[TV static drones]
[bright tone]
[upbeat rock music]
♪ ♪
[cheers and applause]
- Welcome, welcome, welcome to "Last Week Tonight."
I'm John Oliver.
Thank you so much for joining us.
And let us begin with the biggest story of the week,
which once again concerns President Trump,
two words that continue to sound revolting together
like "viscous discharge" or "moist stockings."
The president made news on Tuesday
with a startling decision.
- Breaking news: President Trump has just fired
the embattled FBI director James Comey.
- Surprise, everyone!
Do you remember normal weeks? 'Cause I don't.
I don't remember what they felt like.
Everything about Comey's firing was unusual,
from the fact that he himself found out about it from TV
to the termination letter, which was genuinely weird,
and not just because it featured Trump's signature
which looks like a heart rate monitor
of a hamster on meth.
It really does.
It looks more like that
than it looks like his name.
But--but it was weird because of this.
- Trump firing Comey in a bizarre letter stating...
- Okay, it is just inherently suspicious
to try and put words in Comey's mouth
as you kick him out the door.
That--that is the equivalent of a breakup text reading,
"Which I greatly appreciate you informing me
"on three separate occasions
"that I was the most enthusiastic, dexterous,
"and intuitive lover you ever had,
"I nevertheless must terminate your position
as my girlfriend."
Eggplant emoji.
And--and it kept going,
because the White House spent the week
emitting a series of confusing and contradictory explanations
claiming that Trump was following the recommendation
of his Deputy Attorney General Rod Rosenstein,
who had barely been in office two weeks,
and that he was acting on behalf of a demoralized FBI,
neither of which seemed entirely plausible.
And Trump blew up the whole narrative anyway
on Thursday when he sat down with Lester Holt
and undid two days of damage control
in just a few sentences.
- Monday you met with the Deputy Attorney General,
Rod Rosen--Rosenstein--
- Right.
- Did you ask for a recommendation?
- Uh, what I did is, I was going to fire Comey.
My decision. It was not--
- You had made the decision before they came in the room?
- I was going to fire Comey.
- Now, think about what just happened there.
Trump is so desperate to appear dominant,
he will rush to take the credit for anything,
no matter how bad it is.
If you wanted him to confess to murder,
all a lawyer would have to say is, "Your Honor,
"the killer could not possibly have been Donald Trump.
"It must have been someone much stronger
and smarter, with a much hotter daughter."
And before they finish that sentence,
Trump would be yelling, "I did it, it was me!
Lock me up! Lock me up! Lock me up!"
But--but Trump didn't just clarify who advised him
to fire Comey.
And quick recap, it was a mirror.
He also--he also indicated one reason why he did it.
- And in fact, when I decided to just do it, I said to myself--
I said, "You know...
"This Russia thing with Trump and Russia
"is a made-up story.
"It's an excuse by the Democrats
"for having lost an election
that they should have won."
- What are you doing?
"I was thinking of the Russia investigation
when I fired Comey" is the one thing
that you are not supposed to say out loud.
It's the kind of response that makes you ask three questions:
one, can he really be this stupid?
Two, does he really think we as a country are this stupid?
And three, are we as a country this stupid?
And it's entirely possible the answer to all three questions
are "yes."
And it got even worse
as Lester Holt asked Trump about his claim
that Comey had exonerated him three times.
- He said it once at dinner,
and then he said it twice during phone calls.
- Did you call him?
- Uh, in one case I called him; in one case he called me.
- And did you ask, "Am I under investigation?"
- I actually asked him, yes.
I said...
"If it's possible, would you let me know,
am I under investigation?"
He said, "You are not under investigation."
- I call bullshit.
I call turbo bullshit on that.
There is no way those conversations
went down in that manner.
Trump has somehow managed to be both a terrible
and an amazing liar,
and I don't know how that's physically possible.
And sure enough, Comey's far more plausible version
of the dinner Trump mentioned soon made its way to the press.
- Comey told associates that at dinner,
the president asked if he would pledge his loyalty.
Comey declined,
instead telling the president he would always be honest.
The president asked two more times,
and Comey refused again.
