Last Week Tonight with John Oliver (2014–…): Season 4, Episode 12 - Dialysis - full transcript

John Oliver highlights the opportunities for improvement of the for-profit dialysis industry.

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Season IV
Episode 12

Welcome to Last Week Tonight.
I'm John Oliver.

Thank you for joining us, we begin
with the biggest story of the week,

which once again,
concerned President Trump,

two words that continue
to sound revolting together,

like viscous discharge
or moist stockings.

The president made news
with a startling decision.

President Trump fired the embattled
FBI director James Comey.

Surprise, everyone !
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 weird.

Not just because it featured
Trump's signature,

which looks like a heart rate
monitor of a hamster on meth.

It looks more like that
than it looks like his name.

But it was weird
because of this.

Trump firing Comey
in a bizarre letter.

While I appreciate you informing me
on three separate occasions

that I am not under investigation,
I nevertheless concur

with the judgment
of the Department of Justice

that you are not able
to effectively lead the bureau.

It is inherently suspicious to
put words in Comey's mouth

as you kick him out the door.

That is the equivalent
of a breakup text reading,

while I appreciate you informing me
on three separate occasions

that I was the most enthusiastic
and intuitive lover you ever had,

I nevertheless must terminate
your position as my girlfriend.

Eggplant Emoji.

And it kept going, because
the White House spent the week

emitting a series
of confusing explanations

claiming that Trump was following
the recommendation of 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.

Trump blew up the narrative
when he sat down with Lester Holt

and undid two days of damage
control in a few sentences.

You met with the Deputy Attorney
General Rob Rosenstein.

- Did you ask for a recommendation ?
- I was going to fire Comey...

- You have made the decision ?
- I was going to fire Comey.

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
have been Donald Trump.

It must have been someone
much stronger and smarter,

with a much hotter daughter.

And before they finished that sentence,
Trump would be yelling I did it !

It was me ! Lock me up !

Trump didn't just clarify
who advised him to fire Comey,

and quick recap:
it was a mirror,

he also indicated
one reason why he did it.

When I decided to just do it,
I said to myself,

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 is the 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 ?

Three: are we as a country
this stupid ?

It's possible the answers
to all three questions are yes !

Lester Holt asked Trump
about his claim

that Comey had exonerated him
three times.

He said it once at dinner and
twice during phone calls.

Did you call him ?

In one case I called him,
in one case he called me.

Did you ask:
"Am I under investigation ?"

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 managed to be both
a terrible and an amazing liar.

I don't know how
that's physically possible.

Comey's far-more-plausible version
of the dinner mentioned

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
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:
"yes, you will have that".

To which Mr. Trump said:
"how about loyal honesty ?"

Comey said: "how's that
different from honest loyalty ?"

Trump said: "if you don't see what
difference it makes, 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,

turning back to him and saying:
"are you coming ?"

Because frankly
I'm done with this shit.

Trump denied Comey's account
and then, on Friday morning,

he tweeted something ominous
even by his standards.

The President threatened
the man he fired as FBI director.

In an extraordinary tweet today,
Trump warned:

"Comey better hope that there
are no tapes of our conversations"

"before he starts
leaking to the press."

Tweets like that
are difficult to parse,

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.

I will say this: if he is recording
everything in the Oval Office,

I don't want to hear those tapes.

I'm assuming it's his voice
muttering the sentence:

"I never wanted any of this"
over and over again,

interrupted by mattress commercials
and string cheese farts.

Trump has made it very clear:
he fired the director of the FBI

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 nothing Trump could do
to genuinely shock me now.

If he fired Comey because he's
investigating Russia, I'd believe you.

If he did it because Comey is 6' 8"
and Trump feels tiny next to him,

I would believe you.

If he fired Comey,
spread peanut butter on his genitals,

brought in 35 squirrels and
yelled: "daddy's brought dinner !",

I'd say, sure, yeah,
sure, why not.

That sounds like something
the President of the US would do,

that's the world
we live in now.

It is too easy to point
at Trump being crazy.

That's not going to stop and it's going
to be exhausting for everyone.

The 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.

It is time for for them
to pick a lane here.

They do have options.
There are the investigations ongoing.

