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

Speaker 0:00 The story of dialysis is an amazing case study of good intentions being thwarted by bad incentives, poor oversight, and profiteering.

Speaker 0:07 When I was working at Davita, the priorities was to get them on dialysis and get the next patient on as soon as possible. It was all about numbers.

Speaker 0:16 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.

Trevor Noah 0:27 [upbeat music] This is What Now? With Trevor Noah. This episode is presented by Whole Foods Market. Eat well for less. [upbeat music] I've never known you without glasses, now that I realize it. You actually have. When? Half of our relationship was without glasses. What? Yes. Take off your glasses? Remember this guy? No, actually, yeah, no, you're right. It was the beard. You're right, actually. Yes. Yeah, yeah, the beard. Now it's like a flip.

Trevor Noah 1:06 Yeah. It's like a- There was, there was no beard, more hair, no glasses. It's like I've known every version of you. [laughs] Do you know this guy? Eugene, where are you? [laughs] I'm here. Oh, Eugene, you're back.

Speaker 1:17 I think someone else has his glasses.

Trevor Noah 1:18 Where is he? [laughs]

Speaker 1:21 [laughs]

Trevor Noah 1:21 [laughs] Welcome.

Speaker 1:22 I'm just saying.

Trevor Noah 1:23 Welcome to, welcome to our idiot friendship, Tom. I'm so sorry. [laughs]

Speaker 1:27 Thank you very much, Trevor, Eugene. I feel like I fit right in.

Trevor Noah 1:30 Oh, you do actually. You do. If you want to, you do, man. You do indeed. Um, actually, you know why I feel like you fit right in is because you, you, you got like one of the, the, the most beautiful, weird stories of how you've lived your life, you know? A- and, 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, ju- just, just take us through some of this, so ... 'Cause a- a lot of people are fans of your books, but I don't think a lot of people know a bit of your life. It's like, where were you born?

Speaker 1:57 I was born in New York City.

Trevor Noah 1:58 Okay.

Speaker 1:59 Left six months later, went to London and Paris.

Trevor Noah 2:02 I like how you say that like you left. You were like, "I'm out."

Speaker 2:04 I was lefted, yes. [laughs]

Trevor Noah 2:05 You were like, "I'm out. I'm out, parents."

Speaker 2:08 That's right.

Trevor Noah 2:08 "I can't do this anymore."

Speaker 2:09 Yeah. When I say I was born in Columbia-Presbyterian, my New Yorker friends say, "Yeah, but you're not a New Yorker, you know?"

Trevor Noah 2:14 [laughs]

Speaker 2:14 So I try to make that clear at the outset.

Trevor Noah 2:16 Yeah, yeah.

Speaker 2:17 And I ... And we moved around a lot in the United States. Um, California, upstate New York, Texas. Um, I, I did my high school in Houston, Texas.

Trevor Noah 2:26 Mm-hmm.

Speaker 2:26 Which I do not recommend.

Trevor Noah 2:27 [laughs]

Speaker 2:27 But was an experience. I learned about football, which is something. And, uh, 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.

Trevor Noah 2:43 Wow. That is wild.

Speaker 2:44 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.

Trevor Noah 2:53 Do, do you think, like, some of that has affected how you're able ... Like, maybe I'm projecting here, but I, I sometimes feel regardless of nationality, one of the best things you can do is remove yourself from a situation to be able to see it better.

Speaker 3:05 Mm-hmm.

Trevor Noah 3:06 Doesn't matter who you are in the world.

Speaker 3:07 Mm-hmm.

Trevor Noah 3:08 Spend time away from your family, come back to them. You'll see them slightly differently than when you're always in it. And I feel like you've done that with America, with the corporations, with the way we see, you know, the way things just work. Is, is that, do you think that's partially because of just, like, how you've lived, where you've been?

Speaker 3:25 I think no question. Stepping back and looking at the way in which, uh, for instance, you mentioned the corporations, the way in which in America, corporations and money are regarded with a, a certain religious awe.

Trevor Noah 3:36 Yeah.

Speaker 3:36 Whereas in other places it's, you know, they are welcome, uh, and, and they are come- sometimes very powerful. Uh, but they're not the be all and the end all. And, uh, and again, stepping back into a place where you've been born and raised, you realize, my gosh, you know, things really have changed here. And that, and that's-

Trevor Noah 3:54 Yeah, yeah, yeah, yeah

Speaker 3:54 ... in the last, the last 30 p- plus years, things in America have, uh, changed at an accelerating

Speaker 4:00 pace, at 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. So.

Trevor Noah 4:07 How did you get into writing? 'Cause I, I, I don't know if my research was correct, but were you in banking at some point?

Speaker 4:11 [laughs] Yes. I, um, I did a PhD in history.

Trevor Noah 4:15 Yeah.

Speaker 4:15 And love history, but realized I was not cut out for academia. So I thought, well, um, I know languages. Europe 1992 is happening. Let's try, you know ... Th- there were recruiters on, on, uh, on campus, uh, checking for people who were interested in recruit, uh, in banking and in-

Trevor Noah 4:34 Yeah, yeah

Speaker 4:35 ... uh, um, consultancies and various others. And I ended up at Goldman Sachs in London, uh, doing mergers and acquisitions, which for two years, which was a remarkably good experience from a business point of view. Um, I met some of the fan- 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 [laughs] giving their lives away for a modest amount of money. I mean, it was big money, but-

Trevor Noah 4:58 Wait, wait, wait. What do you mean by that?

Speaker 4:59 They, um, were indentured servants to this company. Um-

Trevor Noah 5:03 Oh

Speaker 5:03 ... and simply their lifestyles were terrible. Their incomes were very good, but, uh, terrible, terrible lifestyles. And, uh, and that was well before, you know, the run-up to 2008 and all the massive crime. I was in a business where it was still the relationship was important.

Trevor Noah 5:19 Mm-hmm. Mm-hmm.

Speaker 5:20 Um, and, and if you screwed up with a client, you were done. I mean, y- you were finished. Um, and then later, s- clients became sock puppets, and traders replaced relationship bankers, and you got 2008. Uh, so you know, one of my closest collaborator or bosses and collaborators at the bank was on the 1MDB indictments. I mean, he was, you know, the head of investment banking.

Trevor Noah 5:40 This was l- we're talking about, like, the-

Speaker 5:42 The 1M-

Trevor Noah 5:42 This was the 2008 Wall Street crash financial collapse?

Speaker 5:46 Yeah. I mean, they were testifying before Congress. They were explaining why, um, you could call a client a sock puppet, and you could create financial, um, vehicles.

Trevor Noah 5:57 Wait, wait, Tom. That was an actual term?

Speaker 5:59 Actual term. Sock puppets, yes.

Trevor Noah 6:01 Was it used within your circles, or just within your-

Speaker 6:03 Not within my circles, but my, you know, my-

Trevor Noah 6:05 It worked

Speaker 6:05 ... the folks that I worked with who stayed at the bank, that's what they were talking about, yeah. And the, and again, trading is very, very different from relationships.

Trevor Noah 6:12 Yeah.

Speaker 6:12 Trading is One day at a time.

Trevor Noah 6:14 Mm-hmm.

Speaker 6:15 I win, you lose. I mean, there's a w- 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.

Trevor Noah 6:25 Oh, wow.

Speaker 6:25 And that means I can take advantage of you. Um, and that's what happened in the run-up to 2008.

Trevor Noah 6:30 Hmm.

Speaker 6:30 And Goldman was, in particular, I mean, involved in all sorts of bad stuff. But they were basically building, uh, financial vehicles to fail and then selling them to unsuspecting pension funds and various other, you know, uh, innocent parties as a good investment.

Trevor Noah 6:44 Yeah.

Speaker 6:45 And then betting against them.

Trevor Noah 6:46 Mm. That's insane, man. I still can't believe that that happened.

Speaker 6:50 Yeah.

Trevor Noah 6:50 And then I ... You know what shocks me even more, is that the ramifications were barely felt.

Speaker 6:56 Absolutely.

Trevor Noah 6:56 Do you get what I'm saying?

Eugene 6:56 Yeah, yeah.

Trevor Noah 6:57 It's one thing to go, "Something wild took place." It's another to go, "Nothing happened."

Eugene 7:03 But I think that's why a lot of people have sympathy and sometimes admire people who do white collar crime, right? 'Cause it almost feels like it's a victimless crime. If someone is bleeding on the side of the road and someone has a firearm in their hand, that's a crime.

Trevor Noah 7:15 Yeah.

Eugene 7:15 If someone says, "I lost millions of dollars," and people go, "How much do you still have?" "A couple of million more."

Trevor Noah 7:20 [laughs]

Eugene 7:20 "Ah, there's no crime here, no foul." Y- you see what I'm saying?

Speaker 7:22 Yeah.

Eugene 7:22 So-

Speaker 7:23 No, I mean, you look at Mike Milken. I mean, he was actually prosecuted and sent to jail for m- multiple felonies.

Eugene 7:27 Mm-hmm.

Speaker 7:28 Comes out, he's the toast of the Nobel p- Prize community. He's got billions still in his, in his foundation. It's ... No, I mean, white collar crime is vastly more ... It's the cancer of society.

Eugene 7:40 Right.

Speaker 7:40 It's vastly more damaging. It causes massive amounts of m- of harm.

Speaker 7:45 But as you say, um, i- it's, it's almost lionized in, in the business school community-

Eugene 7:51 Huh

Speaker 7:51 ... as something, "Hey, you know, he really is a risk taker," right?

Eugene 7:55 Mm-hmm.

Speaker 7:55 "He's a real har-" You know, you talk about killers in business. You talk about making a killing.

Trevor Noah 8:00 Yeah, yeah, yeah, yeah, yeah.

Speaker 8:01 That's a good thing. That's supposed to be a positive attribute.

Trevor Noah 8:04 They see it different than we do.

Speaker 8:05 Yeah. And, and if you're flying, you know, close to the, to the wind in legal terms or beyond, that's, it's viewed as an incentive. There's no normative quality to a law.

Trevor Noah 8:15 Yeah.

Speaker 8:15 You break the law-

Trevor Noah 8:16 Yes

Speaker 8:16 ... you're, it's wrong.

Trevor Noah 8:17 Yes.

Speaker 8:17 "What are 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 out a checkbook, write it. And while you're at it, individuals don't go to jail anymore. It's corporations, right? So it's the perfect crime. I mean, you, you, you are lionized as a killer on Wall Street. Um, you, uh, 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. [laughs]

Eugene 8:46 You're the perfect person to be having this conversation with. In South Africa, we had the state capture commission.

Trevor Noah 8:51 Yeah.

Speaker 8:51 Mm.

Eugene 8:52 Where bas- You ... Did you read about it?

Speaker 8:53 I did, I did.

Eugene 8:54 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 ha- in having government contracts. That went on for, I think, almost two years. A billion rand later, not a single prosecution. Everyone got away with everything. But when I was having conversations with my friends even, I would always say, "Why is it that whenever we talk about corruption, we speak about the person whose hand is caught in the cookie jar?"

Speaker 9:26 [laughs]

Eugene 9:27 So if you and I steal, we make a billion dollars, we still have to go buy Ferraris, Maseratis, Lamborghinis. Who's selling us those cars? We have to go buy mansions.

Trevor Noah 9:36 Yeah.

Eugene 9:36 Who's selling us those mansions?

Speaker 9:37 Absolutely.

Eugene 9:38 Who's investing our monies? Where are those funds kept?

Speaker 9:41 Yeah.

Eugene 9:41 Where are we making the transaction and the withdrawals?

Speaker 9:43 Yeah.

Eugene 9:43 And I always think to myself, "I would love to meet someone who can make me understand why is it that even when corruption is thwarted, it doesn't go further than when people exchange the same money for goods."

Speaker 9:55 Uh, those enablers, I mean, there, as, as one whistleblower in finance, um, who

Speaker 10:00 revealed that a certain bank, um, Wells Fargo bought it, was, um, laundering money for the Sinaloa cartel. He said, "Those enablers, those bankers, had their finger on the trigger every time the Sinaloa cartel fired a gun."

Trevor Noah 10:12 Damn.

Speaker 10:13 And that's true. I mean, we cannot look at enablers, bankers, real estate people, corporate fi- you know, corporate, um, foundations-

Trevor Noah 10:22 Yeah, yeah, yeah

Speaker 10:22 ... um, all the other folks that make their lives possible, tax advisors, all these offshore-

Trevor Noah 10:28 Yeah, yeah

Speaker 10:28 ... you know, those are fundamental figures-

Trevor Noah 10:32 Yeah

Speaker 10:32 ... in the crime syndicate. And they are as responsible for every bullet that hits as the actual person who pulls the g- trigger. As I would argue, that they're more responsible.

Trevor Noah 10:41 Hmm.

Speaker 10:41 I mean, I would argue that people who do it just for the money, um, 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?

Trevor Noah 10:58 Mm-hmm.

Speaker 10:58 The hitmen and women of this world.

Eugene 11:00 They're the lowest in the food chain.

Speaker 11:01 Yeah. They're just tools in the hands of these other people. But we, we admire the lawyers, the white shoe lawyers-

Trevor Noah 11:07 Yeah, yeah

Speaker 11:07 ... and the, and the big bankers and so on. We admire them. They get their names written on, you know, New York Public Library. All sorts of very special perks for them.

Trevor Noah 11:15 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.

Eugene 11:44 Mm-hmm.

Trevor Noah 11:44 But why? Do you know what I mean?

Speaker 11:46 Yeah.

Trevor Noah 11:46 Why is it a, "No, no, this is a white collar crime." We've almost, we've almost given it a, a respectability that it doesn't deserve. It's like-

Speaker 11:52 What kind of collar do the people-

Trevor Noah 11:53 Yeah

Speaker 11:53 ... who define it wear?

Trevor Noah 11:54 Exactly.

Speaker 11:54 They wear white collars. They're judges. They're lawyers.

Trevor Noah 11:57 Oh, man. Do you know what I mean?

Speaker 11:57 They're the folks who are making these rules.

Trevor Noah 11:59 Wow.

Speaker 11:59 Right? I mean, you know, they are the people who see this. They see someone-

Trevor Noah 12:02 Wow

Speaker 12:02 ... bursting into their house and, and sh- and robbing them or shooting things-

Trevor Noah 12:05 Exactly

Speaker 12:05 ... as a major threat. They do not see, um, someone who is defrauding a pension fund and having, you know, elderly, uh, teachers eat dog food for the rest of their

Speaker 12:15 lives, which is something that happens.

Trevor Noah 12:16 Yeah.

Speaker 12:17 Um, they don't see that as a problem because they're not elderly teachers. They don't see, they don't see at the ul- 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

Trevor Noah 12:28 Yeah

Speaker 12:28 ... it's an Ayn Rand world, and it's, um, I win, you lose. That's it. And that's ultimately why the heroes of, of finance, the heroes of the law and so on, are so clubbish and so in agreement, um, along with the judges, when it comes to defining the social damage by certain kinds of crime. And a- 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.

Trevor Noah 13:01 People don't realize how much the things they're experiencing in the world every single day are a byproduct of those crimes. And while we'll never dismiss a murder or a robbery, those crimes have far less of a ripple effect out into the world. Do, do you know what I mean?

Speaker 13:18 100%.

Trevor Noah 13:19 So when, 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, when you see your, your, your retirement fund disappear, when you ... Those types of things have such a widespread effect. You know what I mean?

Speaker 13:37 100%.

Trevor Noah 13:37 They're more likely to create more of the thing-

Speaker 13:39 Yes

Trevor Noah 13:40 ... that you don't wanna see. And, and it's, it's, it's so crazy to see that I, I, I actually wonder, like, how you had this ... Because your, your life is really, it almost feels like a series of trap doors when I think of your life.

Speaker 13:50 [laughs]

Trevor Noah 13:51 You know, you, you're studying history and then you fall down this trap door, and then all of a sudden you're in London, you fall down a trap door, and then at some point you were studying music. You know, and then it's like you-

Speaker 13:58 Yeah

Trevor Noah 13:59 ... you fall down another trap door, another trap door, 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.

Speaker 14:10 [laughs]

Trevor Noah 14:10 Which seems like a, such a, like, light topic. You know? So i- so when I saw that I was like, "Ha, corruption in olive oil? Well, this is like a, a, a, a cute world to be in." You, you know? But you expose so many of the layers. And then your next book you talk about whistleblowers-

Speaker 14:25 Hm

Trevor Noah 14:26 ... and, and, and, and the, the role they play in society and how we don't protect them enough, and what they've done to-

Speaker 14:32 Yeah

Trevor Noah 14:32 ... 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.

