What Now? with Trevor Noah - The Most Dangerous Part of America’s Healthcare System Isn’t What You Think with Tom Mueller
Episode Date: November 27, 2025Trevor, Eugene, and author Tom Mueller examine how corruption, greed, structural failures, and declining public trust in the American healthcare system have shaped patient care — and whether meaning...ful reform is still within reach. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.
Transcript
Discussion (0)
The story of dialysis is an amazing case study of good intentions being thwarted by bad incentives, poor oversight, and profiteering.
When I was working at the Vita, the priorities was to get them on dialysis and get the next patient on as soon as possible.
It was all about numbers.
Tom Mueller is the author of How to Make a Killing, an investigation of the dialysis industry.
In America, patients on dialysis die one to two times faster than in any other developed country.
This is What Now with Trevor Noah.
This episode is presented by Whole Foods Market.
Eat well for less.
I've never known you without glasses now that I realize it.
You actually have.
When?
Half of our relationship was without classes.
What?
Take off your classes?
Remember this guy?
No, actually, yeah, no, you're right.
You're right, actually.
Yeah, the beard now it's like a flip.
Yeah, there's no beard, more hair, no classes.
It's like I've known every version of you.
Do you know this guy?
Eugene, where are you?
I'm here.
Oh, Eugene, you're back.
I think someone else in his classes.
I'm just saying.
Welcome to our idiot friendship, Tom.
I'm so sorry.
Thank you.
Very much, but Eugene, I feel like I fit right in.
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.
Because a lot of people are fans of your books, but I don't think a lot of people know a bit of your life.
It's like, where were you born?
I was born in New York City
Okay
Left six months later
Went to London and Paris
I like how you say that
Like you left you were like
I'm out
I was lefted
You were like I'm out parents
I can't do this anymore
Yeah when I say
I was born in Columbia Presbyterian
My New Yorker friends
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 it was an experience.
I learned about football, which is something.
And then, yep, we went east for college
and then went to England for grad school
and have really not lived in the United States
since Ronald Reagan was president.
That is wild.
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.
Do you think that some of that has affected
how you're able
like maybe I'm projecting here
but I sometimes feel
regardless of nationality
one of the best things you can do
is remove yourselves
from a situation
to be able to see it better
it 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
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
I think no question is stepping back and looking at the way in which, for instance, you mentioned
to 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, you know, things really have changed
year. And that's in the last 30 plus years, things in America have changed at an accelerating
pace, 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. How did you get into writing? Because I don't know if my research was
correct, but were you in banking at some point? Yes. I did a PhD in history and love history,
but realize it was not cut it out for academia. So I thought, well, I know languages, Europe, 1992,
happening, let's try. There were recruiters on campus checking for people who were 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.
What do you mean by that?
They were indentured servants to this company.
And simply their lifestyles were terrible.
Their incomes were very good, but terrible, terrible lifestyles.
And that was well before the run-up to 2008 and all the massive crime.
I was in a business where still the relationship was important.
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 collaborator
were bosses and collaborators at the bank was on the one NDB indictments. I mean, he was,
you know, they had investment banking. We're talking about like the, this was the 2008 Wall Street
crash financial collapse. Yeah. I mean, they were testifying before Congress. They were
explaining why you could call a client a sock puppet and you could create financial
vehicles. Wait, Tom. That's an actual term? The actual term, sock puppets, yes. Was it used
within your circles or just? Not within my circles, but the folks that I worked with who
stayed at the bank, that's what they were talking about. Yeah. And again, trading is very, very
different from relationships. Trading is one day at a time, I win you lose. I mean, 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. And then betting against them.
That's insane, man. I still can't believe that that happened.
And then I, you know what shocks me even more, is that the ramifications were barely felt.
Do you get what I'm saying?
Yeah, yeah.
It's one thing to go something wild took place.
It's another to go, nothing happened.
But I think that's why a lot of people have sympathy and sometimes admire people who do white-collar crime, right?
Because it almost feels like it's a victimless crime.
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 problem.
You see what I'm saying?
No, I mean, you look at Mike Milken.
I mean, he was actually prosecuted and sent to jail for multiple felonies comes out.
He's the toast of the Nobel Prize community.
He's got billions still in his foundation.
It's no, I mean, white-collar crime is vastly more, it's the cancer of society.
It's vastly more damaging.
It causes massive amounts of harm.
But, as you say, it's almost lionized in the,
business school community as something, hey, you know, you really is a risk taker, right?
He's a real hard.
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.
They see it different than we do.
Yeah.
And if you're flying, you know, close 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.
Yes.
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 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.
You're the perfect person to be having this conversation.
with. In South Africa, we had the State Capture
Commission. Did you
read about it? I did. 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 rent 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 a cookie jar. So if you and I steal,
we make a billion dollars, we still have to go buy Ferraris, Maserati's, 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
And why is it that even when corruption is thwarted, it doesn't go further than when people exchange the same money for goods?