But they could also press Deputy
AG Rod Rosenstein to appoint

a special counsel within
the Justice Department.

But at the very least here,
they need to acknowledge

that what has happened is fucked up
and not continue to give non-answers

like Paul Ryan when asked about
Trump's tape recording threat.

I'm not going to comment on the tweets
of the day or the hour.

I haven't seen them all.
Some of you want to ask this question,

the president has the right
to hire, fire an FBI director.

He made that decision.

Yeah, but that's not answering,
just regurgitating what happened.

It's 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.

Some members of Congress,
like Rod Blum from Iowa,

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,

would he fire the FBI director,
that'd be a dumb move.

Yeah, it would, Rod !
Yes !

Unless Blum has a disease where
he says genuine things sarcastically,

that was also
a very stupid thing to say.

Unicorns are imaginary and penises
are where the pee comes from.

Whatever, idiot.
Leave me alone.

The Founding Fathers created
a system of checks and balances

to limit
the power of the president.

But it only works if someone
checks or balances.

And if you don't, it's no longer
on Trump, it's on you.

When you've got the presidential
equivalent of a five year old

shitting on the salad bar
of a Ruby Tuesdays,

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 all I'm saying.
Stop that boy, now !

Moving on to a quick update
regarding New Zealand:

wallaby fuck-island.

Last week, we talked about
the historically stupid legal battle

involving that country's ruling Party
being accused of ripping off

the song
"Lose Yourself" by Eminem,

or as they call him
in New Zealand, Immynim.

Our piece was brought to the attention
of New Zealand's Prime Minister,

Bill English, the very poorest
man's Daniel Craig.

It turns out, he is not a fan.

Seen the John Oliver piece
where he mocks the National Party

for allegedly ripping off Eminem ?

- No.
- Do you intend to watch it ?

Some of the stuff I've seen
isn't very funny.

You really want to do this, Bill ?

Is this really what you want ?

When your fellow party member,
Stephen Joyce,

got dick-smacked in the mouth
by a rubber floppy-cock

and then suggested someone
send the GIF over to John Oliver

so we can get it over with,

we ended the show
with a flying dildo-palooza.

When it comes to Kiwis,
Johnny don't play.

Bill English must know that
the moment he mentioned my name,

I was going to find the stupidest,
most humiliating things about him.

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.

I'm about to head out for a,
what I call a walkrun,

where I walk up the hills
and run the downhill bits.

This is one bit where I run.

And bits like this, I walk.

Still walking.
I'm running this bit.

This bit makes you feel fast.
And this bit makes you feel slow.

I would give anything for Bill English
to make a sex tape.

I'm about to head in
for what I call a penis-vagina,

where I penis the vagina bits
and she vaginas the penis bits.

This is the bit where I penis fast.
This is the bit where I penis slow.

Stick around.
This is gonna to take a while.

The worst thing Bill English
has ever been responsible for

is this recent Facebook post,
where he writes:

cooked dinner for the family,

like if you agree with tinned
spaghetti on pizza

with photos of canned spaghetti
poured all over a revolting pizza.

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.

That is not a thing
anybody should be doing.

A divorced dad cooking for his kids
would not put spaghetti on a pizza.

The caterer
for Chef Boyardee's funeral

would not put
canned spaghetti on a pizza.

You also added pineapple
to that abomination.

And that's not dinner,
that is an actual hate crime.

What is your problem, Bill ?
You made that to feed to your family ?

To your children, Bill ?
How are you not in prison now ?

The point is, I am sorry if our show
is not to your liking, Bill English,

Prime Minister of New Zealand.

If I appealed to someone with your
level of taste, I would be mortified.

At times like these a lyric from
"Lose Yourself" comes to mind:

His palms are sweaty
knees weak, arms are heavy

There's vomit on his sweater
already, mom's spaghetti.

The reason those lyrics
come to mind is though,

I would rather eat Eminem's
vomit spaghetti off his sweater

than canned spaghetti and pineapple
off one of your garbage pizzas.

And now this.

A series of terrible pizzas

that New Zealand Prime Minister
would probably enjoy.

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.

Bon appetit, Bill, you filthy animal.

Our main story is something
you're probably not expecting.

We're going to talk
about kidney dialysis.