Speaker 14:42 Right.

Trevor Noah 14:43 You know? How to Make a Killing in Healthcare in America is like, you know, you look at all the stories that have popped up, the Luigi Mangione story. You know, you, you, you look at, uh, people, you know, going on strike or rioting in certain

Trevor Noah 15:00 parts of the world, you look at, because they're losing their health benefits. You, you look at people just losing faith in the societies-

Speaker 15:06 The system

Trevor Noah 15:06 ... that they live in, in the system.

Speaker 15:08 Mm-hmm. Yeah.

Trevor Noah 15:08 And when I read your book, I went, "This guy, you didn't just critique it, you, you, you break it down on the, on, on the, like, the most minute levels."

Speaker 15:20 [laughs]

Trevor Noah 15:20 And I wanted to know, like, why you started with dialysis, because that's, that's like the, you know, the, the, the real crux of your book, but it exposes everything. You, you, you went, you go into dialysis. Why, why that topic? Help me understand.

Speaker 15:33 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-

Trevor Noah 15:42 Right

Speaker 15:42 ... and the, uh, defense contractor whistleblowers, the big bank whistleblowers, all this.

Trevor Noah 15:46 Mm-hmm.

Speaker 15:46 And there was this weird outlier, um, dialysis whistleblowers. The finance people in dialysis who were, who were bringing s- false claims suits, wh- whistleblower lawsuits against the big dialysis companies. And I'm like, "What's going on here?" And they were, the dialysis companies were signing 400 and then $500 million, uh, settlements-

Trevor Noah 16:04 Psh

Speaker 16:04 ... at a pop.

Trevor Noah 16:05 No way.

Speaker 16:05 Their stock price is going through the roof. Uh, Warren Buffett owned 40% of one of them, and I'm like, "Okay, what's going on here?" My, my bank, inner banker was like-

Trevor Noah 16:13 [laughs]

Speaker 16:13 ... bing, bing, bing. The, my board is lighting up red.

Trevor Noah 16:15 All the alarm bells are going off, yeah.

Speaker 16:17 Yeah. Uh, what is going on here? And so I looked into, um ... Well, first I started with the finance people, then I worked my way back into nephrologists, kidney doctors, who were working for these companies, and then gradually backed down to the blood floor where dialysis is actually delivered.

Trevor Noah 16:32 Mm.

Speaker 16:32 And that's when I realized, this is not a chapter in a whistleblower book, this is its own book. 'Cause as you said, Trevor, I mean, it is, it is a perfect microcosm of what can go horribly wrong-

Trevor Noah 16:41 Yeah

Speaker 16:42 ... when you put profits before patient care.

Trevor Noah 16:44 It's also a terrible story of, of how a miracle can be turned into a curse, right?

Speaker 16:50 Mm-hmm.

Trevor Noah 16:50 Because you look at when this technology's invented. You know, and I, I only learned this from your book. I- it's not like I knew this before reading the book.

Speaker 16:56 I didn't either. [laughs]

Trevor Noah 16:57 You, you look at this world where it's like dialysis is this miracle.

Speaker 16:59 Yeah.

Trevor Noah 17:00 It's like, wow, we've invented this way to basically, you know, f-

Speaker 17:03 An external kidney

Trevor Noah 17:03 ... create some ... Yeah, an external mechanical kidney.

Speaker 17:06 Exactly. Mm-hmm.

Trevor Noah 17:06 What, what have we done?

Speaker 17:07 Yeah.

Trevor Noah 17:08 And v- 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, w- when you, when you, when you stepped into it, what made it the perfect place to start? Like, what, what would people not understand about dialysis? Like, they might be like, "Oh, yeah, wha- what, what makes dialysis so big or, or, or so unique?" Or, "Why dialysis versus everything else?" What was it about this spec- specific topic?

Speaker 17:36 Well, first of all, um, as you say, it was a miracle, and it's such a miracle, such a breakthrough. The first replacement organ, uh, that i- that had the potential to save millions of lives.

Trevor Noah 17:46 Yeah.

Speaker 17:47 Um, and it was such a miracle that the US Congress got involved. I mean, they were, this was 1972, the early '70s, um, 1972 the actual law was passed. Congress got involved at a time when, and this is gonna take you

Speaker 18:00 back, at a time when the Republicans, the Democrats, the insurance companies, the AMA, everybody had their plan for national health.

Trevor Noah 18:07 Yeah.

Speaker 18:07 The US was gonna have national health, and they viewed dialysis, this breakthrough, um, cure, which had hit the news in a way that made it very difficult for them to ignore. There was, who d- decides who lives and who dies. There was, you know, Life magazine cover stories about this. There's, um, Edward Newman doing, doing, um, NBC reporting on it. And, uh, and it's pretty blunt i- 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 die, were dead

Eugene 18:39 Yeah.

Speaker 18:39 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 gonna have national health. Everybody else, I mean, most other countries around that same time adopted national health. Australia, which is the, the counterpart that I compare the-

Eugene 19:00 Mm-hmm

Speaker 19:01 ... US to a lot-

Eugene 19:01 Mm-hmm

Speaker 19:01 ... in 1972. But then Watergate consumed Nixon, the Vietnam War went ballistic. Um, s- you know, uh, the OPEC oil embargo, stagflation, and the entire government pivoted from build a great society to cost cutting-

Eugene 19:19 Hmm

Speaker 19:19 ... and Reaganomics very soon after.

Eugene 19:21 Mm-hmm.

Speaker 19:22 And, and govern- government's the problem, not the solution.

Eugene 19:24 Damn.

Speaker 19:24 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 relic-

Eugene 19:30 Tipping point

Speaker 19:31 ... of a different era where government felt and the people felt the government had a role in taking care of human beings. Um, that's an important part of being a citizen-

Eugene 19:40 Yeah

Speaker 19:41 ... is getting healthcare, so we once thought. Um, and then, then the dialysis, uh, 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-

Eugene 19:57 Mm-hmm

Speaker 19:58 ... or you die.

Eugene 19:59 Whoa.

Speaker 19:59 So-

Eugene 19:59 It's as simple as that. They own you.

Speaker 20:02 If, if it's a good organization, they are looking out for you.

Eugene 20:05 Yeah, yeah, yeah, yeah.

Speaker 20:05 They're saving your life every single time. They ... If they're, 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 gonna run this company," then it, they own you. They actually possess your body. So it reminded me, one of the lawyers who got in ... I, I have, in order to help a lot of patients who have contacted me, I've been contacted [laughs] by over 3,000 patients and, and family members since this book came out and long before. Uh, one of the lawyers who really got it was a former Innocence Project lawyer, so people, um, in, unjustly incarcerated people on death row, mostly Black and brown.

Eugene 20:42 Huh.

Speaker 20:43 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.

Eugene 20:49 Yeah.

Speaker 20:49 And I, and I said, "You've gotta get involved with this, uh, 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." Uh, oh.

Eugene 21:00 Damn.

Speaker 21:00 Punch in the gut.

Eugene 21:01 That's exactly what it is.

Speaker 21:02 But I suddenly saw what he meant about this combination of healthcare and incarceration. So to come back to your question, this is ex- let's say one of the most extreme cases of healthcare delivery, where you need it, and you gotta ... If you don't get it, you're gonna die.

Eugene 21:18 Yeah.

Speaker 21:18 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.

Eugene 21:26 Yeah.

Speaker 21:26 And if those-

Eugene 21:27 Hmm

Speaker 21:27 ... th- that ... And there are good organizations, and there are good facilities, and there are wonderful people, um, and they do a good job about focusing on the individual and their individual needs-

Eugene 21:36 Yeah

Speaker 21:36 ... as with all medicine. But there are big companies that are running things on an assembly line, one size fits all basis, and they're really looking much more at Wall Street than they are at their individual patients. I mean, they are hedge funds with an exposure to healthcare. That's not an overstatement. They are financial vehicles with exposure to healthcare.

Eugene 21:55 How complicit or how complicit is the average person who buys stock in these companies?

Speaker 22:03 Why, why did you look at me when you said that?

Eugene 22:05 [laughs]

Speaker 22:05 That was weird.

Eugene 22:07 Complicit is ours.

Speaker 22:08 No, no, no.

Eugene 22:08 Complicit-

Speaker 22:09 No, but-

Eugene 22:09 ... is Tom's world. [laughs]

Speaker 22:10 No, no, no. But what you, you went, "How complicit are y- y- you?"

Eugene 22:14 The average person.

Speaker 22:15 We. [laughs]

Eugene 22:15 And you looked at me.

Speaker 22:16 Y- y- y- y- you, we, us.

Eugene 22:17 You looked directly at me as if I've bought stock in any of these-

Speaker 22:22 Co- complicit-

Eugene 22:23 Yeah, that was, that was weird

Speaker 22:23 ... to a friend of yours who has an afro-

Eugene 22:25 That was really weird

Speaker 22:26 ... and is wearing a tan sweater.

Eugene 22:27 Ask, ask your question and look away from me.

Speaker 22:29 [laughs]

Eugene 22:29 Don't be looking at me like that.

Speaker 22:30 Look the other way. Look the other way when you say that.

Eugene 22:31 This guy. I have never bought any stock in a healthcare ... You look the other way.

Speaker 22:34 [laughs]

Eugene 22:34 Don't, don't do that.

Speaker 22:35 No, take that back. [laughs]

Eugene 22:36 [laughs] I, I take it back.

Speaker 22:40 [laughs]

Eugene 22:41 Do you feel better now? [laughs]

Speaker 22:45 Ah.

Eugene 22:46 People like to wash their hands off of something that is innately horrible, when people say if there's insider trading, and you give me a tip-off, and I put a million dollars in something, and I make a lot of money. But if I put $5 because my banker said I should, and this company ends up blowing up like it does, and it does the things that you say it does, how complicit am I?

Speaker 23:07 Yeah, it's int- it's an interesting thought of, like, how far away do we get the blame from? Because-

Eugene 23:11 Mm-hmm

Speaker 23:12 ... yeah, like, do you ... If I'd expand on, on that, it is, it is a difficult question, but do you think people know when they're investing in these companies?

Eugene 23:22 Mm-hmm.

Speaker 23:22 Like, the average person, do you think they know what they're investing into? No idea. No, I, I think they have no clue-

Eugene 23:29 Mm

Speaker 23:29 ... what they're investing in. And, and the, all of the signaling, all of the PR, um, is about health and wellness and-

Eugene 23:37 Yeah

Speaker 23:37 ... you know, thriving, UnitedHealth, just to take one example. Um, but, um, y- you know, for me, the individual investor, you should probably do your homework because that's part of your re- responsibility as a citizen, but the people who are really complicit to me-

Eugene 23:53 Yeah

Speaker 23:53 ... are people like Warren Buffett. I mean, you own 40% of a company. You have owned it for a long time.

Eugene 23:57 Hmm.

Speaker 23:57 You yourself have made a killing in this investment.

Speaker 24:00 You should be kicking the tires on what's going on.

Eugene 24:02 Hmm.

Speaker 24:02 Right? I think that's very important, and I think people should be able to call folks on that. Um, now, it, he might argue that, uh, this is a good investment, and what I'm doing is investing, and that is precisely the argument. Uh, that I, there's zero social, you know, uh, obligation on my part. I am an investor, and that's just 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 a, there's an argument that says social responsibility in running a company is actually, should be illegal.

Trevor Noah 24:35 Yeah.

Speaker 24:36 I mean, your only legal obligation is to shareholder value.

Trevor Noah 24:38 Yeah.

Speaker 24:39 Um, that's another of those insane things, like corporations are people and money is speech. One of those complete idiotic, insane things. But we-

Trevor Noah 24:48 Corporations are people?

Speaker 24:48 Keep... This is United, uh-

Trevor Noah 24:50 Yeah

Speaker 24:50 ... Citizens United.

Trevor Noah 24:51 Okay.

Speaker 24:51 Corporations are people as a, as a legal entity.

Trevor Noah 24:53 Yeah.

Speaker 24:54 And, and their money, and any money, is speech. Those are two things that s- s- uh-

Trevor Noah 24:57 Yeah, that's one of the worst decisions America ever made.

Speaker 25:00 It's preposterous.

Trevor Noah 25:01 It's, it's-

Speaker 25:01 I mean, just if you think about it, what is... That's, that's crazy.

Trevor Noah 25:03 Yeah.

Speaker 25:03 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. Like, those really smart people are saying it." It's, it's, not only is it insane, it's also hugely damaging because of course then the corporations with their speech are gonna go in and buy politicians, and that's what our... I mean, the US campaign system, campaign finance system, is illegal in most countries.

Trevor Noah 25:26 Yeah.

Speaker 25:27 I don't know how it is in South Africa.

Trevor Noah 25:28 No, no, no.

Speaker 25:28 But a big company can't come-

Trevor Noah 25:29 Yeah

Speaker 25:30 ... and give you a million bucks.

Trevor Noah 25:31 So I was just-

Eugene 25:31 Mm.

Trevor Noah 25:31 You can in South Africa.

Eugene 25:33 Mm-hmm.

Trevor Noah 25:33 They, they, they make these big donations, but-

Speaker 25:35 In the past. Mm

Trevor Noah 25:35 ... I was shocked. When I first came to the US, I was shocked at how many things are legal here and just full-on bribery where we're from and in other parts of the world. It's just like, it's just bribery.

Speaker 25:46 Totally bribery.

Trevor Noah 25:46 They would just go, "This is bribery."

Speaker 25:47 Yeah.

Trevor Noah 25:48 Half the stories that make the headlines in South Africa.

Speaker 25:50 Mm.

Trevor Noah 25:50 Politician got a private jet flight to this place and was put up in a hotel for a weekend and-

Speaker 25:56 Yeah

Trevor Noah 25:56 ... went out for, and then spent this much and got... And then you come here and they're like, "No, no, no. That's, that's lobbying. What are you talking about?"

Speaker 26:01 Yeah.

Trevor Noah 26:01 "That's not-

Speaker 26:02 No, it's-

Trevor Noah 26:02 "That's not bribery."

Speaker 26:03 That's speech. Free speech.

Trevor Noah 26:04 No, that's-

Speaker 26:04 First Amendment.

Trevor Noah 26:05 Yeah.

Eugene 26:05 Yeah.

Trevor Noah 26:05 They're expressing themselves.

Speaker 26:07 What? Yeah, I mean.

Trevor Noah 26:07 This poor company needs to speak.

Speaker 26:09 Yeah.

Trevor Noah 26:09 Are you going to silence the company? Oh, poor company.

Speaker 26:12 Yeah.

Eugene 26:12 We, we're going through that actually right now, where officials from our version of the DMV-

Speaker 26:18 Mm-hmm

Eugene 26:18 ... went to France-

Trevor Noah 26:19 Oh, yeah

Eugene 26:20 ... to solicit, you know?

Trevor Noah 26:21 Yeah, yeah.

Eugene 26:21 To hang out and be on private jets, expensive dinners, expensive gifts, with a company that will print driver's licenses in our country.

Trevor Noah 26:28 They have the exclusive contract

Trevor Noah 26:30 essentially for-

Eugene 26:31 Forever

Trevor Noah 26:31 ... and it's, it's massive amounts of money.

Eugene 26:33 Yeah.

Trevor Noah 26:33 But it's exactly what you're saying. And when you, you know when we talk about complicit, I lo- I love that you use that word because when we talk about somebody like Warren Buffett-

Eugene 26:40 Mm

Trevor Noah 26:41 ... 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-

Eugene 26:52 Mm

Trevor Noah 26:52 ... if they, if it turned out they funded the Sinaloa cartel, you know, if they owned 40% of it. Like, imagine if you said to somebody, "I own 40% of the Sinaloa cartel." They'd go, "You're a criminal." And you're like, "No, no, no, no, no. I just invest in the Mexican drug cartels."

Eugene 27:07 Mm.

Trevor Noah 27:08 "I, I don't engage in it."

Eugene 27:10 Mm.

Trevor Noah 27:10 "They're a good investment."

Eugene 27:11 Apart from the guns, yeah.

Speaker 27:11 They are.

Trevor Noah 27:11 "They're a great investment."

Speaker 27:12 They are rapidly growing, good market share.

Trevor Noah 27:14 I, I mean, you know?

Speaker 27:15 All of the, the return on assets is awesome.

Trevor Noah 27:17 It's a, it's a great, uh, uh... But I, look, do I condone everything? Of course I don't. Uh, but I'm not, I'm not there for the murder. I'm just there for the investment.