Those enablers, I mean, there as one whistleblower in finance, who revealed that a certain bank, Wells Fargo bought it, was laundering money for the Sinolaura cartel.
He said, those enablers, those bankers had their finger on the trigger every time the Sinolaa cartel fired a gun.
And that's true.
I mean, we cannot look at enablers, bankers, bankers, real estate.
people, corporate, you know, corporate foundations, all the other folks that make their lives,
possible tax advisors, all these offshore, you know, those are fundamental figures in the
crime syndicate. And they are as responsible for every bullet that hits as the actual person
who pulls a 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 hit men and women of this world. Most in the food chain. Yeah, they're just 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, you know, New York Public Library.
sorts of very special perks for them. You know what's what's 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 cry.
We've almost given it a respectability that it doesn't deserve.
What kind of color do the people who define it where?
They wear white colors.
They're judges, their lawyers, 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, you know, elderly
teachers eat dog food
if 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
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, erosion of the social fabric
than any blue-collar crime.
People don't realize how much the things they're experiencing in the world every single day
are a byproduct of those crimes.
And while we'll never dismiss a murder or a robber,
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,
those types of things have such a widespread effect.
You know what I mean?
They're more likely to create more of the thing 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'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 a,
Such a 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 right you know how to make a killing in health care in
america is like you know you look at all the stories that popped up the luigi
mangioni story you know you 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 yeah and when i read your book i went
This guy, you didn't just critique it.
You break it down on the, 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 real crux of your book, but it exposes everything.
You went, you go into dialysis.
Why that topic?
Help me understand.
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 this.
And there was this weird outlier, dialysis whistleblowers, the finance people in dialysis 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 $400,500 million settlement at a pop.
No way.
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 inner banker was
like, bing, bing, bing, the board is blinding up the reg. 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. It's also a terrible story of how a miracle can be turned into a curse, right?
Because you look at when this technology is invented. I only learned this from your book. It's not
like I knew this before reading the book. I didn't either. You look at this world where it's like
dialysis is this miracle. Yeah. It's like, wow, we've invented this way to basically, you know,
an external kidney. Yeah, an external mechanical kidney. What have we done?
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 stepped into it, what made it the perfect place to start?
Like, what would people not understand about dialysis?
Like, they might be like, oh, yeah, what makes dialysis so big or so unique?
Or why dialysis versus everything else?
What was it about this specific topic?
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 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 plans.
for national health. The U.S. 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, 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 that around that same time adopted national health, Australia, which is
the counterpart that I compare the U.S. 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 reganomics very soon after.
And government's the problem, not the solution.
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 rene-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. It's as simple as that. 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, I have, 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 in 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 and i said you've got to get involved with this involuntary discharge from the
dialysis facilities and he 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 you get it if you don't get
it you're going to die yeah 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 a 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 health care. That's not an overstatement. They are financial vehicles with exposure to health care.
How complicit or how complicit is the average person who buy stock in these companies?
Why did you look at me when you said that?
That was weird.
Complicit is ours.
No, no, no.
It's Tom's world.
No, no, no.
But what 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.
How complicit.
Yeah.
The friend of yours was an average.
That was really weird.
And you're wearing a tan sweater.
Ask your question and look away from me.
Look at me like that.
Look at the other way.
Look at the other way.
I have never bought any stock in the health care.
You look the other way.
Don't do that.
No, take that back.
I take it back.
Do 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,
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 thing that you say it does, how complicit am I?
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?
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, you know, 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, right?
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.
There's zero social 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 an argument that says social responsibility and 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.
Corporations are people?
keep, this is United, citizens
united. Corporations are people
as a legal entity, right? And
their money and any money is speech.
Those are two things. Yeah, that's one of the worst
decisions America ever made. It's preposterous.
I mean, if you think about it, what is that? 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. Those really smart
people are saying it. It's, 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.
And that's what our, I mean, the U.S. campaign system, campaign finance system is illegal in most countries.
Yeah.
I don't know how it is in South Africa.
No, no, no.
But a big company can't come and give you a million bucks.
So ours is, you can in South Africa.
They make these big donations.
But I was shocked, when I first came to the U.S., I was shocked at how many things are legal here and just full-on bribery where we're from and in other parts of the world.
It's just like, it's just bribery.
Holy bribery.
This is bribery.
Yeah.
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 and then spent this much and then you come here
and they're like, no, no, no, that's lobbying.
What are you talking about?
That's not bribery.
Free speech.
No, that's First Amendment.
Yeah, they're expressing themselves.
This poor company needs to speak.
Are you going to silence the company?
Oh, poor company.
