See all LastWeekTonight transcripts on Youtube

Speaker 1

00:00

-♪ ♪ -♪ ♪ 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 1 patient describe a conversation that she had with a neighbor.

Speaker 2

00:23

I have a lady next door to me now. She said to me, where do you go 3 days a week? She knew the 3 days a week.

Speaker 2

00:30

I said, why, are you writing a book, a mystery? I said, I go to dialysis. She said, oh, you were drunk. I thought you said you didn't drink.

Speaker 2

00:37

I said, if you don't get out of my face, you will need a doctor.

Speaker 1

00:41

Wow! 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 here is the answer to that.

Speaker 1

00:55

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 picture for your blood, which, yes, is more disgusting than I needed to make it sound. --AUDIENCE LAUGHS- --Dialysis can be a truly exhausting process. You're typically sitting in a chair, physically attached to a machine, for 3, four-hour sessions a week.

Speaker 1

01:18

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 1 of the industrialized world's highest mortality rates. So we're spending the most to essentially get the least.

Speaker 1

01:45

We're basically paying for a fully loaded Lamborghini and receiving a drunk donkey on roller skates. This story, the story of dialysis, is an amazing case study of good intentions being thwarted by bad incentives, poor oversight, and profiteering. And 1 of the key characters in this story is incredibly this guy. ♪

Speaker 3

02:03

Just take those old records off the shelf

Speaker 1

02:06

♪ ♪

Speaker 3

02:07

I sit and listen to them by myself ♪ ♪ Today's the music game You got the same song ♪ ♪ I like that old time Rock and roll...

Speaker 1

02:18

♪ 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 DeVita 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.

Speaker 1

02:41

Because in the early years of the machines, access to them was so limited, 1 hospital had an actual death panel to decide who would get to use them.

Speaker 4

02:50

Somebody has got to decide who shall live and who shall die. 2 or 3 were rejected, I think. I don't know why, either for medical reasons or psychological reasons, or just didn't have the $30,000.

Speaker 4

03:12

Mr. Duff, what happened to those who were turned down? They're dead.

Speaker 1

03:17

Oh, my God! That man does not sugarcoat things. They're dead.

Speaker 1

03:23

Also, your pet only loves you because 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.

Speaker 1

03:36

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 healthcare in this country for 1 organ in the body. It's like your kidneys and only your kidneys are Canadian. Oh, sorry, there's 2 of us, Don't mean to take too much space up down here, That's a good accent and I do not apologize for it.

Speaker 1

04:05

Now, at the time, that's a great accent. Now, at the time that bill was passed, it only covered around 10,000 patients, but 4 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-fold!

Speaker 1

04:24

Technically speaking, that is a pug's face worth of folds. -...and as a result, And this is true, treating end-stage kidney disease takes up nearly 1 percent of the entire federal budget. Just think about that for a second. We devote 2 percent of the federal budget to the Department of Education, and that's the thing that helps you know what a percent is.

Speaker 1

04:47

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 2 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 DeVita. Their CEO, Ken Theory, is the showboating musketeer that you saw earlier, and he loves to inspire his employees at meetings.

Speaker 1

05:16

He's also made grand entrances on a bicycle. He's even ridden in on a horse. And spare a thought for that horse there. That is by far the most humiliating credits on its resume, and it did used to do porn, so you have to bear that in mind.

Speaker 1

05:33

-♪ ♪ -♪ ♪ Theory is a former Bain & Company consultant who managed to take DeVita 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, his employees teammates or citizens, and as for himself, well, he's got his own special title.

Speaker 5

06:00

This is KT here, your mayor from the Casa Nueva in Colorado.

Speaker 1

06:05

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.

Speaker 1

06:13

-♪ ♪ -♪ That is the most humiliating thing on that bird's resume, and it used to do porn. So... At this... At this point...

Speaker 1

06:23

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 theory says inspired him to make a transformative life decision to take the DeVita 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.

Speaker 4

06:47

If we must die, let it be like this.

Speaker 6

06:51

1 for all, all for 1.

Speaker 1

06:53

♪♪ -♪♪ That... That remains 1 of the weirdest decisions in movie-making history. Hey, the world's biggest heartthrob at the peak of his popularity agreed to be in our movie.

Speaker 1

07:16

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.

Speaker 1

07:32

Theory even closes company meetings quoting that movie. If we must dialize,

Speaker 5

07:37

let it be like this.

Speaker 3

07:38

1 for all! ALL! 1 for all!

Speaker 3

07:41

ALL! 1 for all! ALL!

Speaker 5

07:45

Damn straight. Have fun. Good night.

Speaker 1

07:46

-♪ ♪ -♪ ♪ -♪

Speaker 3

07:49

Celebrate the last... -♪ -♪ Come on! ♪ -♪ ...of

Speaker 1

07:52

the year... -♪ Cool. -♪♪ And look, here's the thing.