Eugene 27:23 No, it's-

Trevor Noah 27:24 There, there is a level of asking yourself like, you know, like, w- who are, if everyone gets to say that they are not responsible, then who is responsible?

Eugene 27:33 Yeah. I think it's also how things are phrased, you know? An inquiry, an inquisition, a, you know, white collar crime, corruption-

Trevor Noah 27:40 Exactly. Yeah

Eugene 27:40 ... bribery.

Trevor Noah 27:41 Yeah.

Eugene 27:41 It's theft.

Trevor Noah 27:42 Yeah.

Eugene 27:43 All of it is just theft. And I was asking you before we started that, what is it that makes people steal?

Speaker 27:51 Hm.

Eugene 27:52 I know what would motivate someone to tell the truth and blow the whistle. I can kind of figure it out. You get tired of how things are. You go, "I have to make a change. I have to be the change that I want to see." But in your research, what makes someone go, "Here's a million dollars that's supposed to go to public good, and I'm just gonna buy a nice car and a nice house"?

Speaker 28:12 Well, first of all, um, steal from necessity. I'm hungry and I gotta eat.

Eugene 28:16 Yeah.

Speaker 28:16 My family has to eat. I get that.

Eugene 28:18 Mm-hmm.

Speaker 28:18 Um, I'm not condoning it, but I get it. Um, and, and a lot of that is caused by the white collar crime we were talking about earlier, right?

Eugene 28:24 Right. Right.

Speaker 28:24 Um, but second of all, if you ultimately, um, if you and your peers are, uh, an aggressive corporate culture and you talk about how you really gotta push things, you really gotta go for the, go for the throat, you know, all these sort of sports/killing analogies of war. I mean, s- go, uh, corporations as war-fighting machines.

Eugene 28:46 Hm. Yeah.

Speaker 28:46 That's kind of-

Eugene 28:47 Yeah

Speaker 28:47 ... you know, penetrate and, and, and, uh, take, uh, 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 this sort of nudge, nudge, wink, wink. We, the compliance department says we're doing everything just right.

Eugene 29:04 Ah, yeah.

Speaker 29:04 And we have a gold-plated compliance department.

Trevor Noah 29:07 Just right.

Eugene 29:07 Plausible deniability.

Speaker 29:08 But go ahead, Joe.

Trevor Noah 29:08 Go on, go on.

Speaker 29:09 Off camera, you can do, you know. But then there's this, 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 whe- when you're doing the right thing. If you're saying, "Am I doing the right thing today by, uh, I don't know, by writing a book, by doing a comedy show-

Trevor Noah 29:27 Yeah

Speaker 29:27 ... by talking," it's hard to at the end of

Speaker 29:30 the day or the end of a year to say, "I've done something really important." It's easy to count money. And if you're in that culture where you say, "Look, look at that, I got 5 million bucks," that's very tangible.

Eugene 29:41 Mm.

Speaker 29:41 And now it's 5.2, and on the s- and the stock market is growing and growing. The m- wealthy people that I know, the ones that have 100 million, they only talk about the people who have 200 and 300 million.

Trevor Noah 29:50 Yeah.

Speaker 29:50 The ones who have 300 million, they talk about the billionaires.

Trevor Noah 29:52 Yeah.

Speaker 29:53 The ones who have a billion, they, they talk about the two bi-

Trevor Noah 29:55 No.

Speaker 29:55 It's never enough.

Trevor Noah 29:56 Yeah.

Speaker 29:56 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, and condones all of their actions, it becomes this sort of s- um, endless, endless hunt for more, uh, for more money at the end of the day. And it, 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 just a sco- it's a counter for the quality of your life because the quality of your life, I don't know. I mean, again, working in banking for a brief time, I saw some amazing people, incredibly smart people, doing incredibly dumb things with their life. [laughs]

Trevor Noah 30:38 Yeah.

Speaker 30:38 Throwing away their time-

Trevor Noah 30:39 Yeah

Speaker 30:39 ... 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

Trevor Noah 30:49 Yeah, yeah

Speaker 30:49 ... 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 [laughs] I don't have any money.

Trevor Noah 30:56 [laughs] Don't go anywhere, because we got more What Now? after this. This episode is presented by Whole Foods Market. Eat well for less. You know how Thanksgiving always sneaks up on you? One minute you're eating leftover Halloween candy, and the next everyone's arguing about who's making what for Thanksgiving dinner. Who are you talking to? Luckily, Whole Foods Market makes it easy to pull it all together. With great prices on turkey, sales on baking essentials, and everyday low prices from the 365 by Whole Foods Market brand, you can actually prep for the holiday without losing your mind or your budget. Yo, why are you speaking like that? They've got high quality organic produce and grab and go sides, which honestly save your life when you said you'd bring something and completely forgot to cook. Is this an ad? Did you just teleport us into an ad? The 365 brand is all about better everyday essentials, affordable pantry staples, baking must haves, all the basics that still meet Whole Foods Market's quality standards. So whether you're hosting, contributing a dish, or just showing up hungry, Whole Foods Market has everything you need to make this holiday season easier and more delicious. We're sponsored. Shop everything you need for Thanksgiving now at Whole Foods Market. Can we go back to the episode? You, we had a, um, we had an episode of the podcast with, uh, Rutger Bregman,

Trevor Noah 32:30 right? And, uh, some people might not know his name, but he was the guy who rose to a little bit of infamy by, um, he went to Davos.

Speaker 32:39 Mm-hmm.

Trevor Noah 32:40 And at Davos, he, he basically said to everyone in the room, he's like, "Hey, hey, why is everyone here trying to solve the problems of the world as if you are not causing the problems of the world?"

Speaker 32:48 [laughs]

Trevor Noah 32:48 And he said to everyone in that room, "Just pay your taxes. Everyone here is avoiding ta- 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?"

Speaker 32:57 Yeah.

Trevor Noah 32:57 "Don't invite him back again." But one of the things he talks about

Speaker 32:59 Mm

Trevor Noah 32:59 ... and that's what he's working on now, is he said, "We've created a society, a society where the smartest, brightest minds go into fields where they're just trying to extract from society."

Speaker 33:12 Yeah.

Trevor Noah 33:12 There wa- 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, you know what I mean?

Speaker 33:26 Mm-hmm.

Trevor Noah 33:26 And then now that person goes like, "Go to a company that can make as much money as possible, as quickly as possible." Mathematicians were trying to solve going to space or, you know

Speaker 33:35 Yeah

Trevor Noah 33:35 ... trying to figure out the circumference of the globe, what- whatever. And then they were just like, "Go to this company, make as much money as possible, get the trading."

Speaker 33:40 Mm. Yeah.

Trevor Noah 33:41 But, but what you said I think is key. It's the reverence.

Speaker 33:43 Mm.

Trevor Noah 33:45 You turn on the news and they go, "L- Larry Ellison, now the richest man in..." But why? Like, if society, like ... And, and I mean that on like a, a media level, not, not the people on the ground, because I think the people are oftentimes sort of, not victim to it, but you, you, you're experiencing it.

Speaker 34:01 Mm.

Trevor Noah 34:02 If the news tells you that this is good and important, and the media tells you it's good and important, then you think it's good and important.

Speaker 34:09 And not by accident, half the media is owned by those very people.

Trevor Noah 34:12 Yeah.

Speaker 34:12 I mean, if you look at the

Trevor Noah 34:13 Yeah

Speaker 34:13 ... oligarchs that are, that are owning, you know, the big news outlets, they're legion. And, uh, and trying to tell Jeff Bezos that he really shouldn't be, uh, a monopsony in, uh, all, you know, goods sold in the United States, you will not last very long, right? There is a lot of self editing. So I think that's ... No, that's absolutely right. Um, this reverence, this sense that they are gods. And it builds into this sense, too, that there is an ubermensch society, and then there

Trevor Noah 34:40 Yeah

Speaker 34:40 ... are underlings.

Trevor Noah 34:41 Yeah.

Speaker 34:41 And those underlings, if they're, you know, homeless, well, they're not human really.

Trevor Noah 34:45 Mm.

Speaker 34:45 It's not my problem. I mean, that's the sense that I get. It's horrible to say, but, um, there are people who, um, the haves and the have nots have always existed, since ancient Greece, since Rome, since whenever. But this is a sort of a institutionalized, um, form of, of superior being, um

Trevor Noah 35:04 Mm

Speaker 35:04 ... judged by your, you know, net worth. And then everybody else is really expendable.

Trevor Noah 35:08 To talk about expendable, you, you, you, you can look at one of the examples you give in the book. And, and you go through multiple, um, multiple hospitals and healthcare systems. I, I, I was reading about the dialysis and, and, and how each system doles it out. And so what you're saying,

Trevor Noah 35:30 in some of these stories, man, it, it, it sounded less like healthcare and more like a fast food drive through-

Speaker 35:36 Mm

Trevor Noah 35:36 ... chain. It felt like they're trying to get people on and off a machine as quickly as possible

Speaker 35:43 Yeah

Trevor Noah 35:43 ... use as few nurses as possible

Speaker 35:45 Yeah

Trevor Noah 35:45 ... 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, it, it feels like the business model isn't ... It's not about healthcare, it's about health profits.

Speaker 36:03 100%. It's fast food medicine, and it's a model that wasn't invented by dialysis. It was invented in the '60s by, um, by people who actually, um, ran, uh, Kentucky Fried Chicken franchises and, and Wendy's.

Trevor Noah 36:16 Literally.

Speaker 36:17 Literally. Who then started buying up, um, you know, uh, started privatizing hospital systems-

Trevor Noah 36:24 Oh, wow

Speaker 36:24 ... and, and putting together. So they literally were the people with this branding experience and this mass fa- um, you know. Uh, and in theory, I mean, you know, um, Atul Gawande wrote the, the Cheesecake Factory, um, article in The New Yorker, which got a lot of attention. I don't, I don't like it, but he's a smart guy. He's a doctor, and he ... The idea of focusing in on a specific, uh, medical procedure, making it as efficient as possible, and delivering it in as low cost a way as possible, that's a- But potentially a useful idea. The important thing here is that it not become, um, turning patients into widgets on an assembly line.

Trevor Noah 37:02 Yeah

Speaker 37:02 Which is precisely what the fast food model, uh, or the Cheesecake Factory does. Um, you, you're not tailoring your care to the individual needs of your patient. You are looking ... And once again, this is a finance person's view.

Trevor Noah 37:16 Yeah, yeah, yeah.

Speaker 37:16 The person, person who brought this into dialysis or pop- popularized it, Kent Thiry, he was a former CEO and the founder of DaVita, one of the two big companies. He made his bones at Bain Capital. That's a private equity firm. He was a pr- he was a finance guy, the kind of guys that I worked with. Um, and he basically, and he said, speaking to a business school audience, um, he said, uh, "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-

Trevor Noah 37:43 No

Speaker 37:44 ... at DaVita. It's not about the patients," is what he said. And some doctors hate it when I say this. These are quotes, right, from his speech.

Trevor Noah 37:50 This is an actual quote.

Speaker 37:51 Actual quote.

Trevor Noah 37:52 Yeah.

Speaker 37:52 Yeah, I can show you the video. It's quite striking. But again, it fits in a business and situation in which you are Wall Street facing and you're talking about return on assets.

Trevor Noah 38:03 Investment, yeah.

Speaker 38:03 If you have, uh, 2,000 dialysis clinics around the country and your main focus is shareholder value-

Trevor Noah 38:10 Yeah

Speaker 38:11 ... and I'm getting paid in stock as a CEO, so my shareholder value [laughs] is pretty important to me too, right?

Trevor Noah 38:15 Right.

Speaker 38:15 This is conflict of interest on a massive scale. Anyway, if that's your aim, you want to thr- run as many patients through every single one of those facilities as you can, 'cause your asset base, your buildings, your machines and so on, the more units you shoot through them-

Trevor Noah 38:29 Yeah

Speaker 38:29 ... and it

Speaker 38:30 is just like Taco Bell, except people are not burritos, right? Every single person who goes into that facility needs, should have a, 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, um, assembly line model, you're not gonna do that. You're not, you're-

Trevor Noah 38:51 One size fits all.

Speaker 38:53 One size fits all. And you're gonna penalize the people who slow things down.

Trevor Noah 38:55 Mm-hmm, mm-hmm.

Speaker 38:55 Who say, "Oh, actually, you know, Tom here, he should be getting five hours." Uh, no way, no way. And they're, they violently push back. And the doctors, some of the doctors I've talked with who work in these facilities are not best pleased. Uh, and some of them, and some of the workers, um, are also suffering from serious moral harm.

Trevor Noah 39:13 Mm.

Speaker 39:13 Because they realize this is like s- soldiers forced to commit, you know, um-

Trevor Noah 39:17 Yeah, yeah, yeah

Speaker 39:18 ... uh, horrible-

Trevor Noah 39:18 That's the perfect analogy, actually

Speaker 39:19 It is. Yeah.

Trevor Noah 39:20 Actually, that's the perfect analogy.

Speaker 39:20 They're, they're literally, they, they know what's wrong and they are not able to fulfill their Hippocratic Oath to their patients and take care of their patients, 'cause the structure they're working in doesn't permit it.

Trevor Noah 39:31 Yeah, I think that's the perfect analogy because we take for granted how much an overlord and a system can then oppress even the people within it.

Speaker 39:40 Mm.

Trevor Noah 39:40 And then what happens is, in a society, we start fighting amongst ourselves.

Speaker 39:44 Yes. Yeah.

Trevor Noah 39:44 As if there's not one central thing that we should be looking at.

Speaker 39:46 Yes. Right.

Trevor Noah 39:47 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.

Speaker 39:55 Right. Yes.

Trevor Noah 39:55 The defense company doesn't get spat on.

Speaker 39:57 Yeah.

Trevor Noah 39:57 The people who lied about weapons of mass destruction, they don't get spat on.

Speaker 40:01 No, no.

Trevor Noah 40:01 Do you know what I mean?

Speaker 40:01 No, no.

Trevor Noah 40:01 And the same thing happens here. People go, "My doctor is trash. My this is..."

Speaker 40:05 Yeah.

Trevor Noah 40:06 But it's when you delve into it that you go like, "Oh, man, my doctor's victimized by the same system."

Speaker 40:11 A doctor is called a provider now, or even a vendor.

Trevor Noah 40:14 Yeah.

Speaker 40:14 I mean, you know.

Trevor Noah 40:14 Yeah, yeah. [laughs]

Speaker 40:15 [laughs] He or she is a, is a cog in a wheel. And, and again, certain things, maybe, maybe burritos should be made that way. I'm game for that. Um, but healthcare ... And there are other things. I mean, you know, are we good with p- 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 r- facing.

Trevor Noah 40:37 Yeah.

Speaker 40:38 And healthcare is one of them. Uh, but there are a lot of others, and we just, in America, we've lost that discourse.

Trevor Noah 40:43 When you look at other countries, what did you find? Because I, I think there's a perspective that you bring in this book and in your work that I think is really important, 'cause oftentimes people will go, "Well, I mean, show me a better way to do it." And you're like, "Oh, yeah, I can."

Speaker 40:57 [laughs]

Trevor Noah 40:57 And you actually go to other countries.

Speaker 40:58 Yeah [laughs] . Yeah.

Trevor Noah 40:58 And you show a better ... But, but talk us through some of that, because, like, Australia, Japan, like a, a wealth of other wealthy countries show that this is not the normal way that it needs to be.

Speaker 41:09 No, precisely. I mean, we've gotten so caught up in American exceptionalism that we lose sight of the fact that there are a lot of places, uh, uh, where, where things in general, and healthcare in particular, are done a lot better. And the example, and the most brutal example, is how long do patients on dialysis survive in the US versus other countries?

Trevor Noah 41:28 What are the stats?

Speaker 41:29 They

Speaker 41:30 die two to three times faster than any other developed world, and many lesser developed countries as well.

Trevor Noah 41:37 Yeah.

Speaker 41:37 I mean, you know, we're talking tw- 20% to 22% per year death rate, whereas mortality in, in Europe is anywhere 12 to 15%, um, and more on the 12 side. Japan, 6%. I mean, we're talking, uh, uh, the most ... And that's, and that's just how soon do you die. Quality of life is another big issue. But I mean, the, the, the central premise that everything has to be for profit, um, is, is preposterous.

Trevor Noah 42:07 Yeah.

Speaker 42:07 'Cause every other country in the world does it better, does it cheaper.

Trevor Noah 42:10 Yeah.

Speaker 42:10 I mean, the basic pro- promise of the Reaganomics era and ever since is we will do it better 'cause government's the problem.

