]

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

[A]

Your kidneys don't vote, bro. They don't. You know what I mean?

[B]

They do not. And those babies. I've never had such a warm and fuzzy feeling for my kidneys. You don't think about your kidneys, right? Yeah, man, you can. They are the conductor of the whole orchestra of your body without those kidneys. You know, people don't talk about renal fortitude. They talk about guts and brains and heart, but they don't talk about kidney power. They should. They should. Renal fortitude.

[A]

It's one part of you. You know the analogy I used? There was someone I was having this discussion with, like, after reading your book, and they said, I don't know, I think, you know, the market, this and the. And I don't think you should get. The government shouldn't get involved in what's happening.

[B]

Here.

[A]

And I think private companies. And. And I was trying to figure this out because I was like, wait, okay, how would I. How would I explain this? And I struck. And then. And then it struck me. I went. I would never deny that there are many private companies that have done an amazing job providing us with products that we love and use. We're using a bunch of them now.

[B]

Right.

[A]

But there are certain aspects of life where you have to ask yourself, who should be in charge of this? And the reason you need to ask yourself is because of the ramifications on the other side. Yeah, Right. If a private company is in charge of making these microphones, and then they don't make them, I guess we'll talk without microphones. You know what I mean? It's inconvenient, but we'll have to find another way. If a private company is in charge of your health, which is your life, what are the ramifications on the other side? If they screw you over and then someone will go, oh, but who says Government? You know, then I'm. Again, I come back to this. Remember what a government is supposed to be is the collective force of the people.

[C]

Yeah.

[B]

Common good. Yeah.

[A]

We've made it seem like it's this foreign entity. No, no, no. It's our collective force that's acting. It's your friend. It's almost like having one friend. Where you go. They go to the bar, hey, what do you guys want for drinks? Yeah. That's government.

[B]

Yeah.

[A]

You go get us drinks, and then you hold them accountable. Be like, yo, where's my drink? That's what it's supposed to be. But now we've made it seem like. Like your friend at the bar goes to the bar, and then all of a sudden, you're like that bar guy, man. Let me tell you about Barry.

[B]

I took my money.

[A]

Yeah. It's like, no, no, this is.

[C]

Took my money. Yeah.

[A]

It's like, took my money.

[B]

Yeah, yeah.

[A]

But was supposed to take your money to buy you the drink that you wanted them to buy. And when you think about, like, healthcare and these types of industries, I keep. I keep thinking. And this was the analogy I used with this person. I said, so you think it's fine. They're like, yeah, well, they made money. They found a way to make money on these things. I said, okay, okay. What if I found a way to make a technology that could suck the oxygen out of the air? What if I found a way to do that and you lived next door to me, if I sucked the oxygen out of the air. You know, there's no law that like stops this right now. Right. And now I say to you, oh, no, no, no, no, no, please. I'm not saying you shouldn't breathe. I'm just saying you should pay me to breathe. Breathe. Would you accept that? And would you live in that society right now? Even someone would be like, that's a crazy, that's a, that's a ridiculous analogy. Is it though?

[B]

AI what's happening with AI right now, it's sucking the oxygen out of, if.

[A]

Somebody, if somebody has a machine that decides whether you live or die and you have to pay them in order like a crazy amount of money to stay alive. And then your government doesn't really cover you the way they should because that same company has convinced them to not. And they, that. How is it any different?

[C]

I think you said the key word, they're convince. I think we've had, we, we have a lot of whistleblowers, we have a lot of researchers. But I think the fight back from these corporations and these companies and these institutions is how much they invest in marketing.

[A]

Yeah, they do.

[C]

And the language that they put out there, you're not wrong. For example, I, I, I think even body organs are not given priority based on what the, the language, the common colloquial language is for that, that for that organ. For example, a kidney, as essential as it is. Marketing and language has made it seem like you can do without it. And also marketing has also made it feel like it's something that someone will give begrudgingly if you need to, but they'll be fine with it.

[B]

Oh, man. The doctor is not called, the two of them.

[C]

Kidneyologist.

[A]

Yeah.

[C]

Nephrologist. So it's interesting, there's also this. Yeah. Shroud of mystery that's put around things. And sometimes if it's not mysterious, it's trivialized so that you don't take it as seriously as it should be. You know, the biggest example for me is Department of Defense versus Department of War. And I say to people whenever they talk to me about self defense, I'm like, why don't you maybe go to a self offense class? Yes, because that will help you more. Because self defense means we're blocking. Right. Or we're getting away from the thing. So, so it's the language that people use. But I think the fight back right now after people like you have done the job that they've done, is for marketers to reinvent how people see a subject or how people even speak about a Body organ for it to become as. As prolific as it should be in people's lives. And people go, when you talk about kidneys, I know what you're talking about. Yeah.

[A]

It's basically on us in these forums. Essentially. That's what I feel like.

[C]

Absolutely.

[A]

Because there's no money in that market, if we're honest. There's no money in that marketing.

[C]

Yes.