We're going through that actually right now
where officials from our version of the DMV
went to France
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
they have the exclusive contract
essentially
forever
it's massive amounts of money
but it's exactly what you're saying
and when 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 it turned out they funded
the Sinaloa cartel
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
there are good investments
they are great investments
rapidly growing good market share
you know return on assets
This is awesome.
It's a great.
But look, do I condone everything?
Of course I don't.
But I'm not there for the murder.
I'm just there for the investment.
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?
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 going to buy a nice car in a nice house.
Well, first of all, steal from the necessity. I'm hungry. I got to 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 color crime we were talking about earlier. 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 throat, you know, all these sort of sports slash
killing analogies of war, I mean, corporations as war fighting machines.
Yeah.
That's kind of, you know, penetrate and, and take, you know, 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 just sort of nudge, nudge, wink, wink.
The compliance department says we're doing everything just right.
Oh, yeah, we have a gold-plated compliance department.
Plausible denouability.
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 at 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 at that, I got $5 million.
bucks. That's very tangible. And now it's 5.2. And on 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 two billion. It's never enough. It's like the
shark that can never get full. And that's where I think that's the ultimate problem. It becomes,
especially when the society worships these people and condones all of their actions, it becomes
this sort of endless, endless hunt for more, for more money at the end of the day. And it's
a status thing. And it's a, 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, it's a counter
for the quality of your life. Because the quality of your life, I don't know. I mean,
again, working and 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. Um, but they felt successful. And for me, after two years, I was like,
but you're 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. Don't go anywhere because we got more what now after this.
We had an episode of the podcast with Rutka Bregman.
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 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's 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 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 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,
because 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 importance,
and the media tells you it's good and important,
then you think it's good and importance.
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, you know, 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,
the sense that they are gods. And it builds into this sense, too, that there is an ubermensch
society and then they're underlings. And those underlings, if they're, you know, homeless, well, they're
not human, really. It's not my problem. I mean, that's a 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 whatever.
But this is sort of an institutionalized form of superior being judged by your net worth, and then everybody else who's really expendable.
To talk about expendable, you can look at one of the examples you give in the book.
And you go through multiple hospitals and health care 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 man it it sounded less like
healthcare and more like a fast food drive-through chain
it felt like they're trying
to get people on and off a machine as quickly as possible
use as few nurses as possible
make as much time work as possible
look after the patient for the least possible.
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%.
It's fast food medicine.
And it's a model that wasn't invented by dialysis.
It was embedded in the 60s by people who actually
ran Kentucky Fried Chicken franchises and Wendy's.
Literally.
Literally.
who then started buying up, you know, started privatizing hospital systems and putting together.
So they literally were the people with this branding experience and this mass fat, you know.
And in theory, I mean, you know, Atul Goande wrote the Cheesecake Factory article in the New Yorker, which got a lot of attention.
I don't like it.
But he's a smart guy.
He's a doctor.
And the idea of focusing in on a specific.
medical procedure, making it as efficient as possible, and delivering it and as low cost
away 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 of view. The person,
The person who brought this into dialysis or popularized at Kent Theory.
He was a former CEO and the founder of DeVita, one of the two big companies.
He made his bones at Bain Capital.
That's a private equity firm.
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. This is a quotes, right, from his speech.
This is an actual quote. Actual quote. Yeah. Yeah, I can show you the video. It's quite striking.
But again, it fits in a business situation in which you are Wall Street facing and you're talking about return on assets.
If you have a 2,000 dialysis clinics around the country and your main focus is shareholder value.
Yeah. 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.
Except 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, you know, assembly on a model,
you're not going to do that. One size fits all. One size fits all. And you're going to penalize
the people who slow things down. You 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 it's like soldiers forced to commit, you know.
Yeah, yeah, yeah.
That's the perfect analogy.
It is.
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 and doesn't permit it.
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.
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. 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. But it's when you delve into
that you go like, oh, man, my doctor's victimized by the same system.
The doctor is called a provider now or even a vendor.
I mean, you know, he or she is a cog and 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, you know, are we good with private prison systems?
Are we good with private war fighting?
Are we good with, you know, there are certain things that should not be primarily profit,
facing. Yeah. And health care is one of them. But there are a lot of others. And we just, in America,
we've lost that discourse. When you look at other countries, what did you find? Because I think
there's a perspective that you bring in this book and in your work that I think is really
important. Because oftentimes people will 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. No, precisely. I mean, we've gotten so caught up in
American exceptionalism that we lose side of the fact that there are a lot of places where things
in general and health care in particular are done a lot better. And the example and the most
brutal example is how long do patients on dialysis survive in the U.S. versus other countries?
What are the stats? 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's 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 or not Denmark.
You know what I'm not exactly. And you have, so in most countries you have, 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, boop, boop, boop,
to the hospitals, pays the doctors, pays the staff, and gets and pays for the treatments.