Trevor Noah 42:16 Mm-hmm, mm-hmm.

Speaker 42:16 And we will do it cheaper because we are so efficient. Now, uh, in, in America, we do it worse and we do it vastly more expensively at the same time.

Trevor Noah 42:25 Yeah.

Speaker 42:25 So something's rotten in the state of Denmark. [laughs] Uh, not Denmark.

Trevor Noah 42:29 [laughs]

Speaker 42:29 You know what I'm talking about.

Trevor Noah 42:30 Yeah, I know exactly what you're talking about.

Speaker 42:31 And, and, and, and you have ... So in most countries, you have, you have the fisc, you have the treasury that collects taxpayer dollars, and you have, I don't know, patients, um, in, uh, hospitals where patients go. And, and the money goes from the treasury, boop, 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, and in the, or the dialysis facilities in this case. In the middle you have this twin towers or, of, of massive corporate You know, absorption

Trevor Noah 43:04 Yeah

Speaker 43:04 Um, you ready to talk about, um, middleman and the cost to healthcare, this is a classic example. You have these two twin towers that are, that are soaking up a lot of the billions and billions, and we're talking roughly-

Trevor Noah 43:17 I wouldn't do twin towers and the hands like that. It might be the ... It looks like the wrong thing

Speaker 43:21 Yeah, I'm s- yeah, you are using-

Trevor Noah 43:22 Yeah, you went twin towers-

Speaker 43:22 And we're in New York

Trevor Noah 43:23 ... and you used hands, and I was like whoa, whoa, whoa, Tom

Speaker 43:25 Maybe, yeah, yeah

Trevor Noah 43:26 ... Tom, Tom, Tom, wrong hands

Speaker 43:27 Let's, let's find-

Trevor Noah 43:27 Wrong ... Different analogy. Different analogy

Speaker 43:29 Let's find s-

Trevor Noah 43:30 Let's go with something

Speaker 43:30 Two large l-

Trevor Noah 43:31 Yeah, two large ... You know what? Sinkholes

Speaker 43:33 Let's, sinkholes [laughs]

Trevor Noah 43:34 That's better. Two sinkholes

Speaker 43:36 And all the money goes into the sinkholes

Trevor Noah 43:37 And they're sucking everything in. That's way better

Speaker 43:38 And it looks nothing like the 9/11-

Trevor Noah 43:40 'Cause you went towers and then your hands did this

Speaker 43:41 That's ... No, it's just-

Trevor Noah 43:41 And yo, man, we-

Speaker 43:42 No, no

Trevor Noah 43:43 ... we from another country, Tom. Don't be doing that to us

Speaker 43:45 Yeah, but still. Yeah

Trevor Noah 43:46 Yeah, yeah. We [laughs]

Speaker 43:47 Look at the calendar, man. Look at the calendar.

Trevor Noah 43:49 What was yesterday? [laughs]

Speaker 43:50 Yeah, no. [laughs] No, no. That ... You're absolutely right. These are the twin sinkholes of-

Trevor Noah 43:54 Yes, yeah

Speaker 43:55 ... of, of, of money absorption.

Trevor Noah 43:57 Hm.

Speaker 43:57 And the money goes into the sinkhole and not so much comes out

Trevor Noah 44:00 Yeah

Speaker 44:00 And this is, again, this is not unique to dialysis. It's particularly pr- in my view, obscene in dialysis, but it happens. You know, what, what is UnitedHealth Care's model? It's to take as much money as they can and give as mu- little as they can away.

Trevor Noah 44:13 Yeah, yeah

Speaker 44:13 That's it, and the rest goes into the sinkhole.

Trevor Noah 44:16 I feel like it's the Rosetta Stone of healthcare. That's what you've, you've shown us with the dialysis model-

Speaker 44:21 Mm

Trevor Noah 44:21 ... is you've gone, "Let me show you this example."

Speaker 44:24 Mm.

Trevor Noah 44:24 "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?

Speaker 44:33 Mm.

Trevor Noah 44:34 And when, and when you, when you look at these other countries, what would you say is the biggest thing, like just on, on one level, that they're doing differently? I, I mean, I can understand the government is paying and it, you know, it's a different ... But what would you say is, like, something that they're, they're practically doing differently than in the US?

Speaker 44:48 Well, they're following universally accepted medical guidelines, which have to do with how long, how gently you treat-

Trevor Noah 44:56 Yeah

Speaker 44:56 ... uh, at what, what values you treat. Do you do it at home or not? I mean, if you

Speaker 45:00 look at Australia, the majority of, of ... They push patients to home dialysis.

Trevor Noah 45:04 Wow

Speaker 45:04 And ever since the 1960s, ever since this miracle cure was invented, the people w- 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-

Trevor Noah 45:18 Yeah, yeah, yeah

Speaker 45:19 ... to getting well or to feeling better, right?

Trevor Noah 45:21 Yeah.

Speaker 45:21 And being a passive recipient of care, lie down, put your arm out, I'm gonna take your blood. I've heard the, I've heard patients tell me this from [laughs] you know, in, in dialysis facilities. You need to have control of your destiny, and doing that at home is the way to do it. Also, again, you can tailor your care to ... And it's doable. So Australia pushes people home. Um, a- a- but just a fa- that is another of the fundamental, widely, universally accepted laws of dialysis. It's 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, uh, well, the health, um, Health and Human Services, doesn't enforce best practices on their ... You know, I, I, 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, um, wrongdoing in dialysis

Trevor Noah 46:30 What, what is, what is CMS?

Speaker 46:32 Uh, it's the Center for Medicare and Medicaid Services.

Trevor Noah 46:34 Okay, got it. Yeah, yeah.

Speaker 46:34 So it's the ones that administer Medicare and Medicaid funds

Trevor Noah 46:37 Right

Speaker 46:37 And they know what good dialysis is.

Trevor Noah 46:40 Yeah. Oh

Speaker 46:41 They know what the metrics are.

Trevor Noah 46:42 Okay

Speaker 46:42 They're just not counting them.

Trevor Noah 46:43 Okay

Speaker 46:43 So they don't count treatment time.

Trevor Noah 46:45 Yeah

Speaker 46:46 They don't penalize people who don't treat longer, um, and, and they don't count, um, UFR, ultra- ultrafiltration rate, which is the speed with which you remove liquid from someone's blood and their body, um, which are critical to survival.

Trevor Noah 46:59 Yeah

Speaker 47:00 They don't count those things. Like the ... W- what are you counting exactly? They don't count, uh, septicemia, which is, you know, one of the major causes of death. What ... 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.

Trevor Noah 47:13 Yeah, but the question is who's telling them what to count and how to count?

Speaker 47:17 I guarantee you the answer is the revolving door.

Trevor Noah 47:20 Yeah

Speaker 47:20 I mean, I, in my book, I, I, I, I cite several examples of people from the White House who have gone to the board of-

Trevor Noah 47:28 Yeah

Speaker 47:28 ... of the big pharma comp-

Trevor Noah 47:30 Yeah, man

Speaker 47:30 ... the big-

Trevor Noah 47:30 Same thing there

Speaker 47:31 ... big dialysis companies

Trevor Noah 47:32 Mm-hmm

Speaker 47:32 And vice versa

Trevor Noah 47:33 Yeah

Speaker 47:33 People from, you know, from the, from, from, um, the boardrooms of the big healthcare companies who go straight into government and are making these policies

Trevor Noah 47:43 Policies, yeah

Speaker 47:43 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's gonna 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

Speaker 48:00 common good anymore. It's just, uh, let's grab as much as you can [laughs] before, you know, while it's your turn to eat.

Trevor Noah 48:05 You know why? The, they've done a great job of tricking us, you know?

Speaker 48:09 Yeah.

Trevor Noah 48:09 It, it's, it's one of the greatest scams that has ever been pulled on people collectively. What they did was governments were providing a good. It doesn't mean that they were perfect, but the good was being provided by the governments. In this case, it's the 1970s when Medicare says they're going to cover dialysis.

Speaker 48:26 Yeah

Trevor Noah 48:26 This is revolutionary. You have this problem with your kidneys. They're gonna come in. The machine will be there. The government is going to help you out.

Speaker 48:33 Yeah

Trevor Noah 48:33 And because you can amortize the cost acr- across a population-

Speaker 48:36 It becomes cheaper

Trevor Noah 48:37 ... it will work.

Speaker 48:38 Yeah.

Trevor Noah 48:38 It will work.

Speaker 48:38 Yeah.

Trevor Noah 48:39 And then very quickly, companies who see a gap go, "Wait, wait, wait. If the government's paying for it, we can get that money."

Speaker 48:47 Yeah

Trevor Noah 48:47 And then they go, "If we can get that money, how do we get more of that money?" And then they become part of the cycle. It's so crazy how you see this in every country, whether it's the UK-

Speaker 48:55 Yeah

Trevor Noah 48:55 ... whether it's South Africa, whether it's the United States, where- wherever you're having these issues.

Speaker 48:59 Hm.

Trevor Noah 49:00 The people who work in governments work with the companies To make the government look inept.

Speaker 49:06 Yeah.

Eugene 49:07 Mm-hmm.

Trevor Noah 49:07 The people on the ground then go, "The government is terrible."

Eugene 49:10 Mm.

Trevor Noah 49:10 "We should give this to the private companies." The private companies then take the work.

Speaker 49:14 Yep.

Trevor Noah 49:14 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 gonna be maybe not great.

Speaker 49:26 Yeah.

Trevor Noah 49:27 But they weren't gonna be as expensive.

Speaker 49:29 Yeah.

Trevor Noah 49:29 And now you're getting a shit thing for an expensive price.

Speaker 49:32 Yeah.

Trevor Noah 49:32 But you then hate the government. You go, "The government doesn't do anything." It's like, yeah, and the companies that made that happen are the reason you keep com- ... It's, it's such a-

Speaker 49:40 Exactly

Trevor Noah 49:40 ... it's such a pernicious cycle

Speaker 49:41 It's such a con job, and exactly, and, and the government does become pe- people in America, "Oh, big government, that's really bad." I mean, you look at the f- the Pentagon. Trillion dollar, uh ... And that is a bunch of sock puppets. I mean, they have Lockheed Martin up their butt with their-

Trevor Noah 49:54 Yeah

Speaker 49:54 ... h- hands going like this.

Trevor Noah 49:55 Right

Speaker 49:55 [laughs] You know? I mean, and you see the revolving door between the generals who go onto Lockheed's board, and-

Trevor Noah 50:01 Mm

Speaker 50:01 ... I'm just picking Lockheed. Even Raytheon, you name it-

Trevor Noah 50:03 Mm-hmm

Speaker 50:03 ... they've got it. The whole outsourcing government contracting thing is such a scam.

Trevor Noah 50:07 It's a great scam.

Speaker 50:08 'Cause it corporatizes-

Trevor Noah 50:09 Yeah

Speaker 50:09 ... and at the same time g- is able, as you say, to, to, to push the blame onto, onto government, big government, which never gets it right. And talk about socialism. I mean, you look at war fighting in America, a trillion dollars a year to the, to the Pentagon.

Trevor Noah 50:22 Trillion dollars a year.

Speaker 50:23 Trillion. Uh, uh, that's-

Trevor Noah 50:24 Yeah

Speaker 50:24 ... that's socialism, right? Uh, oh no, no, it can't be, 'cause it's America. Sorry. My, my bad.

Trevor Noah 50:29 Yeah. And because it's war.

Eugene 50:30 Because you-

Speaker 50:30 [laughs] No, it's war.

Trevor Noah 50:30 And it's because it's war.

Speaker 50:31 That's right.

Trevor Noah 50:31 It's like, it's amazing how war-

Speaker 50:32 Sacred

Trevor Noah 50:33 ... yeah, war is always the thing where people are like, "The government shouldn't be smaller there." You're like, why, why shouldn't the government-

Speaker 50:38 Yeah

Trevor Noah 50:38 ... be smaller there?

Speaker 50:39 We cut everything else, but 10% raise for the Pentagon.

Trevor Noah 50:41 You know, they're like, "Oh, we need smaller government." And he's like, "Well, except for war." "Oh, well, war."

Speaker 50:44 Yeah.

Trevor Noah 50:44 "I mean, no, well, that's, that's-"

Speaker 50:45 And how successful have our wars been recently at producing security and national defense? Not so much, actually, you know, if you think about it.

Trevor Noah 50:54 More importantly-

Speaker 50:55 But I don't wanna think about it. Sorry.

Trevor Noah 50:56 Yeah.

Speaker 50:56 I wanna ...

Trevor Noah 50:57 More importantly, this is the question I often ask people, is I go-

Eugene 50:59 Oh, man. Mm

Trevor Noah 51:01 ... 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-

Eugene 51:11 Far from America

Trevor Noah 51:11 ... that's what you say, right?

Eugene 51:12 Mm-hmm.

Trevor Noah 51:13 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-

Eugene 51:26 Mm

Trevor Noah 51:26 ... that are too expensive, healthcare that's not being provided,

Trevor Noah 51:30 you know, food on a basic level, that's a war that you could be fighting in your country without-

Speaker 51:35 100%

Trevor Noah 51:35 ... bombing anybody.

Speaker 51:36 And that's exactly the r-

Trevor Noah 51:37 You know what I mean?

Speaker 51:38 ... the reason-

Trevor Noah 51:38 Yeah, yeah

Speaker 51:38 ... in the 1970s, a number of people, this is during the c- you know, the, the Cold War, the coldest part of the Cold War, and the fight against Russia and everything else, and yet, at the same time, um, bipartisan congressional figures, Republicans and Democrats, are saying, "We're spending billions," and back when a billion was a big number, "billions to build these rockets, and we can't even take care of our own citizens."

Trevor Noah 51:59 Yeah.

Eugene 51:59 Yeah.

Speaker 52:00 And they were pushing for dialysis in that, in that way. And the other thing about war is, of course, a- and, and the trillion dollar Pentagon, is that, you know, as, as one former general told me, when you get to be a big hammer, everything starts looking like a nail, right?

Trevor Noah 52:12 Yeah.

Eugene 52:12 Mm.

Trevor Noah 52:12 Yeah.

Speaker 52:12 I mean, you gotta go out there and b- I built all this k- cool stuff.

Trevor Noah 52:15 You've gotta find reasons to use it

Speaker 52:16 I'm trained, highly trained-

Trevor Noah 52:17 Yeah

Speaker 52:17 ... in doing this stuff. We gotta find a way to use it.

Trevor Noah 52:19 And we have to get rid of it.

Speaker 52:20 Yeah. [laughs]

Trevor Noah 52:21 'Cause we have to make more.

Speaker 52:22 That's true.

Eugene 52:22 Oh, you're not wrong.

Trevor Noah 52:22 There's inventory.

Speaker 52:23 That's right. That's right.

Trevor Noah 52:24 You're not wrong.

Speaker 52:24 That's right. There's, there's new stuff coming on, so we gotta-

Eugene 52:26 And some of it gets lost in these smaller-

Trevor Noah 52:29 Oops

Eugene 52:29 ... third world countries

Trevor Noah 52:30 Oh my goodness.

Speaker 52:30 Oh.

Eugene 52:30 Yes, and then it-

Trevor Noah 52:30 Oh, don't even get me started on that

Eugene 52:32 ... it, it c- it's almost like what you guys are explaining to me, it's almost like a shepherd-

Speaker 52:36 Hmm

Eugene 52:37 ... that is not tending to the flock, but is out there hunting for wolves.

Speaker 52:40 That's, that's good.

Trevor Noah 52:41 That's a perfect analogy, actually.

Speaker 52:42 That's very good. [laughs]

Eugene 52:43 Yeah.

Speaker 52:43 That's very good.

Trevor Noah 52:43 That's the perfect analogy.

Eugene 52:44 Yeah.

Speaker 52:44 Yeah. The wolves are taking over in the, in the shepherd's-

Trevor Noah 52:47 Yeah, yeah

Speaker 52:47 ... room. Like, wolves are cooking dinner and ... [laughs]

Trevor Noah 52:50 [laughs] Having lamb chops.

Speaker 52:52 Are you okay there? You can st- shepherd, you know what? You can take, sit this one out. We'll take care of it.

Trevor Noah 52:56 You wanna, you wanna do something about that wolf? Whoa, whoa, whoa.

Speaker 52:58 [laughs]

Trevor Noah 52:58 Wolves have their rights too, you know. These poor ... You, do, do you know how the wolf feels about the sheep?

