PowerLiving with Kimberlee Langford
PowerLiving with Kimberlee Langford
Unveiling the Harsh Realities of Dialysis Care and the Quest for Reform
Venture beyond the glossy facades of dialysis center advertisements with Tom, an author who uncloaks the somber truths of an industry at odds with protecting and serving some of the most vulnerable patients.
In this conversation, we exchange our some of our most memorable experiences; I recall my days in home health care, witnessing the grueling battles of kidney disease patients, while Tom reveals his transformation into an informed critic, guided by whistleblowers' revelations. We confront the industry's stark dilemmas, where healthcare workers tread the thin line between profit and patient care, and the alarming compromises that endanger lives.
This episode doesn't just skim the surface—it probes into the unsettling vulnerabilities within dialysis care. The risks associated with inadequately trained personnel are laid bare, alongside firsthand accounts affirming the distressing realities exposed in Tom's book. We discuss the alarming state of the dialysis industry and the necessity for systemic reform. Moreover, we grapple with the commodification of human health as we dissect the ethical quandaries facing professionals in the field, who must navigate the waters of a profit-driven healthcare system.
Finally, we turn our focus to the broader spectrum of healthcare challenges, including the management of chronic kidney disease and diabetes. The life-saving potential of new medications is weighed against their prohibitive costs, igniting a call for federal action to ensure equitable access. By the end of the episode, we underscore the paramount need for a healthcare paradigm that champions patient outcomes over fleeting profits. Join us for a session rich with insight, as we pay tribute to the relentless pursuit of knowledge and its power to spearhead meaningful change for patients - and health plans everywhere.
There we go. We're recording in progress, so it should be good.
Speaker 2:Super excited. So I have to tell you, tom, my leadership team here at Specialty Care Management sent me your book. I was so excited to get your book and I have to say, from the very first few pages I thought, oh, this guy has been there. The stories that you share. It really is like getting a behind.
Speaker 2:I was just talking with a colleague of mine today about how you know, when I, how I developed this passion for working with folks with kidney disease was largely because of the time I spent working with people in home health and I worked with a lot of people who you know. They all had diabetes and they all had, you know, ulcers, foot ulcers and they all ended up on dialysis and it was a horrible, horrible experience for them. And I used it at Christmas time and I highly encourage it at Christmas time to take a plate of cookies and go to the dialysis facility, facilities in your, in your area, and just get a glimpse of what life is like. And it is not, you know, the bright, shiny interiors that they put on their ads.
Speaker 1:It is not that at all.
Speaker 2:They're dark and dreary and scary, lonely places, and and so, anyway, that's what I thought of when I read this book was here's a guy who's I mean, because you're not a nurse, you're not a doctor, and yet you know the landscape of dialysis in a way that very few people really, really get, and I'm super excited to have you here and to talk about you know, what was it that got you started and sharing this inside you? Now I have a number of questions in here.
Speaker 1:That's always good to see a book that's been marked up and, you know, doggiered and little stick it, since that's a warms a writer's heart.
Speaker 2:Yeah, yeah. Well, my copy is well worn and well notated and some spots you might even find an amen in there.
Speaker 1:No, that's great. Thank you, kimberly. I mean coming from you. The fact that this rings true is very important to me. You know I started off completely ignorant of dialysis, as I suspect most people outside of healthcare are Most people in healthcare, for that matter Correct, I kind of stumbled into it while writing about whistleblowers.
Speaker 1:My previous book was about whistleblowing and, and you know, here was this industry where these, these, while there was a registered nurse and a phrologist and then a finance guy, all three had blown the whistle, all three had had reached settlements in excess of $400 million, I mean 400, between $400 and $500 million, settlements for illegal kickbacks and allegations of illegal kickbacks. That's the beauty of the legal settlement is you get to say you were innocent. Yeah, and at the same time, you know, these companies were were sitting pretty there where they continued to do business with the government. They continued to to the stock continue to rise and and Warren Buffett continued to own 40% of of one of them, davida Trisinius, likewise thriving. And I thought what's going on here?