The third time, Mr. Trump asked for "honest loyalty."
To that, Comey responded...
- To which Mr. Trump said, "How about loyal honesty?"
And then Mr. Comey said,
"Well, how's that different from honesty loyalty?"
And then Mr. Trump said,
"If you don't see what difference it makes,
just agree to it."
And then Mr. Comey said, "No way,"
to which Mr. Trump replied,
"Why not? Scared?",
prompting Mr. Comey to respond,
"Idiot says what?",
to which Mr. Trump replied,
"What?"
And then Comey's soul left his body,
walked out of the room,
turning back to him and saying,
"Are you coming?
Because frankly, I'm done with this shit."
Now, Trump unsurprisingly denied Comey's account.
And then on Friday morning,
he tweeted something ominous even by his standards.
- The breaking news this morning:
the President of the United States just threatened the man
he fired as FBI director.
- In an extraordinary tweet today, Trump warned...
- Tweets like that are actually really difficult to parse,
because they are somehow both
a borderline obstruction of justice
and the meaningless rantings of a confused old idiot.
They exist in two opposite states simultaneously.
Trump is truly a Schrodinger's Asshole.
And--and I will say this.
If he is recording everything that happens in the Oval Office,
I actually don't want to hear those tapes,
'cause I'm assuming it's just his voice
muttering the sentence,
"I never wanted any of this" over and over again,
occasionally interrupted by mattress commercial jingles
and string cheese farts.
So--so at this point,
President Trump has made it very clear,
he fired the director of the FBI
at least partially due to unhappiness
with the Bureau's investigation
into his campaign's possible collusion with Russia,
which is both shocking and yet completely unsurprising.
There is really nothing Trump could do
to genuinely shock me right now.
If--if you said he fired Comey
because he's investigating Russia, I'd believe you.
If you said he did it because Comey is 6'8"
and Trump feels like a tiny little man standing next to him,
I would believe you.
If you said he fired Comey,
walked into the Oval Office,
spread peanut butter on his genitals,
brought in 35 squirrels and yelled,
"Buckle up, Daddy's brought dinner,"
I'd say "Sure, yeah. Sure, why not?"
That sounds like something
the President of the United States would do.
That's the world we live in now.
You know what?
It--it is too easy
to point at Trump being crazy.
That's what he does, that is not going to stop,
and it's going to be exhausting for everyone.
The important question is, what do the rest of us do?
And that brings us to Congress:
534 people less annoying than Ted Cruz
and also Ted Cruz.
Because it is time for each and every one of them
to pick a lane here.
They do have options.
Obviously, there are the investigations that
are currently ongoing.
Uh, but they could also, uh,
press Deputy AG Rod Rosenstein
to appoint a special counsel within the Justice Department.
But at the very, very least here,
they need to acknowledge that what has happened
is fucked up
and not continue to give non-answers
like the one Paul Ryan did
when asked about Trump's tape-recording threat.
- I've decided I'm not gonna comment
on the tweets of the day or the hour.
Uh, I haven't seen them all, to be candid with you.
Uh, look, the comment, I'm-- I'm sure some of you
probably want to ask this question as well,
um, no one's disputing the fact that the president
has the right to hire or fire an FBI director.
He made that decision; it's been made.
- Yeah, but that's not answering the question, is it?
That's just regurgitating what happened.
It's honestly incredible to watch a man
who spends 90 minutes every morning working out
refuse to show any strength whatsoever.
Apparently, no part of P90X targets the backbone.
And--and at town halls this week,
some members of Congress like Rod Blum from Iowa
have been in such deep denial,
they don't seem aware of how bad
what they're saying sounds.
- Will you support an independent investigation
into Trump and his campaign's purported ties to Russia?
- Not at the current time.
If Trump was guilty of something,
would he fire the FBI director?
'Cause that's a pretty-- that'd be a pretty dumb move.
- Yeah.
Yes, it would, Rod.
Yes.
And unless Plum has a disease
where he says genuine things in a sarcastic voice,
that was also a very stupid thing to say.
"Oh, yeah, right, unicorns are imaginary.
"And penises are where the pee comes from.