Speaker 53:04 [laughs]

Trevor Noah 53:05 You're the shepherd, though. Oh, yeah, yeah, yeah. But I mean-

Speaker 53:08 Have another beer

Trevor Noah 53:09 ... you know, come on.

Speaker 53:10 [laughs]

Trevor Noah 53:11 You know?

Speaker 53:11 That's, that's-

Trevor Noah 53:12 You, you know what?

Speaker 53:12 That's very good. Wow

Trevor Noah 53:12 When you, when you, when you think of it, like-

Speaker 53:14 Yikes

Trevor Noah 53:15 ... man, it's scary because you see this moving into everything.

Eugene 53:18 Yeah.

Trevor Noah 53:19 People wonder why things are getting shittier and shittier-

Eugene 53:23 Yeah

Trevor Noah 53:23 ... in everything.

Eugene 53:24 Yeah.

Trevor Noah 53:26 And when I looked at this dialysis story, I couldn't help but think of the analogy of it's almost like what, what these healthcare companies did would be the equivalent of car companies realizing the value of a seatbelt-

Eugene 53:40 Yeah

Trevor Noah 53:40 ... and then going, "We're gonna charge you every time you need to put it on."

Eugene 53:44 Yeah.

Trevor Noah 53:44 "And now you have to gamble with your life and go, do I afford that?"

Speaker 53:48 Can I afford that today? Yeah.

Trevor Noah 53:49 Can I, can I afford it? Can I not afford it? C- but you shouldn't, this shouldn't be a choice. We know that you need the seatbelt.

Eugene 53:54 Mm.

Trevor Noah 53:54 Put it on. And now it's like, ah, but, but can I? Can ... And they're like, "Oh, do you wanna, do you wanna play with your li- ..." And they know because to your point, it's, it's a duopoly. It's what, two companies?

Speaker 54:01 Yeah.

Trevor Noah 54:01 Is it still two companies?

Speaker 54:02 The two major companies own-

Trevor Noah 54:04 Yeah

Speaker 54:04 ... own and control-

Trevor Noah 54:04 Pretty much

Speaker 54:04 ... 80% of the market.

Trevor Noah 54:05 Yeah, but I mean, that's a duopoly.

Speaker 54:06 Yeah.

Trevor Noah 54:06 That's, like, you, you control everything. No one can push you around. And then what ... And because it's your life, that's the craziest thing.

Eugene 54:13 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'll leave no sacred spaces."

Speaker 54:22 Yeah, that's true.

Eugene 54:22 They've moved into organized sport.

Trevor Noah 54:25 Yep, you're not wrong.

Eugene 54:26 Yeah.

Speaker 54:26 That's right.

Eugene 54:26 You're buying the, the, the soccer jersey.

Trevor Noah 54:28 Yeah, you're not wrong.

Eugene 54:28 You're coming to the matches.

Trevor Noah 54:29 Yeah.

Speaker 54:29 That's right.

Eugene 54:29 They're paying your hero. They're controlling your life.

Speaker 54:32 Religion. Yeah.

Eugene 54:32 Religion.

Speaker 54:33 Religion.

Eugene 54:33 They've made them miserable.

Speaker 54:34 Big money.

Trevor Noah 54:34 Yeah.

Eugene 54:35 So they've made us all complicit.

Speaker 54:36 Yeah.

Eugene 54:36 And I, I worry a lot.

Speaker 54:37 That's true.

Eugene 54:37 Uh, when I, whenever I watch big organized sport-

Speaker 54:40 Mm

Eugene 54:40 ... I'm like

Trevor Noah 54:41 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?

Speaker 54:53 Oh, yeah, yeah.

Trevor Noah 54:54 And I'm like, "No, no, before corporations were involved in sports-

Speaker 54:57 Yes, yeah

Trevor Noah 54:57 ... how fair was sport?"

Speaker 54:59 Right.

Trevor Noah 54:59 Right?

Speaker 54:59 Exactly.

Speaker 55:00 And the money aspect, again, you see f- sports betting now, and to me-

Trevor Noah 55:03 Mm

Speaker 55:03 ... that is another thing where-

Trevor Noah 55:04 Oh, don't even. Oh, man

Speaker 55:05 ... it's like the st- stock market versus the real economy.

Trevor Noah 55:08 Who are we?

Speaker 55:08 I mean, when you're putting a bet on something, you debase it inherently, and your focus, again, turns from the activity on the field to-

Trevor Noah 55:15 Outcome

Speaker 55:15 ... outcome. And you can have derivatives that are bets on bets, and th- and this is all-

Trevor Noah 55:19 Yeah, it is

Speaker 55:19 ... stock market stuff. This is a way in which you think if you're not really engaging with the real world. And not only is it not helpful to what's going on in the field or what you're eating or what you're, uh, healthcare, it's diametrically opposed. If you focus all your energies on making it into a money-making operation and betting on it-

Trevor Noah 55:36 Mm

Speaker 55:36 ... you're actually taking the energy away and the resources and the s- and the intelligent people and all the things who should be saying, "How do we make a better dialysis machine?" There hasn't been a better dialysis freaking machine in the, in 40 years because-

Trevor Noah 55:49 No way, Tom

Speaker 55:50 Oh, no. Absolutely. There have been tiny little adjustments there, but there's no, been no phase shift, major breakthrough. Why is that? Because there's no freaking money in it. These two corporation, uh, big corporations, before them, there were others, have s- 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.

Trevor Noah 56:10 Yeah.

Speaker 56:10 They're not interested in the cow.

Trevor Noah 56:12 Yeah. I mean- You know what I've realized as well with the ... I don't know how it is in this country, but in South Africa, when you get life cover now- Yeah ... you're not obligated to take an HIV test, where else before you were obligated to take an HIV test if they're gonna insure you for a certain amount of money. Huh. So they'd have to test or they have to know- Yeah ... what your lifespan is, what your CD4 cell count is. Hmm. But right now, they're like, "No, just bring it, and then we'll, we'll see when we get there." So I'm like, was HIV always that dangerous to the body and your longevity? Huh. Or they found a way to not profit from you having HIV anymore? 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. I'm with you.

Speaker 56:47 Oh, okay.

Trevor Noah 56:47 So they, 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, 'cause my brain goes, which one is it?

Speaker 56:54 Hmm.

Trevor Noah 56:54 Have they found a way to de-risk it, or have they found a loophole on the other side? I'm, 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. You can- Like, like, like what switches in a system that changes something? How do we look at it differently?

Speaker 57:10 Hmm.

Trevor Noah 57:10 I, I even think of-

Speaker 57:11 Hmm

Trevor Noah 57:11 ... man, that, can I tell you? The-

Speaker 57:12 Hmm

Trevor Noah 57:13 ... there are parts of your book where I was just like, "I have to just meet this person." 'Cause no, there's, there's books and there's thinkers that you encounter in life where you go, "Who is this person, and how are they so magical in, in the way they approach things?" Yeah, absolutely.

Speaker 57:24 Or crazy. [laughs]

Trevor Noah 57:24 Because ... No, but crazy in a good way. Can I- Who takes naps- Yeah, with you ... at

Trevor Noah 57:30 noon. [laughs] He's a noon napper.

Speaker 57:32 Fair comment.

Trevor Noah 57:33 He's a noon napper. He's a noon napper. [laughs] But, like, there's, there's a part of the book where, man, I was, I was so impressed and, like, just, like, taken by how you stitched together even civil rights in, in American healthcare-

Speaker 57:46 Hmm

Trevor Noah 57:46 ... and the way we think about how it's doled out and not doled out. Because you see, again, I, I didn't know, and I would have never known how you can trace dialysis and Medicare and who gets treatment and who doesn't get treatment-

Speaker 57:59 Hmm

Trevor Noah 58:00 ... back to segregation and desegregation- No way ... in the United States. No, literally. Uh, I mean-

Speaker 58:04 Yeah

Trevor Noah 58:04 ... talk a little bit about that because it's, it's ... That blew my mind. I was just like, oh, man, we, we, we really have to think holistically, and sometimes I don't think our brains are big enough.

Speaker 58:12 No, I ... Yeah. It, one of the most shocking things in my research for this book was the way in which dialysis impact, um, impacts disproportionately Black and brown communities. Um, if you're Black in America, you're 13% of the population, but you're 35% of the, um, end-stage renal disease or f- kidney failure population.

Trevor Noah 58:34 Wow.

Speaker 58:34 You're m- four times more likely to get dialysis than if you're white. And, and it's this death by ZIP code r- redlining-

Trevor Noah 58:42 Wow

Speaker 58:42 ... you know, that, that I've gradually begun to see. I mean, dialysis is a perfect map for it, but there are many other, uh, diseases that, you know, the incidence of, of hypertension, diabetes, um, and, and obesity, the way in which these communities historically the wrong side of the tracks-

Trevor Noah 59:00 Yeah

Speaker 59:00 ... and I mean that literally. I'm working in, um, I'm working in South Chicago, um, where there's a disparity in life, uh, in, in longevity in between North and South Chicago of 30.1 years.

Trevor Noah 59:13 In the same city. 30 years.

Speaker 59:13 30 years in the same city, 30 years. If you're in North Chicago, the wealthy areas, you live 30 years longer, 30.1 years longer than in South Chicago.

Trevor Noah 59:21 That's insane.

Speaker 59:22 It is insane. It is utterly, utterly unacceptable, and it has been going on. I mean, a- as one, um, uh, Magellan Hanford, one of my great, um, dialysis nurses who was formerly an LAPD officer, as he said, "It's got Jim Crow written all over it."

Trevor Noah 59:40 Yeah. Mm.

Speaker 59:40 This is absolutely, if you look at the maps of the impact of, of dialysis on communities, and that's kind of what I'm doing now. This book, I couldn't walk away from the book.

Trevor Noah 59:49 Mm.

Speaker 59:49 As usually with i- with, with books, um, you know, I, I write it, I care about it, but six months before it comes out, I'm thinking, "What, what's next?" I don't have any next. This is next.

Speaker 1:00:00 Um, so I've gotten together with, um, folks at the, um, at the new school, the, uh, Institute for Race, Power, and Political Economy, and we're doing some research on, on these areas in, in Chicago, South Chicago, and East LA, um, Boyle Heights, where the impact of dialysis is disproportionate. Trying to understand not just on, on individuals what bad dialysis does, but what does it do to a community? How do they start to see dialysis as sort of a-

Trevor Noah 1:00:31 Yeah

Speaker 1:00:31 ... part of their life's arc, where you'll end up in the chair.

Trevor Noah 1:00:35 Hmm.

Speaker 1:00:35 Gran did. My uncle did. My kids are coming with me now to my treatments. They'll probably end up ... I mean, it's just-

Trevor Noah 1:00:41 That's, yeah

Speaker 1:00:42 ... it's nightmarish, and especially when there are solutions that are in hand, that are ... And, and, 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 But come back to your question. I mean, the, it is absolutely, dialysis in America is-

Eugene 1:00:59 Mm

Speaker 1:00:59 ... absolutely perfect, um, radiograph CT scan of what's wrong with racialized structural racism in America.

Eugene 1:01:07 Yeah.

Speaker 1:01:08 It is, it is the poster child of what can go wrong. Um, and it i- it, for me it's been quite a, I mean, a kind of a rediscovery of what America is.

Eugene 1:01:16 Wow.

Speaker 1:01:16 I'm going to places I haven't spent a lot of time in.

Eugene 1:01:18 I can imagine.

Speaker 1:01:19 And, um, and I understand what the wrong side of the tracks means now. I mean, I, in Chicago, you literally walk underneath the tracks and you're in a different world. Everyone's a different color.

Eugene 1:01:31 Yeah.

Speaker 1:01:31 I mean, literally in the space of, it's the most segregated city in the, in the country, but many, many, many areas are like that. And, uh, it's an, yeah, I'm rediscovering my homeland in a way that, uh, is deeply, deeply disturbing.

Eugene 1:01:44 We had an episode where we spoke to one of, one of the most interesting s- people we've spoken to in South Africa, Dan, and we spoke about the remnants of apartheid.

Speaker 1:01:54 Yeah.

Trevor Noah 1:01:55 Yeah.

Eugene 1:01:55 And what, what, what people who say, "It's been 30 years, it's time to move on now."

Speaker 1:01:59 Uh-huh.

Eugene 1:01:59 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-

Speaker 1:02:10 Uh-huh

Eugene 1:02:10 ... a white person."

Speaker 1:02:11 Yeah.

Eugene 1:02:11 And I said, "Here's a typical example. Malnutrition within the Black community-

Speaker 1:02:16 Ugh

Eugene 1:02:16 ... is such a, you might have groceries in your cupboard, but are they keeping you healthy?"

Speaker 1:02:21 Yeah.

Eugene 1:02:21 That is the question.

Speaker 1:02:22 Yeah.

Eugene 1:02:23 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.

Speaker 1:02:31 Mm-hmm.

Eugene 1:02:31 Then we went to a township school-

Speaker 1:02:33 Mm-hmm

Eugene 1:02:33 ... with only Black children, and we took a photo.

Speaker 1:02:36 Hmm.

Eugene 1:02:36 Right? That we just said, "You take this photo, take this photo." And then we compared the photos at the end of the day and we saw the sizes of the kids.

Speaker 1:02:43 Uh-huh. Yeah. Yeah, it's heartbreaking.

Eugene 1:02:45 And they were not even 40 minutes apart from each other.

Speaker 1:02:48 Right.

Eugene 1:02:48 What they ate, what they did. You even see it when they do, they've even stopped doing it now in South Africa-

Speaker 1:02:53 Hmm

Eugene 1:02:53 ... where they do inter schools.

Speaker 1:02:54 Oh.

Eugene 1:02:55 They never mix now schools that are doing well with schools that are not doing so well.

Speaker 1:02:59 Damn

Eugene 1:03:00 In doing sport, because it becomes so glaringly obvious-

Speaker 1:03:03 Uh

Eugene 1:03:03 ... that there's size differences, that there's nutrition differences, and also there's concentration differences.

Speaker 1:03:08 Oh, yeah.

Eugene 1:03:08 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, um, a program by the rugby club. The one thing that happened when all the township buses landed at the stadium or arrived at the stadium is all the township kids went to go queue for food.

Speaker 1:03:28 Hmm.

Trevor Noah 1:03:28 That's the first thing they did.

Eugene 1:03:29 First thing we, we did. Not they.

Speaker 1:03:31 Yeah. Oh, wow.

Eugene 1:03:31 I was part of the, the kids that were in the bus from the township school. This was one of the first things that we did. It was we left where we were, and the first thing we were like, "We're gonna eat something," because clearly it's not gonna be where we come from. And I'm thinking to myself-

Speaker 1:03:44 Hunger and malnutrition as a government, as a, as a-

Eugene 1:03:47 As a weapon

Speaker 1:03:47 ... government agenda or as a weapon, yeah. That's-

Eugene 1:03:49 Of o- of oppression

Speaker 1:03:50 ... oppression, yeah.

Eugene 1:03:50 And no, no one ever talks about that. And I always think whenever big companies expand and whenever corruption is going to take place, you can always see by how much hope they give to people about how many of them they'll employ.

Trevor Noah 1:04:02 Yeah.

Speaker 1:04:03 Yeah, that's right.

Trevor Noah 1:04:03 They love that.

Speaker 1:04:04 Yeah.

Trevor Noah 1:04:05 Bringing, bringing this many jobs, bringing ... Oh, they love that.

Speaker 1:04:07 Love the mining companies

Trevor Noah 1:04:08 Yeah, yeah. They love that.

Speaker 1:04:09 Yeah, they're really nice. Yeah. Aren't they great? Yeah.

Trevor Noah 1:04:10 Oh, no, they love that.

Speaker 1:04:11 Mm.

Eugene 1:04:11 Yes. Yes. In South Africa now, they're trying to clamp down on illegal mining, but the, they've discovered that the billions of rands in illegal gold lands in the mainstream.

Trevor Noah 1:04:21 Yeah. Because-

Eugene 1:04:21 Legally

Trevor Noah 1:04:21 ... because the gold needs to be sold into a market that is formalized. So at the end of the day, it, it, it all comes back.

Speaker 1:04:27 Back to the enablers.

Trevor Noah 1:04:28 Yeah. It all, it all, it all comes back in a loop.

Speaker 1:04:30 Mm-hmm.

Trevor Noah 1:04:30 And that's, that's why, and I, I'm glad you really give them the credit they deserve.

Eugene 1:04:35 Yeah.

Trevor Noah 1:04:35 That's why whistleblowers are so important.

Eugene 1:04:37 Yeah.

Speaker 1:04:37 Mm.