Speaker 1:You know, I had I, I, in a previous life I worked in banking and and I was just curious from a business point of view, what kind of? What kind of a business. This is how can there be so much money in in dialysis? You can write those kinds of checks and still do really well. And so I started talking with well finance people at first, and then caregivers and then patients, and that's when I was hooked. And I have to say, at first I didn't really believe what I was hearing. I have to say I I thought well, you know these bad conditions, the involuntary discharge problem, the notion of people getting sucked into dialysis before they need it.
Speaker 2:They don't do that in healthcare.
Speaker 1:Exactly. It can't be. It can't be right. I mean this and I figured I talked with a lot of whistleblowers and whistleblowers are incredibly brave and incredibly, but they you know, some of them talk obsessively about themselves and kind of inflate what happened to them and so on, just because they've lived this and so and I thought maybe I was running into that same thing, these patients who were saying they had been discharged. Well, maybe they, maybe they did something, I don't know, maybe they and and again, I'm sure that in some cases that does happen, but I never encountered one of them where they, where the patient, actually did something dangerous or hurtful. But I did run into a lot of cases where they were accused of it and and in some cases the nurse or the person who was responsible for the accusation told me look, I got to tell you, I was told to put that in their record and I was. Can I?
Speaker 2:just say for good nurses everywhere, shame on them.
Speaker 1:It's shame.
Speaker 2:Shame on them for for caving to that kind of pressure.
Speaker 1:I agree. And on the other hand, they were saying, look, my nurses license is at stake. I have to work in this industry. I don't. I'm not defending it, believe me, it's. I agree with you. Shame on them. But there is the other side of the story. If you have a duopoly that is, in many markets a monopoly it's not like you can just say, okay, well, I turn in my resignation and go find some some more else to work. It ain't that easy, right? So I understand the pressures that people are under.
Speaker 1:Also, you know there was a Magellan Hanford who, who was a he is remains a registered nurse in a dialysis, in dialysis facilities. When I talked with him he was working in California, he's in smooth Texas, but he had previously been in LAPD policeman on some pretty tough beats and he'd been in shootouts and he'd been. So he, you know, he knew what tough was right. And he described his life as a dialysis nurse in in the big two as like a mash hospital in a war, you know, moving from from patient to patient Are you still breathing? Okay, gotta go.
Speaker 1:You know. And and the way he described it and the way he described his own stress, the way he described, you know, not being able, physically not being able to take care of the people that he had sworn, and he used the to protect and to serve. He said, you know, just like when I was with the LAPD, I had that oath to protect and to serve and and I, you know he felt, at least the way he described it he felt like he was not in a position physically to keep that oath and to keep that faith with his patients and it was breaking his heart.
Speaker 2:Absolutely. Yeah, it's interesting. We talk a lot about that here. At specialty care management, our focus is working with folks who are on dialysis perspective. We put a bridle on these types of high cost claims in a pretty sexy way, I'd say. But also to help members thrive on dialysis, to feel good on dialysis and then working upstream to help them avoid the need for dialysis, which is my personal and professional passion, and you know we talk a lot about that here, where you know it's interesting.
Speaker 2:And nursing and healthcare in general. Healthcare has definitely changed quite a bit. The pandemic had a lot to do with that. We fired a lot of people, very highly experienced people, and they're not coming back. And so you know when I talk to dialysis facilities across the country a lot of them. It's apocalyptic and it's not just in the dialysis facilities and the hospitals, just people are gone. You're experienced when the old gal, when the old person on the hospital floor of the dialysis unit has been out of school three years, that should scare the pants off of all of us, right, the wise mentors and the experience is and it's the same thing in nursing and in medicine.
Speaker 1:It should scare the pants off of all of us. And yeah, you know the notion that somehow this dialysis is something that you can comfortably do with modestly trained or largely untrained people. You know learn on the job. Sticking 12 gauge needles into people's. You know blood vessels wow, that's a big ass.
Speaker 2:You know, you can be flipping burgers and the next day you can be holding somebody's life in your hands? Absolutely yeah, these a lot of people don't know that about dialysis the people that are performing and and and taking care of those people there, they do not have a healthcare background.