Whatever, idiot. Leave me alone."
The point is, the founding fathers created a system
of checks and balances to limit the power of the president,
but it only works if someone fucking checks or balances.
And if you don't,
it's no longer on Trump.
It's on you.
Because when you've got the presidential equivalent
of a five-year-old shitting on the salad bar
of a Ruby Tuesday's, at some point
you stop blaming the five-year-old,
and you start blaming the people who are not stopping him.
Stop that boy. That's what I'm saying.
Stop that boy now.
[cheers and applause]
Now, for now--move--moving on
to a quick update regarding New Zealand,
Wallaby Fuck Island.
Now, you may remember last week,
we talked about the historically stupid legal battle
involving that country's ruling National Party
being accused of ripping off the "8 Mile" song
"Lose Yourself" by Eminem,
or as they call him in New Zealand, Eemineem.
Our piece was actually brought to the attention
of New Zealand's prime minister Bill English,
uh, the very poorest man's Daniel Craig.
And it turns out he is not a fan.
- Have you seen the John Oliver piece
where he mocks, uh, the National Party
for allegedly ripping off Eminem?
- No, I haven't.
- Do you intend to watch-- watch it?
- Nah, no.
Yeah, for the sake of his audience, I hope it's funny.
Some of the stuff I've seen he does isn't very funny.
[audience oohs]
- You really want to do this, Bill?
[laughter and applause]
Is this really what you want?
Because need I remind you
that when your fellow party member
Steven Joyce got dick-smacked in the mouth
by a rubber floppy cock
and then suggested "someone send the gift over to John Oliver
so we can get it over with,"
we ended that show with a flying dildopalooza.
So careful, Bill, 'cause when it comes to Kiwis,
Johnny don't play.
And Bill English must know
that the moment he mentioned my name,
I was going to immediately find the stupidest,
most humiliating things about him that I could,
like this actual photo of Bill English
in a virtual reality headset,
which makes him look like a masturbating cyborg.
Or this indescribably lame video he made of his exercise routine.
- What?
You know, after seeing that,
I would give anything for Bill English
to make a sex tape.
"Well, I'm about to head in for what I call a penis-vagina,
"uh, where I penis the vagina bits
"and, uh, she vaginas the penis bits.
"Uh, this is the bit where I penis fast.
"And this is the bit where I penis slow.
Uh, stick around, this is gonna take a while."
But perhaps the worst thing Bill English
has ever been responsible for
is this recent Facebook post where he writes,
"Cooked dinner for the family last night.
Like if you agree with tinned spaghetti on pizza,"
with photos of fucking canned spaghetti
poured all over a revolting pizza he made.
And I think I speak on behalf of all humanity
when I say, no.
Hard no there, Bill.
I do not agree with canned spaghetti on a pizza,
because that is not a thing anybody should be doing.
A divorced dad cooking for his kids on the weekend
would not put canned spaghetti on a pizza.
The caterer for Chef Boyardee's funeral
would not put canned spaghetti on a pizza.
And let's not forget, Bill,
you also added pineapple to that abomination.
And that's not dinner.
That is--and this is true--
an actual hate crime.
What the fuck is your problem, Bill?
You made that to feed to your family?
To your children, Bill?
How are you not in prison right now?
The point is...
I'm sorry, the point is,
I am sorry if our show
is not to your liking, Bill English,
Prime Minister of New Zealand.
Although to be honest, judging from your pizza choices,
if I appeal to someone with your level of taste,
I'd be absolutely mortified.
And you know, it's times like these
that a lyric from the song "Lose Yourself"
comes to mind:
"Yo, his palms are sweaty, knees weak,
"arms are heavy.
"There's vomit on his sweater already.
Mom's spaghetti."
And the reason those lyrics come to mind is,
though I would honestly rather eat
Eminem's vomit spaghetti off his sweater
than canned spaghetti and pineapple
off one of your garbage pizzas, Bill.
[cheers and applause]
And now, this.
A pizza topped with Skittles, baking soda,
and condoms.
A pizza topped with Altoids and horse laxatives.
And you don't know which is which.
So good luck with that.
A pizza made by a purebred Golden Retriever.