Trevor Noah 1:04:38 Like you-

Speaker 1:04:38 Oh

Trevor Noah 1:04:38 ... I mean, I know you've got a whole book on it.

Speaker 1:04:40 Yeah.

Trevor Noah 1:04:40 But without these people, you just don't know.

Speaker 1:04:44 No, exactly.

Trevor Noah 1:04:45 You lit- you literally just don't know. Without a whistleblower i- in FIFA, without a whistleblower in the banking system-

Eugene 1:04:51 Yeah

Trevor Noah 1:04:51 ... without a whistleblower in the healthcare industry, without a whistleblower in the defense contractors, without a whistleblow-

Speaker 1:04:56 Yeah

Trevor Noah 1:04:56 ... you just wouldn't know.

Speaker 1:04:58 And it's fascinating to see the, um, the organizational reaction to a whistleblower.

Trevor Noah 1:05:02 Oh, hell yeah.

Speaker 1:05:02 And it's like this immune response-

Eugene 1:05:04 Oh, hell yeah

Speaker 1:05:04 ... and the T-cells go out there.

Trevor Noah 1:05:06 Yeah.

Eugene 1:05:06 Fight the bacteria.

Speaker 1:05:06 They start, I mean, the people lose their minds.

Eugene 1:05:08 Yeah.

Speaker 1:05:08 They're so angry and so f- and frightened.

Eugene 1:05:10 Yeah.

Speaker 1:05:10 Because at the end of the day, what you said is exactly right, that those whistleblowers really do have the kryptonite.

Eugene 1:05:16 Yeah.

Speaker 1:05:16 The question is whether they'll be able to give the kryptonite to someone who can use it before they are rubbed out, literally or figuratively.

Eugene 1:05:22 Yeah, yeah.

Speaker 1:05:23 And, uh, but it is a really interesting thing to see this sort of organizational, people just, it's perfectly sane professional people go completely off their rocker, um, when a whistleblower stands up in their, in their, in their midst.

Eugene 1:05:36 But there's so ... You, you are making me realize there's so much power in words and phrasing.

Speaker 1:05:40 Mm.

Eugene 1:05:40 You started with a, w- with white collar crime, and now you even speaking about whistleblowers. When it's corporate, it's whistleblowing.

Trevor Noah 1:05:46 Yeah.

Speaker 1:05:47 Yeah.

Eugene 1:05:47 And when it's violent crimes, it's a-

Trevor Noah 1:05:49 Witness

Eugene 1:05:50 ... it's, n- n- no, besides, it's not a witness, it's a, it's an informant.

Speaker 1:05:53 Ah.

Trevor Noah 1:05:53 Oh, yeah, yeah, yeah.

Eugene 1:05:53 The person is bringing information.

Trevor Noah 1:05:55 That's interesting.

Speaker 1:05:56 Yes.

Trevor Noah 1:05:56 That's true.

Eugene 1:05:56 That could ultimately lead to something.

Speaker 1:05:57 Yeah, yeah.

Trevor Noah 1:05:58 Yeah.

Eugene 1:05:58 But when I'm telling the truth about how many

Eugene 1:06:00 people are losing lives and how much money [imitates whistle] .

Speaker 1:06:01 Yeah.

Eugene 1:06:02 What are you doing? Why are you blowing the [laughs]

Trevor Noah 1:06:03 [laughs]

Eugene 1:06:03 Who still blows a whistle?

Speaker 1:06:04 Exactly.

Eugene 1:06:04 Information is timeless.

Speaker 1:06:06 Yeah.

Eugene 1:06:06 But whistleblowing also makes, makes it feel like you shouldn't be doing it in the first place.

Trevor Noah 1:06:09 Yeah. It's a n-

Speaker 1:06:10 That's right

Trevor Noah 1:06:10 ... it has an annoying connotation to it if you are-

Eugene 1:06:11 Yes. Where did you find a whistle?

Trevor Noah 1:06:13 Yeah, that's right. Yeah.

Eugene 1:06:13 You had to have it first.

Trevor Noah 1:06:14 You look at a whistleblower-

Speaker 1:06:15 You're a snitch.

Eugene 1:06:15 Yeah. It's, it's got a ratty vibe

Speaker 1:06:17 ... you're a snitch sort of a, yeah. Exactly.

Trevor Noah 1:06:17 Whistleblower.

Eugene 1:06:18 And why are you blowing it?

Trevor Noah 1:06:19 Yeah, yeah.

Eugene 1:06:19 Why is everyone keeping their whistles quiet? And-

Speaker 1:06:22 Yeah

Eugene 1:06:22 ... there's, and there's always in whistleblowing, there's never plurality.

Speaker 1:06:26 No. No, no. That's right. The individual-

Eugene 1:06:27 A lone jewel standing on its own

Speaker 1:06:29 ... standing up. Yeah.

Eugene 1:06:29 Yes. It's always the shunned person who will generate as much noise as possible.

Trevor Noah 1:06:34 Edward Snowden.

Eugene 1:06:35 Snowden.

Trevor Noah 1:06:35 Yeah, yeah.

Eugene 1:06:35 Yes.

Speaker 1:06:35 Yeah.

Eugene 1:06:35 But if you get rid of them, you almost feel like you've gotten rid of the problem.

Speaker 1:06:39 Yeah.

Eugene 1:06:39 Right?

Speaker 1:06:39 Exactly.

Eugene 1:06:40 There's n- never-

Speaker 1:06:40 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 the message. Quite often-

Eugene 1:06:51 Yeah

Speaker 1:06:52 ... a, you know, a corporate informer will say th- there's a trillion dollars in fraud here, or they've been dumping arsenic into the water, or the Bhopal or whatever. And so you can't actually say, "Well, actually not so much," or, "Not too many people were die- died." They, you go after the messenger, you totally destroy their credibility, you destroy them financially, you destroy their hou- their home life, you-

Trevor Noah 1:07:11 Yeah, yeah, yeah, yeah, yeah

Speaker 1:07:11 ... destabilize them psychologically. And all of a sudden they're just kind of a quirk or a disgruntled person. You can dismiss them. So that's the way, uh, 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 'Cause the person is right, the whistleblower is right.

Trevor Noah 1:07:28 Mm.

Speaker 1:07:28 You just destroy their credibility, and it goes away. And say, "Oh, you know, a disgruntled employee," you know? Someone who's deeply or, or just psychologically not stable. It's-

Trevor Noah 1:07:37 Yeah, but th- what, what they don't realize is they can only kill the messengers for so long, and then at some point-

Speaker 1:07:44 Mm

Trevor Noah 1:07:44 ... as we saw with Lui- Luigi Mangione, society turns around and goes, "All right, I guess I'm also gonna make my own rules." I'm not saying Luigi did or didn't do it.

Speaker 1:07:52 Yeah.

Trevor Noah 1:07:52 Disclaimer.

Speaker 1:07:52 Absolutely.

Trevor Noah 1:07:52 I'm just saying, like-

Speaker 1:07:53 Yeah

Trevor Noah 1:07:53 ... we saw in that trial in that case.

Speaker 1:07:55 Yeah, yeah.

Trevor Noah 1:07:56 Someone said, "You know what? I, I don't agree with this, and I realize that I cannot beat you in the game because you have created the rules."

Speaker 1:08:05 Precisely.

Trevor Noah 1:08:05 "So I will then play my game by a different set of rules."

Speaker 1:08:09 Precisely.

Trevor Noah 1:08:10 And y- you know, one of the reasons I think it's so important, w- we have these conversations where I, I try and talk to as many great authors as possible, particularly people who, who have done, like, all the real research.

Speaker 1:08:21 Yeah.

Trevor Noah 1:08:21 I always say this to Eugene. One of the things that, that I hate the most is how people w- will say something, they'll go like, "I'm gonna do my own research." And I'm like, "No, you're not."

Speaker 1:08:28 [laughs]

Trevor Noah 1:08:29 "You're not gonna do your own

Trevor Noah 1:08:30 research. You are going to go read an article that either affirms what you think or that-"

Speaker 1:08:34 Gonna read someone's research.

Trevor Noah 1:08:35 Yeah.

Speaker 1:08:36 Yeah.

Trevor Noah 1:08:36 You're gonna go read someone's, you're not gonna go do the research. And yes, you can argue on a, like a-

Speaker 1:08:40 My own truth

Trevor Noah 1:08:40 ... semantic level.

Speaker 1:08:41 Yes.

Trevor Noah 1:08:41 Yeah, on a semantic level, you can be like, "But that is research."

Speaker 1:08:43 Yeah.

Trevor Noah 1:08:43 No. No, no, no. No.

Speaker 1:08:45 It's-

Trevor Noah 1:08:45 I like to-

Speaker 1:08:45 ... cumulative effort

Trevor Noah 1:08:46 ... yeah, I like to read the, the work of people who have done the work. Do you get what I'm saying?

Speaker 1:08:50 Mm-hmm.

Trevor Noah 1:08:50 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.

Speaker 1:08:58 [laughs]

Trevor Noah 1:08:58 You know?

Speaker 1:08:58 No.

Trevor Noah 1:08:58 We can apply-

Speaker 1:08:59 You're not gonna run those experiments.

Trevor Noah 1:09:00 Exactly.

Speaker 1:09:00 Yeah.

Trevor Noah 1:09:00 Exactly.

Speaker 1:09:00 Cumulative process. Exactly.

Trevor Noah 1:09:02 You know what I mean?

Speaker 1:09:02 Yes.

Trevor Noah 1:09:02 But, but-

Speaker 1:09:03 Yeah

Trevor Noah 1:09:03 ... you know, but when, when I, when I, when I look at that situation where the UnitedHealth CEO was shot, and then even that, that story, there was, like, a weird one. You know, the, the, the gunman in Manhattan went into that tower.

Speaker 1:09:15 Oh, yeah, yeah, yeah.

Trevor Noah 1:09:16 Oh, yes. And then shot-

Speaker 1:09:17 Yes

Trevor Noah 1:09:17 ... and then they said, like, they said they sh- they were there to shoot the NFL person, but then they shot a, a, a person who was in, um, I think they were a CEO, or, or they, they headed up a division that was specifically tasked with housing.

Speaker 1:09:30 Oh.

Trevor Noah 1:09:31 But I also think-

Speaker 1:09:32 Housing is-

Trevor Noah 1:09:32 And everyone was like, "Well, wait, wait, wait, this is weird. You're saying they went there to shoot someone in the NFL?" "Yes." "But they shot somebody who a lot of people don't like?" "Yes." "Did they shoot anyone else?" "Not really."

Speaker 1:09:43 [laughs]

Trevor Noah 1:09:43 "And you're sure they were going for that?"

Speaker 1:09:44 What a coincidence.

Trevor Noah 1:09:44 Yeah. And you're like, "W- wait."

Speaker 1:09:46 Mm.

Trevor Noah 1:09:46 A- and, and what I found most interesting is, l- just off the, the Luigi Mangione story, what I found most interesting, and I'm not naive about this, is how the news and how these healthcare CEOs and all the CEOs in general came out on TV and they're like, "I, why would people be celebrating this? Why, why?" Then I was like, wait, wait, I'm not condoning any of this.

Speaker 1:10:08 Yeah.

Trevor Noah 1:10:08 But you're shocked?

Speaker 1:10:10 Right.

Trevor Noah 1:10:10 You, you really don't know why people are cheering for this? You're really gonna act like you don't know why people are cheering for this?

Speaker 1:10:16 No, exactly.

Trevor Noah 1:10:18 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 on.

Speaker 1:10:25 Mm.

Trevor Noah 1:10:25 I was like, because the thing about the book is it expands, it dives deep, it gives you concrete understandings-

Speaker 1:10:34 Yeah

Trevor Noah 1:10:35 ... of what the situation is.

Speaker 1:10:36 Mm-hmm.

Trevor Noah 1:10:37 It's not glamorous.

Speaker 1:10:38 Mm-hmm.

Trevor Noah 1:10:38 It's not glossy. It's not quick. It's not snappy. It doesn't catch you really quickly.

Speaker 1:10:43 Yeah.

Trevor Noah 1:10:43 But what it, what, when you're done reading it, you really, really, really understand, and I, I, I, 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," and then Shein was selling T-shirts of Luigi Mangione's face, and then there's, like, a movie. Emma Stone's gonna be doing a movie about Luigi Ma. And then it just trickles out, and then, and then you just see new headlines, healthcare s- he- UnitedHealth buying this, UnitedHealth 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, how do you keep yourself going despi- I, I'm assuming you might be f- but m-

Trevor Noah 1:11:30 but I, but maybe I'm wrong.

Speaker 1:11:31 No, no, it's deeply frustrating and, and to see something with a sort of a lot of PR, um, potential, um, an, an opportunity, a crisis gone wasted, um, because you haven't changed the structure. You, you haven't-

Trevor Noah 1:11:44 Yeah

Speaker 1:11:44 ... basically asked the fundamental question, number one, are you really serious that you don't understand the, the outrage-

Trevor Noah 1:11:50 Yeah

Speaker 1:11:50 ... and the anger and the sense of, of, of powerlessness? And, and number two, are we really going to make sure that something called UnitedHealth Care is primarily focused on health and not primarily focused on their, you know-

Trevor Noah 1:12:03 Yeah

Speaker 1:12:03 ... share price?

Trevor Noah 1:12:04 Mm.

Speaker 1:12:04 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-

Trevor Noah 1:12:14 Yeah, yeah, yeah

Speaker 1:12:14 ... we should be focusing on our healthcare industry? Is it, is really an industry?" You know, these are bigger questions that never get raised, and I, I had my own sort of Luigi Mangione moment. I was cor- corresponding with ... I, since my book came out, I g- have, I had count- countless, um, contacts from people in the industry, and one of them was a young nephrologist, uh, Dr. Andre Aboua, who, um, was very, is and was very, very frustrated about the, um, about, about the misuse of dialysis by certain n- nephrologists that he named. Um, and, um, he sent me a lot of data. He, he showed me, um, he has a website, as a matter of fact, um, kidneykiller.com-

Trevor Noah 1:12:57 Mm

Speaker 1:12:58 ... um, which alleges the use of certain drugs to knock out, um, people's kidneys so they will be on dialysis sooner.

Trevor Noah 1:13:04 Oh, man.

Speaker 1:13:05 All sorts of stuff like that, and he, he wrote, we corresponded, uh, for three months, um, until January of this year, and then three days after his last email, which were data filled, really thoughtful.

Trevor Noah 1:13:18 Mm-hmm.

Speaker 1:13:18 He gets in a car. He drives from Miami to Terre Haute, Indiana. He attempts to, allegedly attempts to murder one of the nephrologists-

Trevor Noah 1:13:27 Wow

Speaker 1:13:27 ... that he had mentioned in his emails, um, and were, and was mentioned in other lawsuits Now I, of course, when I heard this I was horrified. Um, and I went through those emails a million times saying, "What could I have seen this coming?" I mean-

Eugene 1:13:42 Could I have missed-

Trevor Noah 1:13:43 Wow

Speaker 1:13:43 ... they were the absolute picture of data driven thoughtful measured.

Trevor Noah 1:13:48 Right. Yeah.

Speaker 1:13:48 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."

Trevor Noah 1:13:57 [sighs]

Speaker 1:13:57 And you know, it's a horrifying thing to,

Speaker 1:14:00 uh, to, to, to be in the middle of it. But I think the, that sense, as you said, Trevor, of pointlessness, of sense of hopelessness and of powerlessness to stop, um, and just the, just the obscenity of a situation of, uh, the Luigi Mangione situation where you have one person who un- well, 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, um, 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-

Trevor Noah 1:14:39 Yeah

Speaker 1:14:39 ... making an enormous am- making a killing, as I say-

Trevor Noah 1:14:41 Yes

Speaker 1:14:42 ... in the, on denying care as a form of taking people's lives, if we can't say it out loud-

Trevor Noah 1:14:50 Yeah

Speaker 1:14:51 ... we're not gonna get anywhere.

Trevor Noah 1:14:52 Yeah.

Eugene 1:14:52 Yeah.

Speaker 1:14:53 We're not gonna ever get anywhere. And if we can't say it out loud that making money doing that makes it worse, we're really not gonna get anywhere. And money may not be the root of all evil, the love of money, but it's a pretty good proxy until you find it. And we really need to get off the money drug, somehow find a way to s- to reorganize our view of how life should be led so that money isn't [laughs] the number one thing. And those folks can't come out and say, [gasps] "I'm shocked, shocked. I can never condone violent acts against..." But yes, we have two people, and how many, again, how many people has the major healthcare, um, CEO-

Trevor Noah 1:15:31 CEO, yeah

Speaker 1:15:31 ... um, accounted for in his long career?