Speaker 1:And and I'm just, I'm just alarming and you know, I've read some 911 logs from clinics in California where it's heartbreaking to hear the conversations. And in the clinic says he's not responding, he's not breathing, and the 911 sort of perform CPR and and the and the person in the clinic says I don't know how and we don't have crash charts, we have carts, we don't have. I mean. What I mean this is, this is emergency room medicine being practiced at the mall by people with not a great deal in some cases. And again, I want to back up two steps and and for all those out there who are doing a great job and are highly trained and highly motivated and saving people's life, I want to say this book is not about you, because I really don't want to be out there too.
Speaker 1:There are a lot of them out there too, there are, and I've heard from a lot of them Since my book came out. I've gotten a steady stream of messages from insiders everywhere, from very senior nephrologists to fairly junior techs, a lot of patients and a number of other people too, commenting on the book, largely saying you know, yes, absolutely, and you forgot this and this and this. And they send me documents and so you know, it's, it's, it's been, it's been interesting because the book itself had gotten almost zero press. And, in fact, thank you for this invitation, because you were one of very few who has asked me for an interview.
Speaker 1:But no, I'm not actually, and and I think I mean not to sound self serving, but I tend to think that the reason that things have gotten so bad is because the mainstream media has not been paying attention, if not asleep at the switch, right but. But I have gotten an enormous on the other side. I've gotten an enormous reaction from people on the inside saying, finally, someone's talking about this or and. So that's heartening and it's tough because, you know, I get, I get messages from patients saying please help, and I'm like, well, I'll do the best I can, but I'm neither a medical professional, nor a lawyer, nor a regulator, nor any of the people who should be dealing with this. So it's it's tough.
Speaker 2:It's interesting. I was talking with another colleague again today specifically about getting to talk with you. And you know, when it comes to, I think you know dialysis is an industry where all these patients they're so vulnerable, they're about as vulnerable as you can get. And I got to tell you I've worked with literally thousands of people all across the country. I've never once had a person facing dialysis to get excited about it. I will tell you, I've had 100% of people tell me I'll die before I go on dialysis. There's no way I'll do that. And they end up on on dialysis, of course.
Speaker 2:And they're so vulnerable and in healthcare, in any kind of service industry, the vulnerable people we take care of the people who are on dialysis. We take care of those people, we guard them, we advocate for them, we protect them. And in the in the realm of dialysis, I just got to tell you it really feels like for the run of the mill. Right is that the people are pawns to get to the dollar. Patients are just little pieces on this chessboard. We move around because that's how you get to the dollar bill. By the way, so are nurses and doctors anymore today.
Speaker 2:We are the pawns to how you get to the doc. Doc, you move these people around to board until you get to the dollar.
Speaker 1:Yeah, I've talked in my previous, my previous book on whistleblowing. I talked with some doctors who were in the in the profession when the first finance people became CEOs of hospitals. So it tells you it was a while ago, right, and they were like wait a minute, that doesn't make any sense. It's like I don't know, you know a baker driving, flying a 747. That's, how can that be? Well, guess what? It doesn't make any sense, but that's what we've done, and and and the finance people are sitting pretty, but the rest of us including, as you say, the doctors, the nurses, the staff, they're just being wrung out and and that is just wrong.
Speaker 2:And it's such that you know, coming from small towns, I'm a small town North Idaho girl and I know you run in a similar circle up there in North.
Speaker 1:Idaho, absolutely. Spree at Lake Absolutely.
Speaker 2:Spree at Lake yeah. Be, still my heart, you know well.
Speaker 2:I've seen. You know, when you have a small, midsize employer in a community and they have a person or two that goes to dialysis, it can cripple the health, the benefits for the whole company. I've seen it close doors and that doesn't just impact the member who was covered by that plan and it affects everybody in the company and I'll even say it impacts the entire community suffers because of it. And that's just pertaining to the cost, not the human element, not the quality of life element, but just the cost of dialysis being so predatory. And you know it's a multifaceted issue. But I had a few points I wanted to be sure that we got to talk with you about because I think that I think these points are delicious. I'm going to rattle them off and you tell me which one tickles you the most. I want to. I love the part in here where you talk about hippers. I don't think a lot of people.
