    [Senate Hearing 118-74]
    [From the U.S. Government Publishing Office]

                                                             S. Hrg. 118-74

        UNDER THE WEATHER: DIAGNOSING THE HEALTH COSTS OF CLIMATE CHANGE

    =======================================================================

                                    HEARING

                                   before the

                            COMMITTEE ON THE BUDGET
                              UNITED STATES SENATE

                        ONE HUNDRED EIGHTEENTH CONGRESS

                                 FIRST SESSION

                                   __________

                                 April 26, 2023

                                   __________

               Printed for the use of the Committee on the Budget

                    [GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

                                www.govinfo.gov

                                   ______

                     U.S. GOVERNMENT PUBLISHING OFFICE

    53-165                    WASHINGTON : 2023

                            COMMITTEE ON THE BUDGET

                   SHELDON WHITEHOUSE, Rhode Island, Chairman

    PATTY MURRAY, Washington             CHARLES E. GRASSLEY, Iowa
    RON WYDEN, Oregon                    MIKE CRAPO, Idaho
    DEBBIE STABENOW, Michigan            LINDSEY O. GRAHAM, South Carolina
    BERNARD SANDERS, Vermont             RON JOHNSON, Wisconsin
    MARK R. WARNER, Virginia             MITT ROMNEY, Utah
    JEFF MERKLEY, Oregon                 ROGER MARSHALL, Kansas
    TIM KAINE, Virginia                  MIKE BRAUN, Indiana
    CHRIS VAN HOLLEN, Maryland           JOHN KENNEDY, Louisiana
    BEN RAY LUJAN, New Mexico            RICK SCOTT, Florida
    ALEX PADILLA, California             MIKE LEE, Utah

                       Dan Dudis, Majority Staff Director
            Kolan Davis, Republican Staff Director and Chief Counsel
                       Mallory B. Nersesian, Chief Clerk
                      Alexander C. Scioscia, Hearing Clerk

                                C O N T E N T S

                                  ----------

                           WEDNESDAY, APRIL 26, 2023

                    OPENING STATEMENTS BY COMMITTEE MEMBERS

                                                                       Page
    Senator Sheldon Whitehouse, Chairman.............................     1
        Prepared Statement...........................................    36
    Senator Charles E. Grassley, Ranking Member......................     3
        Prepared Statement...........................................    38

                        STATEMENTS BY COMMITTEE MEMBERS

    Senator Chris Van Hollen.........................................     5
    Senator Alex Padilla.............................................    14
    Senator Ron Johnson..............................................    18
    Senator Tim Kaine................................................    30

                                   WITNESSES

    The Honorable Stephanie Smith, Esq., Member of the House of
      Delegates, District 45, Baltimore City, Maryland...............     6
        Prepared Statement...........................................    40
    Dr. Katelyn Moretti, Assistant Professor of Emergency Medicine,
      Brown Emergency Medicine.......................................     7
        Prepared Statement...........................................    43
    Dr. Michael Greenstone, Milton Friedman Distinguished Service
      Professor in Economics, and Director, Becker Friedman
      Institute, and the Energy Policy Institute, University of
      Chicago........................................................     9
        Prepared Statement...........................................    50
    Dr. Carl J. Schramm, University Professor, Syracuse University...    11
        Prepared Statement...........................................    65
    Mr. Michael Shellenberger, Founder & President, Environmental
      Progress.......................................................    13
        Prepared Statement...........................................    69

                                    APPENDIX

    Responses to post-hearing questions for the Record
        Hon. Smith...................................................    85
        Dr. Moretti..................................................    86
        Dr. Schramm..................................................    87
        Mr. Shellenberger............................................    89
    Charts submitted by Senator Charles E. Grassley..................    90
    Documents submitted for the Record by Chairman Sheldon Whitehouse    92
    Statement submitted for the Record by the National Ski Areas
      Association....................................................   117

        UNDER THE WEATHER: DIAGNOSING THE HEALTH COSTS OF CLIMATE CHANGE

                                  ----------

                           WEDNESDAY, APRIL 26, 2023

                                               Committee on the Budget,
                                                           U.S. Senate,
                                                        Washington, DC.