Trevor Noah 1:15:34 Yeah, but, uh, it's, it's, it's that old line, right? Um, if you owe the bank $1,000, it's your problem. If you owe the bank a billion dollars, it's the bank's problem.

Speaker 1:15:44 [laughs]

Trevor Noah 1:15:45 If you do something on a big enough scale.

Eugene 1:15:46 Yeah, our problem now is-

Speaker 1:15:46 I was thinking of Voltaire, the, you know, murder to the sound of trumpets thou- by the thousands-

Trevor Noah 1:15:51 Yes

Speaker 1:15:51 ... is called, is good.

Trevor Noah 1:15:52 Yeah, exactly.

Speaker 1:15:52 One murder is n- unacceptable.

Trevor Noah 1:15:54 Yeah. There's a, there's a weird thing that happens in society where if you get the scale great enough-

Speaker 1:15:58 Yeah

Trevor Noah 1:15:59 ... it's somehow not seen as the same issue multiplied-

Speaker 1:16:02 Yeah

Trevor Noah 1:16:03 ... when, when in fact it is. And, and-

Speaker 1:16:04 What is this, Stalin's? One murder's a tragedy, a million is a statistic.

Trevor Noah 1:16:08 Yes, exactly.

Speaker 1:16:09 Oof.

Trevor Noah 1:16:09 But that's, that's exactly what it is. And, and, and to your point, accountability is also doled out differently.

Speaker 1:16:14 Oh, yeah.

Trevor Noah 1:16:15 Right? Because-

Speaker 1:16:15 That's right

Trevor Noah 1:16:16 ... if Luigi Mangione-

Speaker 1:16:16 Blue collar, white collar.

Trevor Noah 1:16:17 Yeah.

Speaker 1:16:17 There it is.

Trevor Noah 1:16:18 Yeah.

Eugene 1:16:18 Yeah.

Trevor Noah 1:16:18 If Luigi Mangione is found guilty, he's gone, gone, for gone, for gone.

Speaker 1:16:21 I know.

Trevor Noah 1:16:21 Like life, death, what- like gone, gone, right?

Speaker 1:16:25 Yeah. Yeah.

Trevor Noah 1:16:25 Not if, when healthcare CEOs and their companies are found guilty,

Trevor Noah 1:16:30 there's no life sentence.

Eugene 1:16:32 Right.

Speaker 1:16:32 Check.

Trevor Noah 1:16:32 There's no death sentence.

Eugene 1:16:34 Nope.

Trevor Noah 1:16:34 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.

Speaker 1:16:47 Than all criminal organizations. [laughs]

Trevor Noah 1:16:48 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.

Speaker 1:17:04 Hm.

Trevor Noah 1:17:06 The Sackler family, they didn't even lose all their wealth. Like just, just think of this for a moment. Even if you said to me, "Okay, they're at zero. We took away everything. I know they're not in jail, but they're at zero." I'd go, it's still not fair, but-

Speaker 1:17:16 Hm

Trevor Noah 1:17:16 ... but they didn't even take all their wealth.

Eugene 1:17:19 Hm.

Trevor Noah 1:17:19 The people could still fly away in a helicopter. The pe- like my brain-

Speaker 1:17:23 Yeah

Trevor Noah 1:17:23 ... do you know what I mean? It's like wait, wait, wait, then are we living in a just society? And, 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.

Eugene 1:17:38 Yeah.

Speaker 1:17:38 Yeah.

Trevor Noah 1:17:39 You know what I mean?

Speaker 1:17:39 And we're seeing that more and more. I mean, the violent acts are because the, the safety valve is clogged-

Trevor Noah 1:17:44 Yeah

Speaker 1:17:44 ... and we're blowing gas.

Trevor Noah 1:17:45 You're like why would you, why would you not see this? Do you not see that this is gonna blow back on you? [upbeat music] We're gonna continue this conversation right after this short break. [upbeat music]

Eugene 1:18:04 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.

Trevor Noah 1:18:19 Yeah, yeah, yeah.

Eugene 1:18:19 But if you think about it before, when people trusted a government more, they would buy government bonds.

Speaker 1:18:24 Yeah.

Eugene 1:18:24 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

Eugene 1:18:30 people that make the legislation, which is the guardrails that are supposed to keep people safe, now go into private business. They get rid of the guardrails, but they still keep the government bonds, uh, system by saying you're selling people shares.

Speaker 1:18:41 Hm.

Eugene 1:18:41 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 nonna would come and complain and-

Trevor Noah 1:18:50 Yeah, yeah

Eugene 1:18:51 ... Don Corleone will take care of it. Everyone is wetting their beak.

Trevor Noah 1:18:54 Hm.

Speaker 1:18:55 Hm.

Trevor Noah 1:18:55 Yeah, yeah, yeah.

Eugene 1:18:55 If you are betting online-

Trevor Noah 1:18:57 Yeah

Eugene 1:18:57 ... if you are buying shares-

Trevor Noah 1:18:58 Yeah

Eugene 1:18:58 ... 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.

Trevor Noah 1:19:08 Oh, yeah, yeah, yeah.

Eugene 1:19:08 And then they always give the stat of how many people haven't versus the how many people should. And all of a sudden I look at the drug companies different and I go, but if they care so much, they're here buying ads, but they're, are they advertising the product? Are they-

Speaker 1:19:21 Yeah

Eugene 1:19:21 ... do they really want you? Which lawyers must you call to do this thing?

Trevor Noah 1:19:23 Yeah, it's all, it all becomes-

Eugene 1:19:25 All, yes, everyone's beak is wet.

Speaker 1:19:27 Mm-hmm.

Eugene 1:19:28 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, right?

Speaker 1:19:34 And no one's looking after the little guy, us.

Eugene 1:19:37 Yeah.

Speaker 1:19:37 Right? And no one is looking at, the Consumer Financial Protection Bureau is cons- constantly the target of attacks, has been dis- dismantled. No one is out there saying, "Yeah, but what, what about, you know-

Trevor Noah 1:19:49 Yeah

Speaker 1:19:49 ... 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, in dialysis, but I see it everywhere, is the sense of the most vulnerable people are taking it in the neck.

Trevor Noah 1:20:02 Yeah.

Speaker 1:20:02 And everyone's sort of, "Oh, well, you know, they're sort of vulnerable. It's, maybe it's their fault."

Trevor Noah 1:20:06 Right.

Speaker 1:20:06 Who knows?

Trevor Noah 1:20:07 And blame the victim, yeah.

Speaker 1:20:09 Yeah.

Trevor Noah 1:20:09 Yeah. Medical aid companies do that all the time in our country. They'll co-opt you into going and using their app that monitors how many times you go to the gym.

Speaker 1:20:16 Yeah.

Trevor Noah 1:20:16 How much healthier you are.

Speaker 1:20:17 Uh.

Trevor Noah 1:20:17 But I'm like, "Since when are we being lectured about living our lives when your job is to improve our quality of life?"

Speaker 1:20:23 Yeah.

Trevor Noah 1:20:23 So now you've foisted me with the responsibility of not getting sick, while I pay you to keep me from getting sick.

Speaker 1:20:29 [laughs]

Trevor Noah 1:20:29 And that's why-

Speaker 1:20:29 And give you my data too, yeah

Trevor Noah 1:20:30 ... but that's why I was even saying that I think-

Speaker 1:20:32 Yeah

Trevor Noah 1:20:32 ... as society, especially if you have a platform and a megaphone, we must be very careful not to use our privilege as a way to lecture people who are hopeless.

Speaker 1:20:39 Right.

Trevor Noah 1:20:40 Hmm.

Speaker 1:20:40 Yeah. That's-

Trevor Noah 1:20:41 Right?

Speaker 1:20:41 That's right, yeah. Yeah, the lecturing part is very, is tr- tricky too, when you helicopter into these situations. I, um, I'm working in, in Boyle Heights in Los Angeles.

Trevor Noah 1:20:52 Mm-hmm.

Speaker 1:20:52 And, and it's in an area that's 95% Hispanic, and, uh, you know, I can't just sort of helicopter in and say, "Hi, guys. Uh, how's, how's dialysis working for you?"

Trevor Noah 1:21:00 Yeah, yeah, yeah, yeah.

Speaker 1:21:00 And, and by the way, there's a way to fix this. Um, so I, you know, I hook up with local organizations that, Homeboys I- Industries is the most, if you haven't been, you gotta go.

Trevor Noah 1:21:10 Okay.

Speaker 1:21:10 The coolest place-

Trevor Noah 1:21:11 Yeah

Speaker 1:21:12 ... I have maybe ever been, but certainly the most impressive. It's a gang rehabilitation organization. It 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,

Speaker 1:21:30 and it's in, uh, you know, Boyle Heights centric. Every business has to be in Boyle Heights. They have urban gardening, they have all kinds of other things. They have art, but they are actually taking the people who are most at risk.

Trevor Noah 1:21:43 Mm-hmm.

Speaker 1:21:44 So when I arrived-

Trevor Noah 1:21:45 Mm-hmm

Speaker 1:21:45 ... I mean, the people that everyone else fails-

Trevor Noah 1:21:47 Mm-hmm

Speaker 1:21:48 ... to do, and won't even take a chance at because-

Trevor Noah 1:21:50 Yeah

Speaker 1:21:50 ... their statistics might be s- skewed. When I arrived, um, I couldn't get anyone on the phone, but I wanted to talk with Father Gregory Boyle, and I wanted to talk with, um, you know, the head of, of, of research and so on. So I just arrived and sat down, and they have a wonderful homegirl cafe. I sat down, and, and I said, "I'd love to talk with Father Boyle and, and Mike Larán, and, and the other people." They go, "Oh, well, he's very busy today." And I said, "That's okay. I'll stay as long as is 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, and I really meant it. I had 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 came, and I went back. I, remember, this is gang rehabilitation.

Trevor Noah 1:22:36 Mm-hmm.

Speaker 1:22:36 These are some ser- the people with, like, tattoos-

Trevor Noah 1:22:39 Yeah, yeah, yeah

Speaker 1:22:39 ... over their faces and stuff. They read you in a heartbeat.

Trevor Noah 1:22:42 Yep.

Speaker 1:22:43 They can see. They know their territory.

Trevor Noah 1:22:45 Mm-hmm.

Speaker 1:22:45 They know who you are, and, and 20 minutes later, a couple guys came and sat down and had lunch, and, and one of them looked over each other, "Oh, that's the kidney guy, yeah." And so by, by the, by the third hour-

Trevor Noah 1:22:55 I can imagine

Speaker 1:22:56 ... I had already met with the people I needed to meet with.

Trevor Noah 1:22:58 Mm-hmm.

Speaker 1:22:58 And we are, we are off and running, but that feeling of l- 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 govern- uh, the federal government or the-

Trevor Noah 1:23:16 Hmm. Hmm

Speaker 1:23:16 ... let's do this in a community, is that's, I think, part of the system that we need to, uh, employ to get back on our feet as, as a country. But, uh, but that place is amazing, and that's, and that's the sort of street level, uh, person to person, um, 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-

Trevor Noah 1:23:40 Yeah

Speaker 1:23:40 ... who grew up there, who are really plugged in.

Trevor Noah 1:23:42 The people on the ground.

Speaker 1:23:42 Yeah.

Trevor Noah 1:23:43 You know what I realized, uh, reading your book and then meeting you, is you, you're that person from the movies.

Speaker 1:23:49 [laughs]

Trevor Noah 1:23:50 You know, you, you know those movies we used to watch? They don't really make them anymore.

Speaker 1:23:53 Mm-hmm.

Trevor Noah 1:23:53 But remember you'd watch these movies-

Speaker 1:23:54 That may be my problem. [laughs]

Trevor Noah 1:23:55 You'd watch these movies where there'd be, like, some random person. They'd be in, like, a, a suit

Trevor Noah 1:24:00 that doesn't really fit too well, and they've got their briefcase.

Speaker 1:24:03 Yes.

Trevor Noah 1:24:03 And then they go to, like, an office, and they'd be like, "Excuse me, I, I would like to meet the..." And they're like, "I'm sorry, he has no appointments." So it's like, "Okay, I'll, I'll just sit here." And then it's like, and then, like, two hours later, they're like, "Hey, he's not, he's not coming back." It's like, "It's fine. I'll just sit here." And I, I remember watching the movie, those movies.

Speaker 1:24:16 [laughs] Yes, exactly.

Trevor Noah 1:24:17 And I'd go, "There's no one like this."

Speaker 1:24:18 Yep. [laughs]

Trevor Noah 1:24:19 Now I've met one. You, you have a, like a, it's a dogged and insatiable attitude towards, like, finding the truth, the people-

Speaker 1:24:28 Mm-hmm

Trevor Noah 1:24:28 ... the, the, the story.

Speaker 1:24:29 Yeah.

Trevor Noah 1:24:29 It's, like, how, how... Is it, is it, is it conscience that's pushing you?

Speaker 1:24:33 Yeah.

Trevor Noah 1:24:33 Is it, like, what is, what's motivating you beyond, don't get me wrong.

Speaker 1:24:37 Yeah.

Trevor Noah 1:24:37 I mean, it, it is, it is a noble cause, but beyond that, like, what, what is, what is making you sit down for that long? What's making you go talk where people don't wanna talk? What ma- what's making you investigate unbeatable, quote-unquote, corporations?

Speaker 1:24:51 Hmm. Yeah, it's a really good question, and, um, 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.

Trevor Noah 1:25:02 Yeah.

Speaker 1:25:02 So you have a bully hypocrite-

Trevor Noah 1:25:04 Oh, yeah, that's the worst combination

Speaker 1:25:05 ... who's feeding you a line, that's the worst of the worst, and I run into that a lot in corporate America. So, um, 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, it can, I think, in, in a, in a pretty short space of time, you can turn something around

Speaker 1:25:30 by taking the small community view-

Trevor Noah 1:25:33 Yeah

Speaker 1:25:33 ... and building outwards, rather than trying to fix it-

Trevor Noah 1:25:35 Yeah

Speaker 1:25:35 ... with a blanket. Everything needs to change.

Trevor Noah 1:25:37 Yes.

Speaker 1:25:37 And, uh, and besides which, there is no blanket anymore, so, you know, might as well do it [laughs] in your own backyard, 'cause no one's gonna be looking out for it.

Trevor Noah 1:25:44 Yeah, but you've also done something that's pretty amazing, 'cause people would write books. People do, you, you, you know, it's, it's, it's so many stages. First of all, you hope someone will help you make the book.

Speaker 1:25:55 Mm.

Trevor Noah 1:25:56 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.

Speaker 1:26:03 Yeah.

Trevor Noah 1:26:04 But the hardest step after all of those hard steps is you hope it'll make a difference.

Speaker 1:26:09 Yeah, that's-

Trevor Noah 1:26:10 And, and there's something that happened with your book that is, a- again, it's like a Hollywood movie that you, you hope would be written. There's a moment where the FDA, the head of the FDA goes, "I, I wanna use your book to go after these two sinkhole companies that are, you know, scamming Americans-

Speaker 1:26:27 Yeah

Trevor Noah 1:26:28 ... for their healthcare-

Speaker 1:26:29 Mm-hmm

Trevor Noah 1:26:29 ... scamming the government essentially for all of the money that it's trying to provide to help people." And I think your book, if I remember correctly, got cited 21 times, and there was a lawsuit. What, what, what's the latest on that is, like, is, is this still moving forward? Are these companies still being held accountable? Because your book actually made a change on a level that people didn't think a change could be made.

Speaker 1:26:51 Well, it, it is work in progress. Nothing has been fixed yet. But I will say that, um, Marty Makary, who before he became FDA head, had read my book. When he became FDA head, he asked me for a memo. "How do you fix dialysis?"

Trevor Noah 1:27:04 Yeah. Wow.

Speaker 1:27:04 "Give it to me." Uh, and he said he's ex- he's, he's, uh, spread it around in, uh, to, to Dr. Oz and to, and to RFK and others, um, at the highest levels. Who knows what's gonna come of that, but at least they asked.

Trevor Noah 1:27:17 Mm-hmm.

Speaker 1:27:18 There has been a, a recent lawsuit, came out in May, um, alleging antitrust violations of all kinds.

Trevor Noah 1:27:23 Right. Yeah.

Speaker 1:27:23 They did cite my book 21 times and cited people I cited, another 15. Um, and

Speaker 1:27:30 they simply lay out, um, in my view, um, 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 moti- motion on this.