Good boy.
A pizza topped with blueberries,
onions, and a printed-out copy
of the Wikipedia entry for "pizza."
And finally, a pizza topped with 25 Blu-Rays
of "8 Mile," because fuck you.
You filthy animal.
[playful music]
[cheers and applause]
- Moving on. Our main story tonight
is something that you're probably not expecting,
because we're going to talk about kidney dialysis.
And I know that right now you're probably getting ready
to push the button on your TV remote marked
"Dear God, Literally Anything Else."
But I promise you this is worth listening to,
because dialysis is not something
that everybody understands.
Just listen to one patient describe a conversation
that she had with her neighbor.
- I have a--the lady next door to me now,
she said to me, "Where do you go
three days a week?"
She knew the three days a week.
I said, "Why, are you writing a book, a mystery?"
I said, "I go to dialysis."
She said, "Oh, you're a drunk.
I thought you said you didn't drink."
I said, "If you don't get out of my face,
you will need a doctor."
- Wow.
If--if I was her neighbor,
I would not fuck with that lady.
What I would do is get out of her face,
go home, Google what dialysis is,
just to cool down the temperature
in that relationship.
And--and here is the answer to that.
Dialysis is basically where a machine acts as your kidneys
by taking blood out of your body, cleaning it,
and then returning it to you.
Think of it as a Brita pitcher for your blood,
which yes, is more disgusting than I needed to make it sound.
Dialysis can be a truly exhausting process.
Uh, you're typically sitting in a chair,
physically attached to a machine
for three four-hour sessions a week.
And Americans have been at increasing risk of needing it,
because chronic kidney disease
is the ninth leading cause of death
in the United States.
And while a lucky few manage to get transplants,
for many, dialysis is their only option to stay alive.
But interestingly here,
while America spends more, by some accounts,
than any other nation on dialysis care,
we have one of the industrialized world's
highest mortality rates.
So we're spending the most
to essentially get the least.
We're basically paying for a fully-loaded Lamborghini
and receiving a drunk donkey on roller skates.
This--this story, the story of dialysis,
is an amazing case study of good intentions
being thwarted by bad incentives,
poor oversight, and profiteering.
And one of the key characters in this story
is, incredibly, this guy.
- ♪ Just take those old records off the shelf ♪
♪ I sit and listen to 'em by myself ♪
♪ Today's music ain't got the same soul ♪
♪ I like that old time rock and roll ♪
- Now, if you are understandably thinking,
"Who is that man doing barefoot gymnastics to Bob Seger
"while dressed like the third saddest waiter
at a Medieval Times?"
Well, that is the CEO of DaVita Incorporated,
a for-profit kidney dialysis company,
and I promise we will get to that man in a moment.
But first, let me give you a sense of the history
of dialysis in this country,
'cause in the early years of, uh, the machines,
access to them was so limited,
one hospital had an actual death panel
to decide who would get to use them.
- Somebody has got to decide
who shall live and who shall die.
- Two or three were rejected, I think.
I don't know why.
Either for medical reasons
or psychological reasons
or just didn't have the $30,000.
- Mr. Duff, what happened to those who were turned down?
- They're dead.
- Oh, my God!
That man does not sugarcoat things.
"They're dead.
"Also, your pet only loves you 'cause you feed it,
"the tooth fairy is your father,
"and 30% of babies grow up to be assholes.
Good day to you, sir."
Now, in 1972, though,
something amazing happened.
Richard Nixon-- yes, Richard Nixon--
signed a bill into law which said that the government
would pay for dialysis for anyone who needed it,
which is really incredible.
Essentially, we have universal health care
in this country for one organ in the body.
It's--it's like your kidneys, and only your kidneys,
are Canadian.
"Oh, sorry there's two of us, eh.
Don't mean to take too much space up down here, eh."
That's a good accent, and I do not apologize for it.
Now--now, at the time-- that's a great accent.
Now, at--at the time that bill was passed,
it only covered around 10,000 patients.
But four decades later, thanks in part
to the rise of diabetes and high blood pressure,
nearly half a million people are undergoing dialysis.
That's a 46-fold rise.