I know you're getting ready
to push the button on your TV remote

marked: "dear, God,
literally anything else".

This is worth listening to. Dialysis is
not something everybody understands.

Listen to one patient describe
a conversation with a neighbor.

I have a lady next door
to me now.

She said to me: "Where do you go
three days a week ?"

I said, why, are you writing a book,
a mystery ? I go to dialysis.

She said: "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."

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 to cool down
the temperature in that relationship.

Here is the answer: dialysis is where
a machine acts as your kidneys

by taking blood out of your body,
cleaning it, and returning it to you.

Think of it as a Brita pitcher
for your blood.

Which is more disgusting than
I needed to make it sound.

Dialysis can be an exhausting process.
You're sitting in a chair,

physically attached to a machine,
for three four-hour sessions a week.

Americans have been
at increasing risk of needing it,

chronic kidney disease is the 9th
leading cause of death in the US.

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

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 get the least.

We're paying for
a fully-loaded Lamborghini

and receiving a drunk donkey
on roller skates.

The story of dialysis is an amazing
case study of good intentions

being thwarted by bad incentives,
poor oversight and profiteering.

One of the key characters
in this story is incredibly this guy !

If you think: who is that man doing
barefoot gymnastics to Bob Seger

while dressed like the third saddest
waiter at a Medieval Times ?

That is the CEO
of DaVita incorporated,

a for-profit kidney
dialysis company.

We will get to that man.

Let me give you a sense of the history
of dialysis in this country.

'Cause in the early
years of the machines,

access to them was so limited,
one hospital had a 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,
either for medical reasons,

psychiatric reasons,
or just didn't have the $30 000.

Mr. Duff, what happened
to those who were turned down ?

They're dead.

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, sir.

In 1972 though,
something amazing happened:

Richard Nixon signed a bill into law
which said that the government

would pay for dialysis
for anyone who needed it.

We have universal health care in this
country for one organ in the body.

It's like your kidneys
are Canadian.

Sorry, there's two 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.

That's a great accent !

At the time that bill was passed,
it only covered 10 000 patients.

Four decades later, thanks 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 !

That is a pug face's
worth of folds.

As a result, treating
end-stage kidney disease

takes up nearly one percent
of the entire federal budget.

We devote two percent of the federal
budget to the Department of Education

and that's the thing that helps
you know what a percent is.

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 percent are owned by
two big, for-profit companies:

Fresenius and DaVita.

There are significant issues
with both of them.

Tonight we're going to focus
on DaVita.

Their CEO, Kent Thiry, is the
showboating musketeer you saw,

and he loves to inspire
his employees at meetings.

He's also made grand
entrances on a bicycle.

He's even ridden in on a horse.
Spare a thought for that horse there.

That is by far the most humiliating
credit on its resume

and it did used to do porn,
so bear that in mind.

Thiry is a former Bain & Company

who took DaVita from near-bankruptcy
to being valued at $13 billion.

He's been the subject
of an admiring case study,

which called his management
style "arguably eccentric".

He calls his company a "village",

his employees
"teammates" or "citizens",

and as for himself,
he's got his own special title.

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

Yes, you heard right:
he calls himself the mayor.

A title so ridiculous, you haven't
noticed he's standing next to a falcon.

That is the most humiliating
thing on that bird's resume

and it used to do porn.

At this point, we should 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 Thiry says inspired him to make
a "transformative life decision"

to take the DaVita job,
which is already insane.

This is a ridiculous movie to choose
as the basis for anything.

Let me give you
just a small taste.

If we must die,
have it be like this.

One for all, all for one.

That remains one of the weirdest
decisions in moviemaking history:

"the world's biggest heartthrob
at the peak of his popularity"

"agreed to be in our movie,
what should we do with him ?"

Let's put him in a weird mask
and just have him stand there.

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.

All for one.

- One for all !
- All for one.

Damn straight, have fun.
Good night !


For shareholders,
Thiry's techniques worked,

DaVita posted nearly $800 million
in profit last year.

The experience for patients
can be different.

DaVita runs a lean operation,
which the government allows.

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 one
nurse be present in the facility.

And a study has found
that for-profit clinics have

about as third fewer nurses
than their nonprofit competitors.