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, you know, a,
absorption. You're talking about middleman and the cost to health care. This is a classic example. You have these two twin towers that are that are soaking up a lot of the billions and billions. We're talking roughly. I wouldn't do twin towers in the hands like that. It might be the, it looks like the wrong thing. Yeah. I'm using. Twin Towers and I was like, whoa, whoa, Tom, Tom, Tom, Tom. Wrong hands. Let's find. Different analogy. Let's go with something. Two large. Yeah, two large. You know what, two. Think holes.
That's better.
Two sinkholes and they're sucking everything in.
That's way better.
It looks nothing like the 9-11.
You went towers and then your hands did this.
And yo man, we from another country time.
Don't be doing that to us.
Yeah, yeah.
Look at the calendar, man.
Look at the calendar.
What was yesterday?
Yeah.
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 United Health Care'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.
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 U.S.?
Well, they're following universally accepted medical guidelines,
which have to do with how long, how gently you treat,
at what values you treat.
Do you do it at home or not?
I mean, if you look at Australia, the majority of, they push patients to home dialysis.
Wow.
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, right?
And being a passive recipient of care, lie down, put your arm out, I'm going to take your blood.
I've heard patients tell me this from.
you know, in diocese 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 a fate, that is another of the fundamental, widely, universally
accepted laws of diocese, 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 what is CMS uh it's the center for
medicare and medicaid services okay got to go yeah yeah administer medicare and medicaid funds
and they know what good dialysis is yeah they know what the metrics are okay they're just not
counting them okay so they don't count treatment time yeah they don't penalize people who don't
treat longer and then they don't count um ufr ultra filtration 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.
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.
Yeah, but the question is, who's telling them what to count and how to count?
I guarantee you the answer is the revolving door.
Yeah.
In my book, I cite several examples of people from the White House who have gone to the board
of the big pharma companies, big 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. 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 government.
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 going to come in.
The machine will be there.
The government is going to help you out.
And because you can amortize the cost across a population, it will work.
It will work.
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 that money?
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.
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.
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.
It's such a con job.
And exactly.
And the government does become people in America
are, oh, big government.
It's really bad.
I mean, you look at the Pentagon,
on a 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. Right. You know, I mean, and you see the
revolving door between the generals who go onto Lockheed's board and, I'm just speaking,
Lockheedon, you name it, they've got it. The whole outsourcing government contracting thing
is such a scam. It's the greatest scam. It's the greatest scam. And at the same time,
is able, as you say, to push the blame onto government, big government, which never gets it right,
and talk about socialism.
I mean, you look at war fighting in America,
a trillion dollars a year to the, to the Pentagon.
Trillion dollars a year.
That's socialism, right?
Oh, no, no, it can't be because it's America.
Sorry, my bad.
Yeah, and because it's war.
It's because it's war.
It's like, it's amazing how war, yeah,
war is always the thing where people are like,
the government shouldn't be smaller there.
You're like, why shouldn't the government be smaller there?
We cut everything else, but 10% raise for the Pentagon.
You know, they're smaller governments, and he's like,
except for war.
Oh, war.
I mean, no.
And how successful have our,
our war has been recently at producing security, a national defense. Not so much, actually,
you know, if you think about it. 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. 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, food on a basic level, that's a war
that you could be fighting in your country without bombing anybody. And that's exactly the
reason in the 1970s, a number of people, this is during 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 a dialysis in that way.
And the other thing about war is, of course,
and the trillion-dollar Pentagon, is that, you know,
as one former general told me,
when you got to be a big hammer, everything starts looking like a nail.
Yeah.
I mean, we've got to go out there.
And I built all this cure.
You've got to find a reason to use it.
Highly trained in doing this stuff,
we've got to find a way to use it.
And we have to get rid of it because we have to make more.
You're not wrong.
That's right.
That's right.
That's right.
There's this new stuff coming on.
And some of it gets lost in these smaller third world countries.
Oh, my goodness.
Oh, don't even get me started on that.
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 it's out there hunting for wolves.
That's a perfect analogy, actually.
Yeah.
That's a perfect analogy.
Yeah.
The wolves are taking over in the, in the shepherd's room.
Like, wolves are cooking dinner.
Having lunch on.
Are you okay there?
You can sit this one out.
We'll take care.
You want to 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, you know, you know, come on.
You know, that's, that's, you know, when you think of it, like.
Yikes.
Man, it's scary because you see this moving into everything.
Yeah.
People wonder why things are getting shittier and shittier in everything.
Yeah.
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 seatbelt.
Yeah.
And then going, we're going to charge you every time you need to put it on.