46 folds!
Technically speaking, that is a pug's face worth of folds.
And--and as a result,
and this is true, treating end-stage kidney disease,
uh, takes up nearly 1% of the entire federal budget.
Just think about that for a second.
We devote 2% of the federal budget
to the Department of Education.
And that's the thing that helps you know
what a percent is.
And--and a vast industry has emerged to accommodate
all these patients.
There are around 7,000 outpatient dialysis clinics
in the country today.
And around 70%
are owned by just two big for-profit companies:
Fresenius and DaVita.
And let me be clear, there are significant issues
with both of them, but to understand this system,
tonight we're going to focus on DaVita.
Their CEO, Kent Thiry, is the showboating musketeer
that you saw earlier.
And he loves to inspire his employees at meetings.
He--he's also made grand entrances, uh, on a bicycle.
He's even ridden in on a horse.
And spare a thought for that horse there.
That--that is by far the most humiliating credit on its resume
and it did use to do porn,
so you have to bear that in mind.
Thiry is a former Bain & Company consultant
who managed to take DaVita from near-bankruptcy
to being valued today at $13 billion.
He's even been the subject of an admiring case study
taught at Harvard Business School,
which called his management style
"arguably eccentric,"
and you can see why.
He calls his company a "village,"
uh, his employees "teammates" or "citizens,"
and as for himself, well, he's got his own special title.
- This is K.T. here, your mayor
from the Casa Nueva in Colorado.
- Yes, you heard right.
He calls himself "the mayor,"
a title so ridiculous,
you may not have noticed
he's standing next to a fucking falcon.
[laughter]
That is the most humiliating thing
on that bird's resume,
and it used to do porn.
So, at this--at this point,
at this point, we should probably address
the whole weird musketeer thing.
It's an obsession that apparently stems
from the Leonardo DiCaprio movie
"The Man in the Iron Mask,"
which, yeah--which Thiry says inspired him to make
a "transformative life decision"
to take the DaVita job, which is already insane,
because this is a ridiculous movie to choose
as the basis for anything.
Let me give you just a small taste.
- If we must die...
let it be like this.
- One for all.
All for one.
[rousing music]
♪ ♪
- That--that remains
one of the weirdest decisions in moviemaking history.
"Hey, the world's biggest heartthrob
"at the peak of his popularity
"agreed to be in our movie.
"What should we do with him?
"Oh, I know, let's put him in a weird mask
"that covers his whole face
"and just have him stand there.
"I guarantee that teenage girls all across America
"are going to have that image on their bedroom walls.
He looks even hotter now."
Thiry even closes company meetings
quoting that movie.
- If we must dialyze, let it be like this.
One for all!
crowd: All for one!
- One for all!
crowd: All for one!
- One for all!
crowd: All for one!
- Damn straight. Have fun, good night.
[cheers and applause]
- ♪ Celebrate good times ♪
♪ Come on ♪
- Cool.
And--and look, here's the thing.
For shareholders, Thiry's techniques have worked.
DaVita posted nearly $800 million
in profit last year.
But the experience for patients can be different.
DaVita runs a pretty lean operation,
which the government allows.
The federal guidelines don't require clinics
to have a doctor onsite
at any given time,
which seems a little odd.
Uh, they also require that only one nurse be present
in the facility.
And a study has found that for-profit clinics
have about as third fewer nurses
than their non-profit competitors,
and that might explain why some DaVita patients
say they can feel like they're a product on a factory line.
- I have techs come up to me
and say, "Oh, that's enough dialysis."
"You done pulled off plenty."
So, a--a wager in my mind
to believe,
am I getting my full treatment
that I'm supposed to be getting,
just because they're behind?
- Yet you can't just speed up dialysis
because you're behind schedule.
It's a critical medical procedure, not a shower.
"Oh, I've only got three minutes,
"so I'm just washing the important parts.
"Hair, armpits, and penis, 'cause it's my little buddy.
I'd never forget you, bud."
Dialysis workers in California
are currently trying to unionize
over issues including staffing levels.