That may 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
that's enough dialysis.

You done pulled off plenty.
It wager in my mind to believe,

am I getting my full treatment ?

Just because they're behind ?

You can't just speed up dialysis
because you're behind schedule,

it is a critical medical procedure,
not a shower.

I've got three minutes,
I'm 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 trying to unionize over issues

including staffing levels.

One former DaVita nurse
of more than a decade,

fired for asking employees to join
a union where he no longer worked,

says workers felt pressured
to transition between patients fast.

Priorities for transitioning patients
was to get them on dialysis

and get the next patient on
and it was all about numbers.

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 a machine,

so you were not properly disinfecting
or doing the things properly.

Not properly disinfecting,
that cannot be ok.

I don't even want to go into a movie
theater that hasn't been cleaned,

and there is shuffling through
a waist-deep layer of popcorn

and dried sticky Cherry Coke.

DaVita will tell you its clinics
operate to a high standard of care,

its patients aren't rushed,
they have happy staff and customers

and shown steady improvement.

They'll even point
to the high number of clinics

that received four and five stars from
the government's rating system.

Weirdly, those ratings don't reflect

things like government inspection
reports for the clinics.

Remember that patient from before ?
We pulled her clinic's recent report,

which cited 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.

Guess how many stars it has ?
Four stars.

That four-star rating should
come with a big asterisk,

which to be fair, does technically
constitute a 5th star.

Congratulations !

If it's beginning to feel like
a volume business,

when you listen to Kent Thiry,
that can seem like it's by design.

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 thing,

for me it's not patients,
it's teammates.

When you're in healthcare
it is nicer, easier

in the sense that you're
very directly helping human beings.

If I had 1 400 Taco Bells

and 32 000 people
who worked in them,

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.

Taco Bell has made a shell
entirely out of fried chicken.

Sounds crazy. But is it ?

When you see
the Naked Chicken Chalupa,

you might think it's crazy,
crazy delicious !

It's a pretty safe sign that
your product is awful

when your commercial has to assure
people on two occasions:

We know we sound mentally ill,
but trust us: it is food.

It's actually food, I know !

DaVita might tell you that they have
to run their business so lean,

because the reimbursement they get
doesn't really cover their costs.

They have been accused of finding
innovative ways around that.

A few years ago, the company
was sued over accusations

it had paid kickbacks
to doctors for business.

The scheme is 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.

It would offer them lucrative deals
to refer patients to their clinics.

So that is 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 you believe in,

like DeWalt ladders.

They don't pay me to say nice things
about their products, people.

Why would they ?
The ladders speak for themselves.

DaVita denied wrongdoing.
But they did settle that lawsuit

for $389 million.

Remember that, because
it's about to become a theme.

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.

Let's say a patient needed 100 mg
of a drug called Venofer.

You could give them,
say, one 100-milligram vial.

Or you could do this.

What DaVita did, is out of this one
vial they gave 50 mg out of this vial.

Where's it go ?

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.

That is the biggest waste of drugs

since anyone who's done cocaine
in a windstorm.

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.

DaVita 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.

A separate case accused them
not so much of throwing

extra drugs into the trash,
as throwing them into patients.

That involved
something called Epogen,

a medication used to raise
a patient's red blood cell count.

A whistleblower said the personnel
referred to it as "liquid gold".

It accounted for a quarter
of the company's revenue

and up to 40 percent
of its earnings.

It was later discovered that at the
higher dosage levels DaVita used,

there was "no solid evidence
that Epogen made people feel better,"

"improved survival, or had
any clinical benefit at all."

Which is also the new tagline
for this television show.

It seems harsh,
but increasingly fair.

I think you know what is coming:
DaVita denied any wrongdoing

and settled that lawsuit
for $55 million.

DaVita keep settle cases, they can't
afford to get shut out from Medicare.

Just the three cases I have
mentioned in the last five years

have resulted in them paying out
nearly a billion dollars.

That doesn't exactly give you
confidence in their product.

If the Fleshlight company paid
a billion dollars in settlements,

you would fuck
a microwaved cantaloupe.

Yeah, 30 seconds on defrost.
Trust me. 30 seconds.

No more, but no less.

30 seconds is the sweet spot,
ding, business time.