Speaker 2:People probably don't know about hippers and hippercompression and the hipper bus.
Speaker 1:Yes.
Speaker 2:I love that one Black listing. I've known. I've known people personally, patients personally who've been blacklisted for just for simply making a complaint. Even today, even in this day, let's see. Of course, everybody always asks about the American kidney fund. That's a good one. I like also in there how you point about how in the United States we have only 1.9% of folks on dialysis or on home dialysis and I would like some time to talk about why that's significant Strategic lab draws.
Speaker 1:Oh boy, you picked out every single one of these Kimberly.
Speaker 2:I like the part, the section in here about the QIP score 5 star seasons. I love that and of course if anybody's watched John Oliver, I share that clip every year, but the whole musketeer skit. I'd love to talk about the behind the scenes. What drove that, because you really delve into detail there. And then I'd love to in the face of value-based care. I think you also bring up an interesting point in here where you talk about joint ventures, the whole anti-kickback statutes, and now in the face of value-based care, we're finding some physicians are coming back and arguing well, it makes sense that physicians own dialysis facilities so we can control quality. So you've got two sides here. Go back and forth. It's funny how we teeter taught her back and forth the same issues. I think that's a good one. The buying and selling of facilities that again got me thinking. People are just the pawn to get to the dollar. Oh, and then the wrong to write commandments Holy heck, not leaving a paper trail. I don't know if I've given you enough meat.
Speaker 1:How many weeks do you have here, Right? I don't know.
Speaker 2:We can carry this on for a while and all of this stuff. If people have not read this book, it is absolutely worth a read, because you talk about all of this meat in here. It's definitely eye-opening. But pick a topic that's juiciest, let's go Well.
Speaker 1:I'll tell you. I mean, the HIPAA business is really was a striking thing for me and basically the concept is look, there are two kinds of patients that are and this is very generalized. There are patients that are government insured, so Medicare, medicare, medicaid, tricare, et cetera. And then there are privately insured patients, and privately insured patients make vastly more for dialysis companies than the publicly insured patients. Now, first of all, I should say that, as with this point, so with almost everything in my book, when I shared my statements with the big companies, they disagreed strongly. They disagreed and their lawyers disagreed strongly with everything I said. It was all full of baloney. I was actually flattered that one of the CEO of one of the companies wrote a letter to all of the teammates saying there's a book coming out. It's full of lies. He didn't mention the title and I got several one-star reviews baloney and other slightly saltier language on Amazon before the book was even available. So I thought, wow, these people, they really do follow the dog whistle, right, ok.
Speaker 2:I think you said you know you're on the right track when you're pissing off the right people.
Speaker 1:Yeah, well, that's fair enough. I mean, if he thought it was worthwhile to write that letter, it meant that I hit a few points. But anyway, coming back to private and public patients, in theory one should treat all patients the same, but in practice, ones that are valued at three to 10 times more. Guess who gets the red carpet treatment? I'll let you guess right. The problem is that it causes a two-tier system and certain people are second-class citizens, they don't get the red carpet treatment. And when they complain, I talked with several patients who were medical professionals, several patients who were registered nurses, so they know about sterile procedure, and they see a tech getting ready to put these needles in into their fistula and they haven't even washed their hands and they say excuse me, please wash your hands.
Speaker 2:And pick it back up. I've heard that too.
Speaker 1:Oh my word, yeah, I mean the mind boggles, but just making a simple statement like that. These people were on Medicare or Medicaid and they were no longer persona non grata in their facilities and in that, in some cases continued to the point where they were involuntarily discharged. Now that for me, I mean just thinking about that again. That's one of those things that took me a long time in this research process to believe that in America today, people on dialysis, which, as you quite rightly pointed out, are some of the most vulnerable people, could be involuntarily discharged and subsequently blackballed in other facilities in the area. Because, well, you know, because they made a valid complaint.