And one former DaVita nurse of more than a decade,
who DaVita told us was fired for violating company policy
by asking employees to join a union
at a clinic where he no longer worked,
says workers felt constantly pressured
to transition between patients
as fast as possible.
- Well, when I was working at DaVita,
the priorities for, uh, transitioning patients
was to get them on dialysis
and get the next patient on as soon as possible.
And it was all about numbers.
You--you want to get 'em in,
get their dialysis done,
and get the next patient on.
And you would have sometimes 15, maybe 25 minutes
to get that next patient on-- on the machine,
so you were not properly disinfecting
or doing the things that you needed to do properly.
- Not properly disinfecting? That cannot be okay!
I don't even want to go into a movie theater
that hasn't had enough time to be cleaned.
And the worst thing that can happen to you there
is shuffling through a waist-deep layer
of popcorn and dried, sticky Cherry Coke.
And--and look, DaVita will tell you
its clinics operate to a high standard of care,
its patients aren't rushed,
they have many happy staff and customers,
and they've shown steady improvement over the years.
And they'll even point to the high number of clinics
that have received four and five stars
from the government's rating system.
But that actually points to another oversight issue here,
because weirdly, those ratings don't reflect things
like government inspection reports for the clinics.
Because remember that patient from before?
We actually pulled her clinic's most recent report,
which cited among other things
multiple problems with infection control practices
and a "failure to demonstrate over-all responsibility
for the governance and operation" of the facility,
which "placed all patients, staff, and visitors
at risk of harm and possible death."
And guess how many stars it has:
four stars!
So that--that four-star rating
should really come with a big asterisk
which, to be fair, does technically constitute
a fifth star.
Congratulations.
And if it's beginning to feel
like DaVita is run like a volume business,
well, when you listen to Kent Thiry,
that can seem like it's by design.
Just listen to him addressing business students at UCLA
about what he sees
as his company's role in society.
- I almost never refer to patients
in the entire, uh, thing,
because it's--for me it's not about the patients.
It's about the teammates.
When you're in health care, it is...
[stammering] It is nicer, easier, whatever,
in the sense that you're actually very directly
helping human beings.
But that's--to me, that's just not it.
If I--if I had 1,400 Taco Bells,
uh, and 32,000 people who worked in them,
I would--I would be doing
all the same stuff.
- Yes, you heard him right.
He just said he manages DaVita,
a health care company,
like he would a Taco Bell,
the exact opposite of a health care company.
Look.
- Taco Bell has made a shell
entirely out of fried chicken.
Sounds crazy. But is it?
- So when you see the Naked Chicken Chalupa
with the first shell made entirely out of fried chicken,
you might think it's crazy.
Crazy delicious.
- You know, it's a pretty safe sign
that your product is awful
when your commercial has to assure people
on two separate occasions,
"Look, we know we sound mentally ill,
"but trust us, it is food.
It's actually food. I know, I know."
And look, to be fair,
DaVita might tell you that they have to run
their business so lean, because the reimbursement they get
from the government doesn't really cover their costs.
But they have been repeatedly accused
of finding innovative ways around that.
For instance, a few years ago,
the company was sued
over accusations it had paid kickbacks to doctors
for business.
- The scheme is kind of complicated,
but it basically works like this.
DaVita would pick out doctors
and physicians' groups
who cared for a large number of patients
who had renal disease,
and then it would offer them lucrative deals
to refer patients to their dialysis clinics.
- Okay, so that is obviously not good.
You want to be sure that a doctor
is referring you to a clinic
because it's the best one for you,
not because they have a financial relationship.
You should only advocate for a product
that you really believe in,
like DeWalt's ladders.
They--they don't pay me to say nice things
about their products, people.
Why would they?
The ladders speak for themselves.
Now--now, DaVita denies wrongdoing.
But they did settle that lawsuit
for $389 million, and remember that,
because it's about to become a theme.
Because in 2012, a former medical director
at a DaVita facility went public with claims
about how DaVita treated some of the medicine
that it could charge Medicare for.
For instance, let's say, uh, a patient needed 100 milligrams
of a drug called Venofer.
Uh, you could give them, say, one 100-milligram vial,
or you could do this.