Speaker 1

07:57

For shareholders, theories, techniques have worked. DeVita posted nearly $800 million in profit last year. But the experience for patients can be different. DeVita runs a pretty lean operation, which the government allows.

Speaker 1

08:10

The federal guidelines don't require clinics to have a doctor on site At any given time, which seems a little odd, they also require that only 1 nurse be present in the facility. And a study has found that for-profit clinics have about a third fewer nurses than their non-profit competitors. And that might explain why some DeVita patients say they can feel like they're a product on a factory line.

Speaker 7

08:33

I have texts come up to me and say,

Speaker 8

08:35

oh, that's enough dialysis. You didn't pull it

Speaker 6

08:39

off plenty. So, it wagered my mind to believe Am

Speaker 8

08:45

I getting my full treatment that I'm supposed to be getting? Just because they're behind.

Speaker 1

08:50

Yeah, you can't just speed up dialysis because you're behind schedule. It is a critical medical procedure, not a shower. Oh, I've only got 3 minutes, So I'm just washing the important parts, hair, armpits, and penis, because it's my little buddy.

Speaker 1

09:05

I'll never forget you, bud. Dialysis workers in California are currently trying to unionize over issues including staffing levels, and 1 former DeVita nurse of more than a decade, who DeVita 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.

Speaker 9

09:29

Well, when I was working at DeVita, the priorities for, 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 want to get them in, get their dialysis done, and get the next patient on.

Speaker 9

09:47

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.

Speaker 1

09:59

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.

Speaker 1

10:07

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 look, Davida 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 4 and 5 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.

Speaker 1

10:38

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 overall 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? 4 stars!

Speaker 1

11:02

So 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 DeVita is run like a volume business, Well, when you listen to Kent Theory, 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.

Speaker 5

11:26

I almost never refer to patients in the entire thing, Because for me, it's not about the patients, it's about the teammates. When you're in healthcare, it is nicer, easier, whatever, in the sense that you're actually very directly helping human beings. But to me, that's just not it.

Speaker 5

11:41

If I had 1,400 Taco Bells and 32,000 people who worked in them. I would be doing all the same stuff.

Speaker 1

11:51

Yes, you heard him right. He just said he manages DeVita, a healthcare company, like he would a Taco Bell, the exact opposite of a healthcare company.

Speaker 10

12:02

Look, Taco Bell has made a shell entirely out of fried chicken. Sounds crazy. But is it?

Speaker 10

12:07

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.

Speaker 1

12:14

-♪♪ You know, it's a pretty safe sign that your product is awful when your commercial has to assure people on 2 separate occasions, look, we know we sound mentally ill, but trust us, it is food. It's actually food! I know!

Speaker 1

12:30

I know! And look, to be fair, DeVita 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.

Speaker 10

12:52

The scheme is kind of complicated, but it basically works like this. DeVita 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.

Speaker 1

13:09

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 1 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.

Speaker 1

13:23

They don't pay me to say nice things about their products, people. Why would they? The ladders speak for themselves. Now, now, DeVita denies wrongdoing, but they did settle that lawsuit for $389 million.

Speaker 1

13:37

And remember that because it's about to become a theme. Because in 2012, a former medical director at a DeVita facility went public with claims about how DeVita treated some of the medicine that it could charge Medicare for. For instance, let's say a patient needed 100 milligrams of a drug called Venifer. You could give them, say, 1 100 milligram vial, Or you could do this.

Speaker 11

14:02

What Avita did, instead of this 1 vial, they gave 50 milligram out of this vial,

Speaker 12

14:08

residual, trash. 25, 75 to the trash. 25 again, 75 to the trash.

Speaker 4

14:17

The more vials DeVita used, the more DeVita was able to bill the government.

Speaker 1

14:22

Holy shit! That is the biggest waste of drugs since anyone who's done cocaine in a windstorm. Although, you know what?

Speaker 1

14:29

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.

Speaker 1

14:39

That's the beauty. Now, now again, again, DeVita 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. And a separate case accused them not so much of throwing extra drugs into the trash as throwing them into patients.

Speaker 1

15:06

And that involved something called epigen, a medication used to raise a patient's red blood cell count. A whistleblower said that DeVita personnel referred to it as liquid gold. And with good reason. At 1 point, it accounted for a quarter of the company's revenue, and up to 40% of its earnings.

Speaker 1

15:24

Although, it was later discovered that at the higher dosage levels that DeVita was using, there was no solid evidence that Ipogen made people feel better, improved survival, or had any clinical benefits at all, which is incidentally also the new tagline for this television show. And it seems fair. It seems harsh, but increasingly fair. And I think you know what is coming now.

Speaker 1

15:49

DeVita denied any wrongdoing and settled that lawsuit for 55 million dollars. And DeVita will say that they keep settling cases because they can't afford to get shut out from Medicare. But the fact remains, Just the 3 cases I have mentioned in the last 5 years have resulted in them paying out nearly a billion dollars in settlements. And that doesn't exactly give you confidence in their product.