And now you have to gamble with your life and go, do I afford that, can I afford it? Can I afford it? Can I afford it? But you shouldn't, this shouldn't be a choice. We know that you need the seatbelt. Put it on. And now it's like, but can I can. They're like, oh, do you want to play with your life? And they know, because to your point, it's a doopoly. It's what, two companies. Is it still two companies? The two major companies own and control 80% of the market. Yeah, but I mean, that's a doopoly. That's like you control everything. No one can push you around. And then what do you? And because it's your life, that's the craziest thing. I think. I think.
corporations realize one thing. The minute a society we said there are no holy cows or sacred
cows, they thought to themselves we will leave no sacred spaces. They've moved into organized
sport. Yeah, you're not wrong. Yeah, you're buying the soccer jersey. Yeah, you're coming to the
matches. Yeah. They're paying your hero. They're controlling their life. Religion. They've made them
miserable. So they've made us all complicit. And I worry a lot. 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.
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.
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.
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 your health care,
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.
the things who should be saying, how do we make a better dialysis machine? There hasn't been a
better dialysis freaking machine in 40 years. No way, Tom. Oh, no. Absolutely. There have been
tiny little adjustments there, but there's been no phase shift major breakthrough. Why is that? Because
there's no freaking money in it. These two corporations, big corporations, before them, there were
others, have locked in the market, they have their cash cow, and they are milking it relentlessly.
They're not interested in a new milking machine. They're not interested in the cow.
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 life cover now, you're not obligated to take an HIV test.
Well, 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 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 and you.
more. Do you know what I'm saying? I wonder which one it'll be though. Because remember that
before there was no home testing. Yeah, yeah, yeah. So they would have to send you to a
facility. Yeah. Then you'd get tested. But I'm saying I wonder which one it is. Because my brain goes,
which one is it. Have they found a way to derrisk 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? Yeah, yeah. 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 books and this 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?
Or crazy.
No, but crazy in a good way.
Or take naps.
Yeah, we need.
At noon.
He's a noon napa.
He's a noon napa.
But like, there's a part of the book where, man, I was, I was so impressed and like just, like,
taken by how you stitched together, even civil rights in American healthcare and the way we think
about how it's doled out to 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.
No. Yeah. One of the most shocking things in my research for this book was a 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, your 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, you know, that I've gradually begun to see. I mean, dialysis is
a perfect map for it, but there are many other diseases that, you know, the incidence 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, I'm working in South Chicago
where there's a disparity in life, in longevity, in between north.
and South Chicago of 30.1 years.
In the same years.
In the same city, 30 years, you're in North Chicago, the wealthy areas.
You live 30 years longer, 30.1 years longer than in South Chicago.
That's insane.
It is insane.
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. Yeah. 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, you know, I write it, I care about it. But six months before it comes out,
I'm thinking, what's next? I don't have any next. This is next. So I've gotten together with
folks at the new school, the Institute for Race, Power, and Politically.
economy and we're doing some research on on these areas in Chicago, South Chicago, and East
L.A., Boyle Heights, where the impact of dialysis is disproportionate. Try 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 is sort of a part of their life's arc where you'll end up in the chair. Grand did,
my uncle did. My kids are coming with me now.
treatments they'll probably end up and it's just that's nightmarish and especially when there are
solutions that are in hand that are in you know again every other country does it better but there
are very straightforward solutions to prevent this from happening in the first place so come back
to your question i mean the it is absolutely dialysis in america is absolutely perfect um radiograph
CT scan of what's wrong with racialized structural racism in america it is it is the
poster child of what can go wrong.
And for me, it's been quite a, I mean, a kind of a rediscovery of what America is.
I'm going to places I haven't spent a lot of time in.
I can imagine.
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.
Yeah.
I mean, literally in the space of, it's the most segregated city in the country, but many, many areas are like that.
And it's a, yeah, I'm rediscovering my homeland in a way that is deeply, deeply disturbing.
We had an episode where we spoke to one of one of the most interesting people we've spoken to in South Africa, Dan, and we spoke about the remnants of apartheid.
Yeah.
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. 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? Yeah. That is the question. And what I did one day with a friend of
mine is we drove to two schools. We drove to a very private school, wealthy, black and white
children. Then we went to a township school with only black children and we took a photo, right,
that we just said, you take this photo, take this photo,
and we compared the photos at the end of the day,
and we saw the sizes of the kids.
Yeah.
And they were not even 40 minutes apart from each other.
Right.
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.
They never mix now schools that are doing well
with schools that are not doing so well
and doing sport because it becomes so clearly obvious
that there's size differences,
that there's nutrition differences,
and also there's concentration differences.
I mean, the queues 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.
That's the first thing they did.
First thing we did. We did.
Not they.
I was part of the kids that were in the bus
from the township school.
that was one of the first things that we did
it was we left where we were
and the first thing we were like
we're going to eat something because clearly
it's not going to be where we come from
and I'm thinking to myself
hunger and malnutrition as a government
as a government agenda
as a weapon yeah
of oppression
and 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
yeah that's right
they love that
bringing this many jobs
or they love the mining companies.