- What DaVita did-- instead of just one vial,
they gave 50 milligram out of this vial--
residual trash.
25, 75 to the trash.
25 again, 75 to the trash.
- The more vials DaVita used,
the more DaVita was able to bill the government.
- Holy shit, that is the biggest waste of drugs
since anyone who's done cocaine in a windstorm.
Although, you know what? You know what?
On the bright side, those pigeons look confident,
and they have somehow written screenplays.
There you go.
That's the beauty of cocaine, everyone.
That's the beauty.
Now--now again, again,
DaVita strongly denied wrongdoing.
And they did so even as they agreed to pay
up to $495 million to settle that case.
That's an almost half-a-billion-dollar oops.
Or as Yankees fans call it,
an A-Rod.
Uh, and a--and a separate case
accused them not so much of throwing extra drugs
into the trash as throwing them into patients.
And then involved something called Epogen,
a medication used to raise a patient's
red blood cell count.
A whistleblower said the DaVita personnel
referred to it as "liquid gold."
And with good reason.
At one point, it accounted for a quarter
of the company's revenue
and up to 40% of its earnings,
although it was later discovered
that at the higher dosage levels
that DaVita was using,
there was no solid evidence
that Epogen made people feel better,
improved survival, or had any clinical benefit at all,
which is incidentally also the new tagline
for this television show,
and it seems fair.
It seems harsh but increasingly fair.
And--and I--I think you know what is coming now.
DaVita denied any wrongdoing
and settled that lawsuit for $55 million.
And DaVita will say that they keep settling cases
because they can't afford to get shut out from Medicare,
but the fact remains,
just the three cases I have mentioned
in the last five years have resulted in them paying out
nearly a billion dollars in settlements.
And that doesn't exactly give you confidence
in their product.
If the Fleshlight company
paid a billion dollars in settlements,
you would do what everyone else does,
and you would fuck a microwaved cantaloupe.
Yeah, 30 seconds on defrost. Trust me.
30 seconds. 30 seconds.
No more, but no less.
30 seconds is the sweet spot. Ding, business time.
But forget that. What was the point?
The point is, here is where we get to the final
and possibly the hardest part of this story,
because the fact is, no matter what standard of care you get,
the longer you are on dialysis,
the worse things look for you.
- People who are on dialysis, how long are they gonna last?
- Right, so the statistics are that
one year after being on dialysis,
your--your death rate is 25%.
By five years, it's 65%.
- And numbers like that are why
if you are at all eligible to get a kidney transplant,
you absolutely should get one.
It can double or even triple your survival rate.
And yet the government's main requirement
for dialysis clinics in educating patients
about transplants is that they simply check a box
indicating that they've done so.
And multiple studies of the industry
have questioned the quality of some clinics' education.
- Thousands of kidney patients in the United States
start dialysis without first being told
about kidney transplants
or that the procedure would be cheaper
and lead to longer lives.
The newspaper reviewed records
from the United States Renal Data System
and they found that some patients spent five years
on dialysis before being put on the kidney transplant list.
- It's true, some clinics are leaving out information
that people really should know.
And information on transplants at a dialysis clinic
is a bit like information about the number of ferrets you own
while you're on a Tinder date.
You need to disclose that shit right up front
so that people don't make a huge mistake.
You have to do that. You have to do that.
It's not right! You disclose that shit!
You let her know! What's wrong with you?
And--and look, DaVita disputes
that those studies reflect their practices,
saying that, uh, their most recent internal figures
show them outperforming their competitors
in percentage of patients receiving a transplant,
although for what it is worth,
we wanted to get a glimpse
of what their education might look like,
and honestly, it wasn't great.
DaVita offers Kidney Smart classes,
basically orientation for pre-dialysis patients.
And they're open to the public, so we sent four staffers,
uh, to classes at four different clinics
here in New York, and they were all struck
by how little emphasis was placed
on the benefits of transplants
and that they were often presented
as an equivalent choice to dialysis.
In fact, here is what happened when one staffer asked
specifically about whether people who came to that clinic
sought transplants.
- Okay, okay.