Speaker 1

16:10

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.

Speaker 1

16:24

No more, but no less. 30 seconds is the sweet spot. Ding, business time. But forget that.

Speaker 1

16:31

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.

Speaker 13

16:44

People who are on dialysis, how long are they gonna last?

Speaker 14

16:47

Right, so the statistics are that 1 year after being on dialysis, your death rate is 25%. By 5 years, it's 65%.

Speaker 1

16:57

And numbers like that are why, If you are at all eligible to get a kidney transplant, you absolutely should get 1. 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.

Speaker 1

17:17

And multiple studies of the industry have questioned the quality of some clinics' education.

Speaker 13

17:23

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 5 years on dialysis before being put on the kidney transplant list.

Speaker 1

17:42

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.

Speaker 1

17:54

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.

Speaker 1

18:03

You disclosed that shit. You let her know. What's wrong with you? -...-And look, DeVita disputes that those studies reflect their practices, saying that their most recent internal figures show them outperforming their competitors in percentage of patients receiving a transplant.

Speaker 1

18:20

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. DeVita offers kidney-smart classes, basically orientation for pre-dialysis patients, And they're open to the public. So, we sent 4 staffers to classes at 4 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 1 staffer asked specifically about whether people who came to that clinic sought transplants.

Speaker 15

18:56

It's a choice. It's actually a choice. You don't have to do a transplant.

Speaker 15

19:00

I've had patients that decided, no, I don't want that. And even if you don't have a donor, you go on their transplant list, when they do call you, of course you have the right to say, no, I don't think so. I don't want it now. You never know.

Speaker 15

19:15

Things happen. This is a family. I know I say this and it sounds crazy, but I've had patients that said, no, I don't think I want to leave. So I won't take the transplant.

Speaker 15

19:25

I need to stay. This is their community.

Speaker 1

19:30

Okay, okay. Suggesting that the cozy atmosphere of a DeVita 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?

Speaker 1

19:46

Are you sure the ocean isn't your community? Are you sure you want the people have turned this rope down before you know? There's no bad decision here. And look, we focused on DeVita because they have the most patience and Kent Theory dresses like an idiot all the time.

Speaker 1

20:03

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 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.

Speaker 1

20:42

And there are things that everyone can do to combat the kidney shortage. Truly amazing people can donate 1 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.

Speaker 1

21:00

And for the rest of us complete assholes, we should at least, at the very least, be organ donors when we die. Because organs can go to waste as families hesitate to give approval when a loved 1 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, hashtag, when I die, please take my kidneys.

Speaker 1

21:22

Because if nothing else, it will really fuck with Twitter's trending topics tomorrow. But here's the thing, this country did a truly amazing thing. Richard Nixon did a truly... Really?

Speaker 1

21:35

Wow! History has changed! Richard Nixon did a truly amazing thing. He said we should take care of people with kidney disease, and we did it.

Speaker 1

21:46

And we should keep doing it, 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 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.

Speaker 1

22:08

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...

Speaker 1

22:22

So don't worry. Take it easy. We've prepared a commercial to return fire for you. Please enjoy.

Speaker 16

22:29

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.

Speaker 3

22:38

You don't want to run a health care business like a Taco Bell?

Speaker 16

22:41

No. To be honest, you shouldn't really run a Taco Bell like a Taco Bell.

Speaker 11

22:46

No shit.

Speaker 16

22:47

Because we're nothing like dialysis clinics. For a start, you might actually be more likely to find a doctor in 1 of our restaurants than in a dialysis clinic. Shit.

Speaker 16

22:57

Can you blur my face? Sure. And the crunch wrap? Fuck yeah, we can.

Speaker 3

23:01

Oh, nice.

Speaker 16

23:02

And look, we've certainly made our fair share of dubious claims. You know those breakfast burritos in our ads? This is what 1 actually looks like.

Speaker 16

23:10

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.

Speaker 5

23:19

If I lick the dust off the Doritos taco shells, they become regular taco shells.

Speaker 1

23:23

♪♪

Speaker 16

23:25

Okay, 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.

Speaker 4

23:33

And he doesn't make us call him the mayor or do any

Speaker 16

23:35

of that weird musketeer nonsense. And you know why?

Speaker 3

23:39

We're a company, not a child's birthday party.

Speaker 16

23:42

Exactly. And while our food may be medically inadvisable, Even we know that if you can, you should get a kidney transplant.

Speaker 3

23:49

Oh, you know, yeah, yeah, you should absolutely get a kidney transplant.

Speaker 16

23:52

Yeah, no shit.

Speaker 3

23:54

How'd you get back here?

Speaker 16

23:56

Taco Bell. Hey, for once, we're the good guys here.