The point is here is where
we get to the final

and possibly hardest part
of this story.

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 ?

The statistics are that one year
after being on dialysis,

your death rate is 25%.

By five years,
it's sixty-five percent.

Numbers like that are why, if you
are eligible to get a transplant,

you absolutely should get one.

It can double, or even triple
your survival rate.

The government's main requirement
for clinics in educating patients

is that they simply check
a box indicating that they've done so.

Multiple studies questioned the quality
of some clinics' education.

Thousands of kidney patients
in the US start dialysis

without first being told
about kidney transplants,

or that that is cheaper
and leads to longer lives.

The newspaper reviewed records
from the US Renal Data System

and they found that some patients
spend five years on dialysis

before being put on
the transplant list.

Some clinics leave out information
that people should know.

And information on transplants
at a dialysis clinic is a bit like

information about the number of
ferrets you own while on a Tinder date.

Disclose that shit, so that people
don't make a huge mistake.

You have to do that.
It's not right.

You disclose that shit. You let her
know. What's wrong with you ?

DaVita disputes that those
studies reflect their practices,

saying that their most recent
internal figures show them

outperforming their competitors
in patients receiving a transplant.

We wanted to get a glimpse of what
their education might look like

and it wasn't great.

DaVita offers "Kidney Smart" classes
and they're open to the public.

We sent four staffers to classes
at four clinics 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.

Here is what happened when one
staffer asked specifically

about whether people who came
to that clinic sought transplants.

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

I've had patients that decided
no, I don't want that.

If you don't have a donor,
you go on the transplant list,

when they do call you,
you have the right to say no.

You never know,
things happen.

I mean 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.

And they stayed.
This is their community.

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 ocean

and not encouraging him
to take a rope.

Are you sure ? Are you sure
the ocean isn't your community ?

Are you sure you want people
have turned this rope down.

There's no bad decision here !

We focused on DaVita because
they have the most patients

and Kent Thiry dresses
like an idiot all the time.

A lot of the problems run throughout
the forprofit dialysis industry,

including Fresenius, who just last year
agreed to a $250 million settlement

for thousands of lawsuits claiming
the company's products

had caused heart problems
and deaths,

claims that they deny, because,
of course they do.

I know that all of this
has been very complicated,

but there are
a few key lessons here.

We need to make sure dialysis
clinics have better oversight.

We need to create better
incentives for transplants,

for treating kidney disease earlier,
to keep patients out of dialysis.

There are things that everyone
can do to combat the kidney shortage.

Truly amazing people can donate
one kidney while they're still alive

and if you are someone
considering doing that, holy shit:

you're an amazing human being.

For the rest of us complete assholes,
we should at least, at the very least,

be organ donors when we die.

Organs go to waste as families hesitate
to approve when a loved one dies.

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".

It will fuck with Twitter's
"trending topics" tomorrow.

This country did a truly amazing
thing. Richard Nixon did a...

Really ?
History has changed.

Nixon did a truly amazing thing.
He said we should take care of people

with kidney disease, and we did it
and we should keep doing it,

but we could do it a lot better.

Is way too important to be treated
like a fast-food experience.

There is another victim of this
story and that is Taco Bell.

Taco Bell is owed an apology.

That sentence has never before
made sense in English.

But Taco Bell, I am sorry
that a middle-aged musketeer

dragged you into this.

I know that you're not going
to stand up for yourselves.

You're too busy plotting your next
"Kristallnacht for the bowels".

Don't worry, take it easy:
we've prepared a commercial 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.

You don't wanna run a health care
business like a Taco Bell.

You shouldn't really run
a Taco Bell like a Taco Bell.

No shit.

We're nothing
like dialysis clinics.

You may 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 crunch wrap ?
- Fuck yeah, we can.

We've made our fair share
of dubious claims.

You know those breakfast burritos ?
This is what one actually looks like.


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.

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

Our food may be barely fit
for human consumption,

but at least our CEO dresses
in a suit like a human person.

He doesn't make us call him
the mayor

or do any of that
weird musketeer nonsense.

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.

You should absolutely
get a kidney transplant.

Yeah. No shit.

How'd you get back here ?

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

That's our show. Thanks so much.
See you next week. Good night !