Suggesting that the cozy atmosphere
of a DaVita dialysis center
is a valid reason to turn down a kidney transplant
is the moral equivalent of watching someone
tread water in the middle of the ocean
and not encouraging him to take a fucking rope.
"Are you sure?
"Are you sure the ocean isn't your 'community'?
"Are you sure you want the--
"people have turned down this rope before, you know.
There's no bad decision here."
And look, we focused on DaVita
because they have the most patients
and Kent Thiry dresses like an idiot all the time.
But a lot of the problems we've seen run throughout
the for-profit dialysis industry,
including their main competitor, Fresenius,
who just last year agreed to a $250 million settlement
for thousands of lawsuits
claiming that the company's products had caused
heart problems and deaths,
claims that they deny, because, you know,
of course they do.
So here's the thing.
I know that all of this has been very complicated.
But there--there are actually a few key lessons here.
First, we need to make sure that dialysis clinics
have better oversight.
And we need to create better incentives
for transplants and for treating kidney disease earlier
to keep patients out of dialysis in the first place.
And there are things that everyone can do
to combat the kidney shortage.
Truly amazing people can donate one of their own kidneys
while they're still alive,
and if you are someone considering doing that,
holy shit, you're an amazing human being.
Feel free to go to giveandlive.us
for more information on that.
And for the rest of us complete assholes,
uh, we should at least-- at the very least--
be organ donors when we die.
'Cause organs can go to waste
as families hesitate to give approval
when a loved one dies.
So please, please make sure
that your family knows that you want to be a donor.
And once you've done that, maybe tweet out...
'Cause if nothing else, it will really fuck with
Twitter's trending topics tomorrow.
But--but here's the thing.
This country did a truly amazing thing.
Richard Nixon did a truly-- - Whoo!
- Really? Wow.
History has changed.
Richard Nixon did a truly amazing thing.
He--he said we should take care of people with kidney disease,
and we did it.
And we should keep doing it,
but--but we could do it a lot better.
The care of America's kidneys
is way too important
to be treated like a fast food experience,
which--which actually reminds me,
there is another victim of this story,
and that is Taco Bell.
Yes, that's right.
Taco Bell is owed an apology,
and that sentence has never before made sense
in the English language.
But Taco Bell, I am truly sorry
that a middle-aged musketeer dragged you into this.
And I know that you're not gonna stand up for yourselves,
Taco Bell.
You're too busy plotting your next
Kristallnacht for the bowels.
So--so don't worry.
Take it easy.
We've prepared a commercial
to return fire for you.
Please enjoy.
- Hi, we're Taco Bell.
You may know us from Volcano Nachos,
the Beefy Fritos Burrito,
and that taco with fried chicken for a shell.
Take it from us...
- You don't want to run a health care business
like a Taco Bell.
[together] No.
- To be honest, you shouldn't really
run a Taco Bell like a Taco Bell.
[together] No shit.
- Because we're nothing like dialysis clinics.
For a start, you may actually be more likely
to find a doctor in one of our restaurants
than in a dialysis clinic.
- Shit. Can you blur my face?
- Sure. - And the Crunchwrap?
- Fuck yeah we can. - Oh, nice.
- And look, we've certainly made our fair share
of dubious claims.
You know those breakfast burritos in our ads?
This is what one actually looks like.
Gross.
But we sure as shit haven't spent the last few years
paying out nearly a billion dollars to settle lawsuits,
because we run a tight ship at Taco Bell.
- If I lick the dust off the Doritos taco shells,
they become regular taco shells.
[rock music]
- Okay, uh, the important thing is,
our food may be barely fit for human consumption,
but at least our CEO dresses in a suit like a human person.
And he doesn't make us call him "the mayor"
or do any of that weird musketeer nonsense.
And you know why?
- We're a company, not a child's birthday party.
- Exactly.
And while our food may be medically inadvisable,
even we know that if you can,
you should get a kidney transplant.
- Oh, you know, yeah, yeah,
you should absolutely get a kidney transplant.
- Yeah, no shit.
- How'd you get back here? - Hm?
[bell dings]
- That's our show. Thanks so much for watching.
See you next week. Good night.
[cheers and applause]
♪ ♪