Trevor Noah 1:27:54 Mm.

Speaker 1:27:54 And there is a sense, I think, and I've r- received thousands of emails from people inside, um, the industry, whether they're patients or families or whatever, and I would say it's bipartisan. There is a sense of enough is enough.

Trevor Noah 1:28:07 Yeah.

Speaker 1:28:07 And some of them are Trumpists.

Trevor Noah 1:28:09 It's health.

Speaker 1:28:09 Some of them are, some of them are voted for Kamala Harris. Some of them, who knows, they didn't vote.

Trevor Noah 1:28:13 Yeah, it doesn't matter.

Speaker 1:28:13 They, it, it's health.

Trevor Noah 1:28:14 Mm. Yeah. It's health.

Speaker 1:28:14 It is a fundamental thing that goes beyond politics and-

Trevor Noah 1:28:17 Your kidneys don't vote, bro.

Speaker 1:28:18 [laughs]

Trevor Noah 1:28:20 [laughs] They don't. You know what I mean?

Speaker 1:28:22 They do not.

Trevor Noah 1:28:23 [laughs]

Speaker 1:28:23 They just ... And, and those babies call-

Trevor Noah 1:28:25 I didn't see that one coming. [laughs]

Speaker 1:28:25 I've never had such a warm and fuzzy feeling for my kidneys.

Trevor Noah 1:28:28 Yeah.

Speaker 1:28:28 You don't think about your kidneys, right?

Trevor Noah 1:28:29 Yeah, man. Your kidneys don't vote.

Speaker 1:28:30 They are the or- they are the, they are the conductor of the whole orchestra of your body. Without those kidneys, you know. People wanna talk about renal fortitude. They talk about guts and brains and heart.

Trevor Noah 1:28:39 Yeah.

Speaker 1:28:39 But they don't talk about kidney power. [laughs] They should. They should.

Trevor Noah 1:28:43 Yeah.

Speaker 1:28:43 Renal fortitude.

Trevor Noah 1:28:43 It's one part of you.

Speaker 1:28:44 Yeah.

Trevor Noah 1:28:44 Y- you know the analogy I use? There, there was someone I was, 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, I don't think you should get, the government shouldn't get involved in what's happening here, and I think private companies..." And, and I was trying to figure this out because I was like, "Wait. Okay, how would I ex- how would I explain this?" And I struck, and then, and then it struck me. I went, "I would never deny that there are many private companies that have done an amazing job providing us with products that we love and use." We're using a bunch of them now, right? But there are certain aspects of life where you have to ask yourself, "Who should be in charge of this?"

Speaker 1:29:23 Hmm. Yeah.

Trevor Noah 1:29:24 And the reason you need to ask yourself is because of the ramifications on the other side.

Speaker 1:29:30 Yeah.

Trevor Noah 1:29:30 Right?

Speaker 1:29:31 Mm-hmm.

Trevor Noah 1:29:31 If a private company's in charge of making these microphones, and then they don't make them, I guess we'll talk without microphones. You know what I mean?

Speaker 1:29:39 Mm-hmm.

Trevor Noah 1:29:39 It's inconvenient.

Speaker 1:29:40 Mm-hmm.

Trevor Noah 1:29:41 But we'll have to find another way.

Speaker 1:29:42 Mm-hmm.

Trevor Noah 1:29:44 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?

Speaker 1:29:51 Yeah.

Trevor Noah 1:29:51 And then someone will go, "Oh, but who says government..." You know, then I'm, a- again, I come back to this. Remember what a government is supposed to be, is the collective force of the people.

Speaker 1:29:58 Yeah. Common good.

Trevor Noah 1:29:59 Yeah.

Trevor Noah 1:30:00 We've made it seem like it's this foreign entity. No, no, no.

Speaker 1:30:01 Yeah.

Trevor Noah 1:30:02 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.

Speaker 1:30:10 Yeah.

Trevor Noah 1:30:11 You go get us drinks, and then you hold them accountable and be like, "Yo, where's my drink?"

Speaker 1:30:14 Mm-hmm.

Trevor Noah 1:30:14 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."

Speaker 1:30:22 Hmm. He took my money.

Trevor Noah 1:30:23 Yeah. It's just like, no, no. This isn't-

Speaker 1:30:24 Hmm, took my money.

Trevor Noah 1:30:25 Yeah. It's like, took my money. Yeah, yeah, but was supposed to take your money to buy you the drink-

Speaker 1:30:29 Get a drink. Yeah

Trevor Noah 1:30:29 ... that you wanted them to buy.

Speaker 1:30:30 Yeah.

Trevor Noah 1:30:30 And when you think about, like, healthcare and these types of industries, I keep, I keep thinking, and this was the analogy I used with this person. I said, "So you think it's fine?" They're like, "Yeah. Well, they made money. They found a way to make money on these things." I said, "Okay. 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?"

Speaker 1:30:53 Hmm.

Trevor Noah 1:30:54 "And you lived next door to me. If I sucked the oxygen out of the air, you know there's no law that, like, stops this right now, right?"

Speaker 1:31:02 Hmm. Hmm.

Trevor Noah 1:31:03 "And now I say to you, 'Oh, no, no, no, no, no. Please, I'm not saying you shouldn't breathe. I'm just saying you should pay me to breathe.'"

Speaker 1:31:09 Hmm.

Trevor Noah 1:31:10 Would you accept that, and would you live in that society? Right now, even someone would be like, "That's a crazy, that's a, that's a ridiculous analogy." Is it though?

Speaker 1:31:19 You know, AI, what's happening with AI right now, it's sucking the oxygen out of our- [laughs]

Trevor Noah 1:31:23 If somebody, if somebody has a machine-

Speaker 1:31:25 Yeah

Trevor Noah 1:31:26 ... 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 no- And the, how is it any different?

Speaker 1:31:41 I think you said the key word there, convince. I think we've had, we, we have a lot of whistleblowers. We have a lot of researchers. But I think the fight back from these corporations and these companies and these institutions is how much they invest in marketing.

Trevor Noah 1:31:54 Yeah, they do.

Speaker 1:31:55 And the language-

Trevor Noah 1:31:56 You're not wrong. Yeah

Speaker 1:31:56 ... that they put out there.

Trevor Noah 1:31:57 You're not wrong.

Speaker 1:31:58 For example-

Trevor Noah 1:31:58 Right

Speaker 1:31:59 ... I, I, I think even body

Speaker 1:32:00 organs are not given priority based on what the, the language, the common colloquial language is for that, for that organ. For example, a kidney.

Trevor Noah 1:32:07 Hmm.

Speaker 1:32:08 As essential as it is-

Trevor Noah 1:32:09 Marketing and language has made it seem like you can do without it.

Speaker 1:32:13 Yeah.

Eugene 1:32:13 Damn.

Trevor Noah 1:32:13 And also, marketing has also made it feel like it's something that someone will give begrudgingly if you need to.

Eugene 1:32:19 [laughs]

Trevor Noah 1:32:19 But you'll still be fine with it.

Eugene 1:32:21 Yeah, a kidney transplant.

Speaker 1:32:23 Get a kidney transplant.

Eugene 1:32:23 Yeah.

Trevor Noah 1:32:23 Get a kid-

Eugene 1:32:24 Oh, man

Trevor Noah 1:32:24 ... the, the, the doctor's not called a k-

Eugene 1:32:26 Yeah, two of them

Trevor Noah 1:32:26 ... kidney-ologist.

Eugene 1:32:27 Yeah.

Speaker 1:32:28 Yeah, yeah, yeah.

Trevor Noah 1:32:28 They're a nephrologist. So-

Eugene 1:32:29 That's interesting

Trevor Noah 1:32:29 ... it, there's also this-

Eugene 1:32:30 Yeah

Trevor Noah 1:32:31 ... shroud of mystery that's put around things. And sometimes-

Eugene 1:32:35 Yeah

Trevor Noah 1:32:35 ... if it's not mysterious, it's trivialized.

Eugene 1:32:37 Yeah.

Trevor Noah 1:32:37 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.

Eugene 1:32:44 War, yeah.

Trevor Noah 1:32:44 And I say to people-

Eugene 1:32:45 Yeah

Trevor Noah 1:32:45 ... whenever they talk to me about self-defense, I'm like, "Why don't you maybe go to a self-offense class?"

Eugene 1:32:50 Yes. [laughs]

Trevor Noah 1:32:51 Because that will help you more.

Eugene 1:32:53 Hmm.

Speaker 1:32:53 Right.

Trevor Noah 1:32:53 Because self defense means we're blocking, right?

Eugene 1:32:55 Yeah.

Trevor Noah 1:32:55 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, as prolific as it should be in people's lives, and people go, "When you talk about kidneys, I know what you're talking about."

Eugene 1:33:17 Yeah.

Trevor Noah 1:33:18 I mean, all of them, but it's like, it's, it's basically on us in these forums, essentially. That's what I feel like.

Eugene 1:33:22 Absolutely.

Speaker 1:33:22 Yeah.

Trevor Noah 1:33:22 Because there's no money in that mar- if we're honest, there's no money in that marketing.

Eugene 1:33:25 Yes.

Trevor Noah 1:33:25 You know what I mean? You're not gonna make money from that part of it.

Eugene 1:33:28 Yeah.

Trevor Noah 1:33:28 But, uh, the, man, the one thing I really love and I appreciate about your work, and that's why I really appreciate your time.

Eugene 1:33:34 Thank you, Trevor.

Trevor Noah 1:33:35 Not you.

Eugene 1:33:35 Oh. [laughs]

Trevor Noah 1:33:35 Not you. I do love your work, but not right now. One, one thing I appreciate about your work, uh, Tom, is like, is it, it reminds us-

Eugene 1:33:45 Hmm

Trevor Noah 1:33:45 ... 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 w- we don't know who will read the books.

Eugene 1:33:56 Mm-hmm.

Trevor Noah 1:33:56 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.

Eugene 1:34:02 Right.

Speaker 1:34:03 Wow.

Trevor Noah 1:34:03 Do, do you get what I'm saying?

Eugene 1:34:04 Yes, yes. Yes.

Trevor Noah 1:34:05 That's like such a crazy ... They, they were not in that position.

Eugene 1:34:08 Yeah.

Trevor Noah 1:34:08 They read your book, they go into that position.

Eugene 1:34:10 You put a message in a bottle.

Trevor Noah 1:34:11 No, and to your point, Eugene, it's like we take for granted what those messages, you know, where those messages land up.

Eugene 1:34:16 Mm-hmm.

Trevor Noah 1:34:17 Like, where those bottles wash up on shore, where they ... You know?

Speaker 1:34:20 Yeah. It's just that there's an urgency to this that gets me, keeps me awake at night. Because every time, you know, um, I, I took a lot of people's, the patients' stories, um, and convinced them to tell me their stories despite the fact that they were putting themselves at risk.

Trevor Noah 1:34:35 Yeah.

Speaker 1:34:35 I mean, there's a real risk of retaliation and-

Trevor Noah 1:34:37 Yeah

Speaker 1:34:38 ... and, and a couple of them used the same kind of language. They said, "Okay, I'll tell you my story."

Trevor Noah 1:34:42 Hmm.

Speaker 1:34:43 "But when I'm gone, you have to promise that this won't happen to somebody else."

Trevor Noah 1:34:48 Wow.

Speaker 1:34:49 And I, you know, you don't, it's not the kind of promise you make lightly.

Trevor Noah 1:34:52 Yeah.

Speaker 1:34:52 And it's not one I take lightly. Every day since we've been talking here-

Trevor Noah 1:34:56 Yeah

Speaker 1:34:56 ... people are in harm's way. This needs to stop, like yesterday. So that's kinda what, uh, at the s- at the same time, there are positive movements-

Trevor Noah 1:35:04 Yeah

Speaker 1:35:04 ... and positive, positive symptoms, and a very clear f- game plan for what needs to happen.

Trevor Noah 1:35:09 Right.

Speaker 1:35:10 It's, it's hard, but very clear 10 point plan. Um, there's an urgency here that just, uh, I can't let go of.

Trevor Noah 1:35:16 Does it make you interact with the healthcare industry on a personal level differently?

Speaker 1:35:21 It does.

Trevor Noah 1:35:22 Hmm.

Speaker 1:35:23 Yeah, it does. And, and, uh, yeah, with, um, with my brother who is, who is, uh, undergoing some real, real health challenges right now, I, uh, I see, [laughs] I see a lot of what I've reported on in a way that hits home, um, hits home very hard. So yeah, I mean, it's, it, we're all in this, and it's all up, 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-

Trevor Noah 1:35:52 Yeah

Speaker 1:35:53 ... the knight in shining armor-

Trevor Noah 1:35:54 Yeah

Speaker 1:35:54 ... is gonna arrive. The cavalry is not coming.

Trevor Noah 1:35:56 Yeah. You are, you are it.

Eugene 1:35:57 Yeah.

Speaker 1:35:57 Yeah. And, and, but we can.

Trevor Noah 1:35:59 Hmm.

Speaker 1:35:59 I mean,

Speaker 1:36:00 we definitely can, and I've seen, you know, these small groups and, and larger groups, People's Lobby in, in Chicago, and the Homeboys in-

Trevor Noah 1:36:08 Mm-hmm

Speaker 1:36:08 ... LA, and a bunch of others-

Trevor Noah 1:36:10 Hmm

Speaker 1:36:10 ... who are just saying, "Okay, let's just do this. You know? Let's just do this right here among us."

Trevor Noah 1:36:15 Yeah.

Speaker 1:36:15 And then we see how it goes. And, and I think that's kind of, that's kind of my model until [laughs] I see a better one.

Trevor Noah 1:36:21 Hey, man.

Speaker 1:36:21 Uh.

Trevor Noah 1:36:21 I'll tell you now, you, 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, uh, yeah, wherever we can help, let us know, man. It's, it's-

Speaker 1:36:35 Thank you

Trevor Noah 1:36:36 ... it's really worth, worthwhile. Thank you for taking the time.

Speaker 1:36:38 Thank you very much, Trevor and Eugene. It's been a pleasure.

Trevor Noah 1:36:42 This was really great, man.

Speaker 1:36:43 Okay.

Trevor Noah 1:36:43 Thank you so much.

Eugene 1:36:44 Tom.

Trevor Noah 1:36:44 For real, man.

Speaker 1:36:47 Thanks.

Trevor Noah 1:36:48 Oof. We've gotta stay in touch.

Eugene 1:36:49 Sorry about your brother.

Speaker 1:36:50 Yeah.

Trevor Noah 1:36:51 Yeah.

Speaker 1:36:51 Yeah, it's tough.

Trevor Noah 1:36:52 Yeah.

Speaker 1:36:52 It's tough.

Trevor Noah 1:36:52 Sorry about your brother.

Speaker 1:36:54 It happens, but you don't think it's gonna happen.

Trevor Noah 1:36:56 Yeah, no, but-

Speaker 1:36:57 Until it happens. Yeah

Trevor Noah 1:36:57 ... but can I, but can I tell you, it's, um, you know, my mom is more prophetic i- in the family, but she would say something to the effect of, "We don't know what wars life is preparing us to fight."

Speaker 1:37:12 Hmm.

Eugene 1:37:13 Right.

Trevor Noah 1:37:13 "We just experience the battles."

Speaker 1:37:15 Hmm.

Trevor Noah 1:37:16 You know? And I, I almost feel like in a, in a, in a, in a weird way it's, it's almost come around where you go like, damn. You're the, you, it, it's, it's, it's put you in the front seat to fight the thing that you're already fighting in an even more-

Eugene 1:37:31 Yeah

Trevor Noah 1:37:32 ... energizing way.

Eugene 1:37:33 Yeah.

Speaker 1:37:33 It's true. Yeah.

Trevor Noah 1:37:34 You already had perspective. You needed urgency.

Speaker 1:37:36 Yeah, that's right.

Trevor Noah 1:37:37 Yeah.

Speaker 1:37:37 That's exactly right.

Trevor Noah 1:37:38 That's a, that's a, that's a more eloquent way to say it. 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. Thank you so much for watching the episode. If you enjoyed it, pass it on to a friend. If you didn't enjoy it, pass it on to your friend still. Let them suffer for a change. And don't forget to engage with us in the comments. Uh, if you wanna, uh, suggest a guest, maybe there's questions you want, maybe there's ideas that you have, you can chat to us. We will read through the comments and we'll get into it. Either way, I appreciate you taking the time. Thank you for hanging out with us on What Now? And remember, we do this for you, so we would like to hear from you. Till next time. Thank you.