04x12 - Kidney Dialysis and DaVita Inc.

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[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 m*rder,

all a lawyer would have to say
is, "Your Honor,

"the k*ller 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 assh*le.

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:


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 f*cked 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
f*cking 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 sh1tting
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 f*ck 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 d*ck-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-vag*na,

"uh, where I penis
the vag*na 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 f*cking
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 f*ck 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 f*ck 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 f*ck 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


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.



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 f*cking 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


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


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.





- The more vials DaVita used,

the more DaVita was able
to bill the government.

- Holy shit, that is
the biggest waste of dr*gs

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 dr*gs

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 f*ck
a microwaved cantaloupe.

Yeah, 30 seconds on defrost.
Trust me.




No more, but no less.


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 f*cking 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 f*ck 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?

- f*ck 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]

♪ ♪