Yeah, yeah, they love that.
They're great.
Oh, no, they love that.
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 their mainstream.
Yeah, because the gold needs to be sold into a market
that is formalized.
So at the end of the day, it all comes back.
To the enablers.
Yeah, it all comes back in a loop.
And that's why, and I'm glad you really give them
the credit they deserve.
That's why whistleblowers are so important.
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 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.
And it's fascinating to see the organizational reaction to a whistleblower.
It's like this immune response.
The T-cells go out there.
They start, 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.
The question is whether they'll be able to give the kryptonite to someone
can use it before they are rubbed out, literally or figuratively.
Yeah, yeah.
But it is a really interesting thing to see this sort of organizational people just,
it's perfectly sane, professional people go completely off the rocker
when a whistleblower stands up in their,
in their in their midst.
You are making me realize
there's so much power in words and phrasing.
You started with white collar crime
and now you even speaking about whistleblowers.
When it's corporate, it's whistleblowing.
Yeah.
When it's violent crimes, it's a witness.
No, besides, it's not a witness.
It's an informant.
Oh, yeah, yeah, yeah.
That's interesting.
That's true.
That's true.
Lead to something.
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's not?
blows a whistle, but information is timeless.
But whistleblowing also makes it feel like you shouldn't be doing it.
It has an annoying connotation to it.
Yes, where do you find a whistle?
You had to have it first.
You're a whistleblower.
You're a snitch.
You're a rat.
It's got a snitchy vibe.
And why are you blowing it?
Why is everyone keeping their whistles quiet?
And there's always, in whistleblowing, there's never plurality.
No, no, no.
That's right.
The individual standing up.
Yes, it's always the shunned person who will generate as much noise as
possible.
Edward Snowden.
Yeah.
But if you get rid of them, you almost feel like you've gotten rid of the problem.
Yeah.
Right?
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, you know, corporate informer will say there's a trillion dollars in fraud here.
They've been dumping arsenic into the water or the bullpile or whatever.
And so you can't actually say, well, 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 life. You destabilize them psychologically. And all of a sudden, there's just 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, oh, you know, a disgruntled employee.
you know, someone who's deeply or just psychologically not stable.
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 going to make my own rules.
I'm not saying Luigi did or didn't do it, disclaimer.
I'm just saying like we saw in that trial and that case.
Someone said, you know what, I don't agree with this.
and I realize that I cannot beat you in the game
because you have created the rules.
So I will then play my game
by a different set of rules.
Precisely.
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 going to do my own research.
I'm like, no, you're not.
You're not going to do your own research.
you are going to go read an article
that either affirms what you think
Yeah, you're going to go read someone's
You're not going to go do the research
And yes, you can argue on a
semantic level
Yeah, on a semantic level you can be like
But that is research.
No, no, no, no, no.
It's cumulative effort.
Yeah, I like to read the work
of people who have done the work.
Do you get what I'm saying?
And that is how we should acquire knowledge in life.
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.
We're not going to run those examples.
It's a community process.
You know what I mean?
But, you know, but when I look at that situation
where the United Healthcare CEO was shot,
and then even that story, that was like a weird one,
you know, the gunman in Manhattan
went into that tower.
Oh, yeah, yeah, yeah.
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 housing.
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're sure they were going for that.
What a 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.
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
came out on TV and they're like, why would people be celebrating this?
Why?
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 going to act like you don't know why people are cheering for this.
Exactly.
But the reason I think we need to keep having these conversations, I'll talk to an author
who's written a book 10 years ago, 20 years ago, like Robert Putnam we had.
I was like, because 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 a moment like Luigi Mangione.
Everyone was in on,
like everyone's like,
healthcare.
Let me tell you what's wrong with them.
And let me tell you.
And then Sheehan was selling T-shirts of Luigi Mangione's face.
And then there's like a movie.
Emma Stone's going to be doing a movie about Luigi-Man.
And then it just trickles out.
And then you just see new headlines.
United Healthcare buying this.
United Healthcare 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?
I'm assuming you might be from,
But maybe I'm wrong.
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 United Healthcare,
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 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 Manjani moment. I was corresponding with,
And since my book came out, I 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 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,
kidney killer.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 are 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 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.
Right. Yeah. But at the very end of one of the last ones, he said, I just can't see a way to make this stop. I can't find a way to make change. And, you know, it's a horrifying thing to 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 Manjoni 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 their, 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, making a killing, as I 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 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,
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 health care CEO
accounted for in his long career?
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,
I was thinking Voltaire, the murder to the sound of trumpets by the thousands is called is good.
One murder is unacceptable.
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 it?