Speaker 1:They spoke up. Maybe you know so. Ok, so I began to see that A there were certain people who were on power trips, but mostly it was because everyone is overworked, Everyone's stressed out, the patients are super sick, they're feeling bad because they're getting this high pressure, high speed, short duration dialysis, so they're feeling horrible. You put these people together, there's going to be tension, there's going to be friction and if there is a possibility, if the option even exists for involuntary discharge, some people will take it and it doesn't necessarily. I mean, it sounds inhuman and I think it is. Ultimately, I think what's inhuman is the system in which people are put and the ability to be able to say OK, you're gone. And that is for me, coming from a business background, that's about business culture, that's about a high pressure, numbers based, money driven culture that ultimately does put the bottom line in some cases the bottom line in front of human well-being. And again I want to say what I've said before, that I'm not talking about a lot of fantastic ethical dialysis.
Speaker 1:People out there, everywhere, from the nephrologists to the registered nurses to the others, and many of whom cannot believe what I'm saying because they themselves could not, they don't have it in their hearts to do such a thing. And so they say, oh, come on, they must be exaggerating. Or you know, there is a troublesome patient every once in a while and I say, oh, really, have you seen one? And they say no, no, but my colleague has it. Yeah, but have you seen one? Because I went out and searched for the patient who brought the gun to the clinic just to see, and I never found that person. I'm sure they exist, I'm sure, but anyway. So, yeah, so involuntary discharge and blackballing for me were just wow. So they end up in the ER. The ER docs are furious about this. I've gotten a number of messages from ER docs as well, saying you're right, and why do we have these people in our ER?
Speaker 2:This is a crazy Because they can't get dialysis anywhere else.
Speaker 1:Anywhere else, and how?
Speaker 2:long are they going to live? What's their quality of life? On one time a week kind of dialysis?
Speaker 1:Right, no, exactly. I spent three days with a dialysis patient who had been terminated in San Jose, california, and he could only dialysis in the ER and he would go in. We'd get up at someone, godly hour of the morning.
Speaker 2:To wait.
Speaker 1:And to go and wait and wait and they take his blood, draws blood and come back and say I'm sorry You're a potassium Isn't high enough for us to dialysis yet You're not quite dead enough yet.
Speaker 1:I mean, that's what. They didn't say, that, but that was the implication. So I'm not a doctor, but I can imagine that would shorten your lifespan if you're getting right to the precipice in death and then getting dragged back and sure enough he is dead. Greg Hanson rest in peace. But anyway, this is part of why this really stuck with me too, because I did. I spent a lot of time with patients, I spent a lot of time with caregivers and, yeah, this shouldn't be happening.
Speaker 2:Well, you know, the folks that we serve are the highly desirable right your employer-sponsored health plans, who are going to pay at least four times as much for dialysis as your government-sponsored plans are. So I do think that's where interesting stat I share, sometimes as well, because sometimes folks are. Really it always kind of strikes me as odd that we would be concerned about dialysis companies' profit. So here's an interesting stat this is from in 2019, DeVita profited. It was $1.77 billion out of $3 billion in revenue, and when you consider that 6% of DeVita and Prasinius' book of business is from Medicare patients and Medicare makes up 94% of their revenue. Yeah, yeah, that to me was a statistic. When I first heard that I thought, holy heck, I'm all for making money. Who doesn't want to make money? But it should be predatory and dialysis is one of these industries that feels highly predatory. I always say the only industry that's dirtier than dialysis is drugs. Pharmacy might have us top Tom.
Speaker 1:Oh, I thought you were talking about the cartels. Well, maybe it's the same thing. Yeah, yeah, no, it is problematic. And again, I know how, when you put business school people in charge of very delicate medical procedures, they feel good. At the end of the day, they're doing what they have been taught to do, which is maximize returns for shareholders, and that's kind of a religion for business people, but it ends up producing really bad results at the sharp end of the week.
Speaker 2:It's not a bad thing to make money. It's a bad thing when we're making a profit at the expense of businesses that make a profit. Typically, in most businesses, we make a profit by creating something of value that has a meaning and a benefit for a lot of other people. Dialysis absolutely does. You can see your kids grow up and you can watch your kids get married and you can live, but the cost sometimes is so hard. So we talked a little bit about hippers. These are your high-income producing patients, your high-revenue patients. What about hippercompression and hipprobus?