[A]

You know what I mean? You're not going to make money from that part of it. But the man. The one thing I really love and I appreciate about your work, and that's why I really appreciate your time. Not you.

[C]

Oh, not you.

[A]

I do love your work, but not right now. One thing I appreciate about your work, Tom, is like, is it reminds us that we are the ones who are supposed to make it matter. You know, we are the ones who are supposed to give it a voice. We are the ones who are supposed to speak out about it. And we don't know who will read the books. That's the ironic thing. You didn't know when you wrote that book that the head of. That the person would become the head of the fda.

[B]

Right. Wow.

[A]

Do you get what I'm saying?

[C]

Yes.

[A]

That's like such a crazy. They were not in that position. They read your book, they go into that position.

[C]

You put a message in a bottle.

[A]

No. And to your point, Eugene, it's like we take for granted what those messages, you know, where those messages land up, like where those bottles wash up on shore, where they, you know.

[B]

Yeah. It's just that there's an urgency to this that gets me, keeps me awake at night. Because every time, you know, I took a lot of people's patients stories and convinced them to tell me their stories despite the fact that they were putting themselves at risk. I mean, there's a real risk of retaliation. And a couple of them used the same kind of language. They said, okay, I'll tell you my story, but when I'm gone, you have to promise that this won't happen to somebody else.

[C]

Wow.

[B]

And I, you know, you don't. It's not the kind of promise you'd make lightly. And it's not one I take lightly. Every day since we've been talking here, people are in harm's way. This needs to stop. Like yesterday. So that's kind of what. At the same time, there are positive movements and positive symptoms and a very clear game plan for what needs to happen. It's hard, but very clear. 10 point plan. There's an urgency here that just. I can't let go of.

[A]

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

[B]

It does. Yeah, it does. And yeah, with my brother, who is undergoing some real, real health challenges right now, I see a lot of what I've reported on in a way that hits home, hits home very hard. So, yeah, I mean, we're all in this and it's all up to all of us. That's the other thing that I think you brought up, but I think is really important for people to remember. It's on you. It's on us. There is no, you know, the knight in shining armor who's going to arrive. The cavalry is not coming.

[C]

You are. You are it.

[B]

Yeah, yeah. And, and, but we can. I mean, we definitely can. And I've seen, you know, these small groups and larger groups, People's lobby in Chicago and homeboys and, and la and a bunch of others who are just saying, okay, let's just do this. Let's just do this right here among us and then we see how it goes. And I think that's kind of my model until I see a better one.

[A]

Hey, man, I'll tell you now, you've put forward one of the best models. I hope as many people as possible read your book because one of them might become the next head of the fda. One of them might become the next something of something. And yeah, wherever we can help, help. Let us know, man. It's. It's really worth. Worthwhile. Thank you for taking the time.

[B]

Thank you very, very much. Trevor and Eugene, it's been a pleasure.

[A]

This is really great, man. Thank you so much. Tom, for real, man.

[B]

Thanks.

[A]

We've got to stay in.

[C]

Sorry about your brother.

[B]

Yeah, yeah, it's tough.

[C]

It's tough.

[B]

It happens. But you don't think it's going to happen?

[A]

Yeah, no.

[B]

Until it happens.

[A]

But can I, but can I tell you, it's. You know, my mom is more prophetic in the family, but she would say something to the effect of we don't know what wars life is preparing us to fight.

[C]

Right.

[A]

We just experience the battles, you know, And I, I almost feel like in a, in a, in a, in a weird way, it's, it's almost come around where you go like, damn you. It's, it's, it's put you in the front seats to fight the thing that you're already fighting in an even more energizing way.

[C]

Yeah, that's true.

[B]

Yeah.

[C]

You already had perspective. You needed urgency.

[B]

Yeah, that's right.

[A]

That's exactly right. That's a more eloquent way to say it.

[C]

Thank you.

[A]

This episode is presented by Whole Foods Market. Whole Foods Market is the place to get everything you need for Thanksgiving. With great prices on turkey, quality organic produce grab and go sides and everyday low prices from 365 brand, you can prep for the holiday with big savings. Shop everything you need for Thanksgiving now at Whole Foods Market. What now with Trevor Noah is produced by DayZero Productions in partnership with SiriusXM. The show is executive produced by Trevor Noah, Sanaz Yamin and Jess Hackle. Rebecca Chain is our producer. Our developer researcher is Marcia Robio. Music, mixing and mastering by Hannis Brown. Random other stuff by Ryan Harduth. Thank you so much for listening. Join me next week for another episode of what Now. Hey crafters. You're invited to visit the new Knit and Sew shop at Michael's. Find hundreds of fabrics in over 800 stores and over 100,000 styles. On michaels.com, shop your favorite yarn brands, including Big Twist, Caron Cakes and Bernat in multiple styles and colors. You'll also find all the machines, tools and notions you need with top brands like Singer Brother and Pellon, plus Essential Thread and Floss. It's all new at Michaels. The 2026 Chevy Equinox is more than an SUV.

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