Stalin's, one murder is a tragedy, a million is a statistic.
Yes, exactly.
But that's exactly what it is.
And to your point, accountability is also doled out differently.
Yeah, right?
Because if Luigi Mangione is found guilty, he's gone, gone for gone for gone.
Like life, death, like gone, like gone, right?
Not if, when healthcare CEOs and their companies are found guilty, there's no life sentence.
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.
They're all criminal organizations.
They're still out there.
Think about how many families have lost a father, a mother, a brother, a sister, a child
because of opioids that they were told were there to help them.
Those people became addicted, died from pain, whatever, you name it.
Sackler family, they didn't even lose all their wealth.
Like, just think of this for a moment.
Even if you said to me, okay, they're at zero.
We took away everything.
I know they're not in jail, but they had zero.
I'd go, it's still not fair, but they didn't even take all their wealth.
The people could still fly away in a helicopter.
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.
Yeah.
And we're seeing that more and more.
I mean, the violent acts are because the safety valve is clogged.
And we're blowing.
You're like, 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.
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 going to private
business, they get real 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 nunna would come and complain and don't call you and will take care of it everyone is
wetting their beak yeah yeah if you are betting online if you are buying shares if you're watching
the stock price go up if once in a while the thing that astonishes me more in this country
is when you watch television these ads about you know you owe this much money if you call
this and then this was up and then they always give the stat of how many people haven't
versus how many people should.
And all of a sudden,
and I look at the drug companies different and go,
but if they care so much,
they're here buying ads,
but they advertise in the product.
Do they really want you?
Which lawyers must you call to do this thing?
Yeah, yeah.
It's all becomes, yeah.
Everyone's beak is wet.
Everyone is eating a little bit here and there
with online betting,
with buying shares,
with working there and knowing someone who is in it.
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 the 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? Right. Plain the victim, yeah. Yeah, medical aid companies do that all the time
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 are we being lectured
about living our lives when your job is to improve our quality of life? So now you've forced
me with the responsibility of net getting sick while I pay you to keep me from getting sick.
And that's what 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. Right. Yeah.
That's right. Yeah. Yeah, the lecturing part is very, is tricky too. When you helicopter into these situations, I'm working in Boyle Heights in Los Angeles, and it's in an area that's 95% Hispanic. And, you know, I can't just sort of helicopter in and say, hey, guys, how's, how's this is working for you? And by the way, there's a way to fix this. So I, you know, I hook up with local organizations that Homeboys industries is the most. If you haven't been, you got to go.
okay the coolest place i have maybe ever been but it's certainly the most impressive it's a gang
rehabilitation organization that was started in the 80s by um father gregory boyle no no relation to the
to the neighborhood and um but now they have this view of boyle heights that is all inclusive
and it's in you know boil 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, you know, the head of research and so on.
So I just arrived and sat down and they have a wonderful homegirl cafe, sat down.
And I said, I'd love to talk with Father.
Boyle and Michael Ron and these are the people.
They say, 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.
I said, oh, that's okay.
I'll stay today, and I'm coming back tomorrow, and I come back the next day.
And I went and sat down.
And I really meant to guy.
I'm my computer.
I was perfectly happy, and I wasn't, you know, and I really needed to meet these people.
And about five minutes later, someone went back.
Remember, this is gang rehabilitation.
These are some, the people with my tattoos or 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
looked at a show, 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 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 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 a sort 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.
You know what I realize, 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.
That made me bad problem.
You'd watch these movies where they'd be like some random person, they'd been like a suit
that doesn't really fit too well and they've got their briefcase.
And then they go to like an office and they'd be like, excuse me, I would like to meet the
and they're like, I'm sorry, he has no appointment.
So it's like, okay, I'll just sit here.
And then it's like, and then like two hours later, like, hey, he's not coming back.
It's like, it's fine.
I'll just sit here.
And I remember watching those movies and I'd go, there's no one like this.
Now I've met one.
You have like a, it's a dogged and insatiable attitude towards like finding the truth,
the people, the, the story.
It's like, is it, is it, is it, is it, is it, is it, is it, is it, what is what's motivating you?
beyond, don't get me wrong, I mean, it is a noble cause, but beyond that, like, what is,
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? Yeah, it's a really
good question. And I, you know, part of it is a sense of unfairness. I do have this sort of
sense that, you know, bullies are one of the worst species. And hypocrites are also one of the
worst. So you have a bully hypocrite with speeding a line.
And that's the worst of the worst.
And I run into it a lot in corporate America.
So also just a sense that, you know, 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 know, might as well do it in your own backyard because no one's going to be
looking out for it.
Yeah, but you've also done something that's pretty amazing because people would write books.
People do, you know, 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.
Yeah.
But the hardest step, after all of those hard steps, is you hope it'll make a difference.