Speaker 1:Well, these are things that a whistleblower one of the whistleblowers I talked with, david Barbetta explained to me in detail. He brought a very successful lawsuit against DeVita for alleged kickbacks and other things. And again, this is all allegations because it was settled. So it was settled for just north of $400 million. So I'm assuming that there's some truth to what was going on. But, in any case, david Barbetta worked in the finance department, in the mergers and acquisitions department, and he described ways in which, according to him, it was possible to adjust the valuation of dialysis facilities depending on whether you wanted to have a high number or a low number. So if you wanted to, let's say, favor a doctor whose practice you wanted to buy with a high valuation for, pay that person and presumably the idea goes that you were paying them ultimately for referrals.
Speaker 1:Now, I don't know whether that was the case. That was alleged by David Barbetta and his lawyer and by the US government, but it was settled, so we don't know. But the idea is that that would be, if it were the case, a form of a kickback. You're paying someone for future patient referrals, which is illegal, but the notion that you could the HIPAA compression is you make it smaller and HIPAA bus is. I mean, you make the number of high income patients in your facility artificially small and HIPAA bus is. You imagine a big Greyhound bus pulling up in front of your facility full of high value patients and they all come in and sit down in the chairs and there you go. You've gotten a huge bump to your income. And that's fanciful, mystical thinking accounting that actually should not be used in a serious valuation. But that's what HIPAA compression and HIPAA bus, as I understand them, were in that lawsuit.
Speaker 2:Interesting and especially the whole concept that you talk about and the joint venture and the buying and selling of facilities and the strategy behind that in terms of profiteering here really got me thinking about kind of a little bit of the environment that I think that I don't know the cynic in me, she's in here. I like to keep her back here in the back, but that I worry about that we're not heading to under the guise of value based care.
Speaker 2:What? No, no, no, I don't know. Value-based care I go round and round with that because it sounds really, really good and I would like to believe. I would like to believe in it, but there's still more money. And putting people in a dialysis chair.
Speaker 2:Yeah, the end of the day and the fact that we're gonna give. There's a cynic in me. She doesn't come out very often, so, but you know, people don't make money when we get them off the insulin, right. Where's the money in helping people revert diabetes? Where's the money in in helping to revert stages of kidney disease? Now I will say we love to do that here at specialty care management and it's really fun to take somebody who comes in and they're sitting at CKD4 and you can help them bump up to a stage 3b or 3a. That's super exciting and that juices me up like nobody's business. Um, but you know, I just I just wonder if that's not. You know something that we should be careful of in the setting, in this setting that we're in in terms of value-based care. What are your thoughts on that?
Speaker 1:Well, I think you put your finger on. I mean, what we're dealing with is is is Perverse incentives, incentives to let people slide until they reach. You know, as one person told, put it the one one medical professional, put it the precipice of death before you start treating them. And, as you said earlier on, preventative medicine is the way to go here. Help people keep their kidneys, for goodness sake. They don't want to get on dialysis in the first place. Since I've published the book Several, I've met several people who are really stars in this Dr Catherine Tuttle, out in Seattle and sorry, in Spokane, at Providence Health in Spokane is is a is a luminary in the field of, you know, the GLP one receptor and SGLT2 inhibitors and Lots of press.
Speaker 2:Right now they are the black sheep and the industry right now because of their cost, but right a tropic effect effects in terms of protecting hearts and kidneys.
Speaker 1:Yeah, and she was the head of the recent Ozympic trial. That was interrupted because it was doing so well for Kidney care and they actually interrupted it because it was immoral not to give it to the control group. And on that day a Davidus stock dropped something like 20%.
Speaker 2:So I read that I.
Speaker 1:Know it is. It is if Right and the big if right, the big if if done right, if used correctly, as Dr Catherine Tuttle and others, many others, are our counseling, this could be a game changer. This is a game changer. I mean that kidney week this year there was a huge amount of buzz around this that I'm told I haven't been kidney-waking off of it, but I'm told was it was new, was it was special and Cheap either.