Yeah.
And there's something that happened with your book that is, again, it's like a Hollywood movie that you hope would be written.
There's a moment where the FDA, the head of the FDA goes, I want to use your book to go after these two sinkhole companies that are scamming Americans for their health care, scamming the government essentially for all of the money that is trying to provide two.
help people. And I think your book, if I remember, Craig, it got cited 21 times and there was a
lawsuit. What's the latest on that? 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. Well, it is work in progress. Nothing has been fixed yet. But I will say that
Martin McCarrie, 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? Give it to me. And he said he's spread it around to Dr. Oz
and to 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 they'd 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, I've received
thousands of emails from people inside the industry, whether the 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 are voted for Kamala Harris. Some of them are who
knows. They didn't vote. It's health. It is a fundamental thing that goes beyond politics.
Your kidneys don't vote, bro. They don't. They do not. And those babies all, I've never had such a warm
and fuzzy feeling for my kidneys. You don't think about your kidneys, right? They are the,
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. 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 here. And I think private companies,
And I was trying to figure this out because I was like, wait, okay, how would I explain this and I struck, 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, right?
But there are certain aspects of life where you have to ask yourself, who should be in charge of this?
Yeah.
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?
Again, I come back to this.
Remember what a government is supposed to be.
There's a collective force of the people.
Yeah, common good.
Yeah, 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.
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 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.
It's like, took my money.
Yeah, it's like, no, no.
Took my money.
Yeah, it's like, took my money.
Yeah, yeah.
But it was supposed to take your money to buy you the drink that you wanted them to buy.
And when you think about like health care 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, 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
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 ridiculous analogy is it though
AI? What's happening with AI right now? It's sucking the oxygen. 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 how is it any different? I think you said the
keyword they're convinced. I think we've had 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. Yeah, they do. And the language that they put
out there. You're not wrong. For example, I think even body organs are not given priority
based on what the language, the common colloquial language is 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. It's something that
someone will give begrudgingly if you need to
but just don't be fine with it
get a kidney transplant
get a kiss
the doctor is not called the kidney
cardiologist
yeah yeah yeah
neurologist
there's also this
shroud of mystery
that's put around things
and sometimes if it's not mysterious
it's trivialized
so you don't take it as seriously
as it should be you know the biggest example
for me is Department of Defense
versus Department of War
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-offence 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 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 prolific as it should be in people's lives.
And people go, when you talk about kids,
I know what you're talking about.
I need all of them to function.
It's basically on us in these forums.
Essentially, that's what I feel like.
Absolutely.
Because there's no money in that market.
If we're honest, there's no money in that marketing.
You're not going to make money from that part of it.
But man, the one thing I really love and I appreciate about your work.
And that's why I really appreciate your time, not you.
Oh, not you.
I do love your work, but not right now.
One thing I appreciate it 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.
Right.
Wow.
Do you get them saying?
Yes.
That's like such a crazy, they were not in that position.
They read your book.
They go into that position.
You put a message in a portal.
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?
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 use the same kind of language.
They said, okay, I'll tell you my story.
But when I'm gone, you have to promise that this won't happen to somebody else.
And I, you know, 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 off.
Does it make you interact with the healthcare industry on a personal level differently?
It does.
Yeah, it does.
And yeah, with my brother, who's 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 that 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 is going to arrive.
The cavalry is not coming.
You are it.
Yeah.
Yeah.
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 in L.A.,
and a bunch of others who are just saying,
okay, let's just do this, you know, let's just do this right here among us. And then we see
how it goes. And I think that's kind of, that's kind of my model until I see a better one.
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, let us know, man.
Thank you. It's really worthwhile. Thank you for taking the time.
Thank you very much, Trevor, and Eugene. It's been a pleasure.
This was really great, man.
Thank you so much.
Tom.
For real, man.
Thanks.
We've got to stay in touch.
Sorry about your brother.
Yeah.
Yeah, it's tough.
Yeah, it's tough.
Yeah, it's tough.
It happens, but you don't think it's going to happen.
Yeah, no.
Until it happens.
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.
We just experienced the battles, you know, and I almost feel like in a weird way,
it's almost come around where you go like, damn, it's put you in the front seat
to fight the thing that you're already fighting in an even more energizing way.
Yeah.
That's true.
You already had perspective.
You needed urgency.
Yeah, that's right.
That's exactly right.
That's a more eloquent way to say.
Thank you.
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 Day Zero Productions
in partnership with Sirius XM.
The show is executive produced by Trevor Noah, Sanaziamin, and Jess Hackle.
Rebecca Chain is our producer.
Our development researcher is Marcia Robiou.
Music, mixing, and mastering by Hannes Brown.
Random Other Stuff by Ryan Parduth.
Thank you so much for listening.
Join me next week for another episode of What Now?