Speaker 2:Ozympic is no real in crushing a lot of companies.
Speaker 1:Yeah, I mean, it's got to be. You know, the fact is that it's being sold right for for weight loss, isn't we? And that's the primary. So you know, we got to get the Elon Musk's who are taking a little bit to look a little more spelt for for Thanksgiving dinner. Forget about that stuff. I mean, this is where the federal government needs to come in and say look, there are 37 odd million Americans with some level of kidney disease. Only 10% even know it. Step in major, major, major Program here to identify and treat with now the tools that we have, which we didn't have what five, ten years ago?
Speaker 2:They didn't yes so you know that and we we've had people because of the shortages of these drugs. We've had some folks who have an organ that doesn't work that really need this medication that can't get it. We've had some folks have to go back on multi, multiple injections a day of insulin because they can't get it. That's crazy to me, and what is that when you think about the implications that's gonna have in terms of being able to meet standards of care? These medications are part of the guideline for kidney disease management because of the protective effects that the profound, perfective attacks effects that it has, and people can't get them. So what is that gonna? How is that gonna show up for us in terms of outcome?
Speaker 1:Yeah, yeah, I mean good question. This is a, this is an opportunity for big pharma to really really burnish it's somewhat tarnished image and say, hey, this, these are the treatments for the masses, these are treatments that should be distributed in many low-income and and minority neighborhoods. I mean, these are, these are.
Speaker 1:These are life-saving and can and game-changing our highest risk populations yes, I risk populations around the nation and, and and you know so, this is something that it is, should be, a matter of federal policy and state policy. It seems to me keeping those prices low and education reaching out to people and, you know, finding out that the the 90% who don't even know that their kidneys are on the downslope, right they got to know in my language.
Speaker 2:That's our passion here saving kidneys, absolutely.
Speaker 1:Well it does sound like a care health management is is has got its heart in the right place and its brains in the right place too. I mean, that's the problem here. There's a. You know you do the. If you follow the money and if you really are Shareholder value-driven, that becomes an excuse for all kinds of behaviors that ultimately, you know Really don't serve patients or workers well at all.
Speaker 2:Well, you know what I say, tom. I say anybody can make profit for a minute, yeah, but to make, to make a kind of legacy in impact, impact to me is so much more than than profit. It when I talk, when I think about the word impact, that has reference to the monetary value as well as the human element. When you combine those two, you have the capacity and the wherewithal to really create a legacy kind of income that that far outlasts you and I Really think that you know there are certainly company, the companies out there that are doing that.
Speaker 2:I think specialty care, Matt even if I wasn't working here at specialty care, imagine I would say that but largely because the head of our company that's is truly that's kind of his. His paradigm Really is to do good in the world. And there's a lot of people out there that really do want to do good in the world, they really do want to create meaningful change and but you know they're still they're not enough of us out there. We're growing. I would say that I think we're growing.
Speaker 1:Yeah, I get closer to the precipice. I think we we begin to say, oh, better get up off the couch or else, right, I mean, if you sit on the couch it's gonna come to you, it'll be coming in your front door, right?
Speaker 1:So that's the couch and do something. I do think, yeah, the things have gotten so bad in in so many areas of health care that People have had enough, and it's, it's a it's, it's one of those truly bipartisan things that that people who will vote for Trump in the next election, people who will vote for Biden in the next election, people who will vote for who knows, won't even vote. They can all agree on one thing, and that is that our health care system is deeply broken and we desperately need to fix it. It's not sustainable. Eight the 18 going on, 19% of gross national product Is spent on health care. That's twice as much as other developed nations. And what are our results?
Speaker 2:You know it's hockey sticks.
Speaker 1:It's hockey. The prices go up and the and the outcomes go down. Now I don't know about you, but that's not the America I was born and raised in.
Speaker 2:I'm seeing Marty McCary, marty, marty, marty McCary does it. I don't know if you followed him. He does a great job talking about that very phenomenon, dr McCary's. When you listen to him talk, it's amazing For such an advanced society as ours how we cannot excel in terms of how we and here's the bottom line you and I were talking about this earlier is that someday it's gonna be you or me, or it's gonna be somebody we care about. That's gonna be in the system that we are either creating or we're allowing to proliferate, and at some point, the consumer. It's kind of like. I don't know if you've got kids, but if you've ever watched the movie ants there are ants and there are grasshoppers, and it's time for the ants to say no more.
Speaker 1:No, it's, and when you have a personal stake. One of my favorite examples is under the Trump administration, alex Azar Now, alex Azar came from pharma. He was a VP at Eli Lilly, under whose watch insulin prices triple. So this is not, you know, in my book, the average nice guy, the guy that's going to take on the big corporations. Well, guess what? His dad was on dialysis for three years before he got a transplant. He, alex Azar, saw behind the curtain. He understood what was going on in the industry and he wrote the executive order which was passed under Trump, which, to my knowledge, in the last 30 years, has been one of the most visionary documents of what to do. You mentioned home hemodialysis.
Speaker 2:Yeah.
Speaker 1:And this is you know, getting I forget what the number is 80 to 90 percent of patients on home hemodialysis and and and and preventative medicine, and you know all of the things that we've been talking about. That executive order stressed and that came from someone who you know I wouldn't have expected it to come from, but he knew.
Speaker 1:And so that person that personal link you know I would give I was going to say my left arm, I'm exaggerating I would give a lot to to have a list of the people in Congress who have relatives on dialysis. I would give a lot to have a list of the sports stars and actors and actresses and, you know, hollywood figures people who have a direct personal connection with dialysis. They're going to feel different and they're going to get it in a way that, in a way that you know that most people don't and I didn't either. Before you know, I was driving by these mall and and and industrial park facilities with their fancy pastel facades and thinking how nice healthcare in the mall, wow, and I didn't realize what was going on behind the mirrored glass.
Speaker 2:Yeah, yeah. Well, tom, I got to tell you I could talk through every chapter in this book with you, but as we're running out of time, how do people get ahold of you If they have questions, if they want to know more? Certainly, I would encourage everybody to get a copy of Tom's book and not just read it, but really digest it, because it really will change how we look at one of the most, one of the most predatory types of claims in our in our industry. But how do people get ahold of you If they have questions or want to talk to you more about?
Speaker 1:Yeah, I guess the easiest way is email. You know, my email is Tom at Tom Muller, that's T-O-M-M-U-E-L-L-E-R. We pronounce it like the prosecutor, right? We can say that for another couple of years. And then people say who, tommullerco? That's dot C-O, not dot com, because there's another long suffering Tom Muller out there who forwards me all the emails that come.
Speaker 2:Oh, not your friends, right.
Speaker 1:Yeah, exactly, there are a lot of Tom Muller's out there. There's actually a film about Tom. My name is Tom Muller, in German, anyway. So yeah, so email is probably the best and my website is wwwTomMullerco and you know you can read up about it. But, yeah, I would really really appreciate all feedback on the book, all questions, all, because this is a work in progress for me. I'm not done with this yet and I'm learning. People teach me every single week I'd learn something new. So I don't pretend to be a know-it-all and people like you can really inform my understanding of this and, you know, make it, make it possible for you to do some good, because ultimately, the end of the day, you know, if that book just sits on people's shelves and doesn't create some kind of positive change, then it's just a waste of a tree. I mean, it really isn't worth doing. That's kind of the way I feel.
Speaker 2:Absolutely Well. Knowledge is where we start. You can't change anything unless you know what it is that needs to be changed and what you want to make better. So, Tom, I know you put a lot of work into the research that you did in here, the stories that you share, the behind the scenes. I just appreciate the work that you put in to talk about an industry that's really important to me on a personal and professional level, and just thank you. I appreciate that and thanks for taking time to talk with us today.
Speaker 1:Thank you very much, Kimberly. And again, coming from a health care professional like yourself with a huge experience, that means a lot to me.
Speaker 2:I'll pay you later.
Speaker 1:All right. Are we off the wall? All right, well, are we off the wall? All right, well, thank you, thank you, thank you, thank you, thank you, thank you.