        The hearing was convened, pursuant to notice, at 10:15
    a.m., in the Dirksen Senate Office Building, Hon. Sheldon
    Whitehouse, Chairman of the Committee, presiding.
        Present: Senators Whitehouse, Kaine, Van Hollen, Padilla,
    Grassley, Crapo, Johnson, Marshall, Braun, and R. Scott.
        Also present: Democratic staff: Dan Dudis, Majority Staff
    Director; Alexandra Gilliland, Climate Policy Expert; Dan
    Ruboss; Senior Tax and Economic Advisor and Member of Outreach
    Director.
        Republican staff: Chris Conlin, Deputy Staff Director;
    Krisann Pearce, General Counsel; Jordan Pakula, Professional
    Staff Member; Nic Pottebaum, Professional Staff Member.
        Witnesses:
        The Honorable Stephanie Smith, Esq., Member of the House of
    Delegates, District 45, Baltimore City, Maryland
        Dr. Katelyn Moretti, Assistant Professor of Emergency
    Medicine, Brown Emergency Medicine
        Dr. Michael Greenstone, Milton Friedman Distinguished
    Service Professor in Economics, and Director, Becker Friedman
    Institute, and the Energy Policy Institute, University of
    Chicago
        Dr. Carl J. Schramm, University Professor, Syracuse
    University
        Mr. Michael Shellenberger, Founder & President,
    Environmental Progress

              OPENING STATEMENT OF CHAIRMAN WHITEHOUSE \1\
    ---------------------------------------------------------------------------

        \1\ Prepared statement of Chairman Whitehouse appears in the
    appendix on page 36.
    ---------------------------------------------------------------------------
        Chairman Whitehouse. Let me call the hearing to order, and
    welcome Ranking Member Grassley and our witnesses and guests to
    our seventh Committee hearing. Today we will continue our
    series on the economic costs of climate change, costs that are
    already affecting workers, families and governments across the
    country.
        Today we explore the climate harms to public health and the
    associated economic and budgetary burdens. As we've heard
    throughout this series, the climate crisis brings with it what
    witnesses have repeatedly called systemic risks, ones that
    cascade beyond a particular troubled sector to harm the entire
    economy and pose serious threats to the federal budget.
        Their warnings aren't for future lawmakers; they're for us
    in this room to protect against. Health care costs related to
    combustion of fossil fuels are estimated to total nearly $820
    billion in the United States annually. Over the ten-year budget
    window, that's over $8 trillion.
        The direct costs of health care, doctor's appointments,
    emergency room visits, rehabilitation and home health support,
    prescription drugs, strain the pocketbooks of American
    families. The indirect economic costs from lost work and school
    days, reduced productivity and increased economic instability
    all add to that $8 trillion budgetary burden.
        If you care about deficits or economic growth, you have to
    care about climate change and its costs and risks. Yet with
    evidence of the economic dangers of climate change piling up
    around us, House Republicans propose eliminating clean energy
    tax credits and investments.
        They have completely lost their grip on reality, and are so
    subservient to fossil fuel overlords that they're willing to
    eliminate hundreds of thousands of clean energy jobs, cause
    trillions in climate harm and shrink our economy by letting
    China build the technologies of tomorrow.
        Their non-starter of a default plan would escalate carbon
    pollution, raising temperatures around the world. In Rhode
    Island in the last century, the average temperature is up three
    degrees. Rhode Island emergency rooms see a rise in hospital
    visits any time there are multiple 80 plus degree days in a
    row.
        On average, there are 702 heat-related deaths and over
    67,000 emergency room visits each year in America due to heat.
    Extreme temperatures are more frequent and severe, and that
    costs lives and dollars. The Pacific Northwest's deadly
    heatwave in 2021 saw approximately 600 additional deaths in one
    week in Oregon and Washington state. A heat wave of that
    intensity would have been virtually impossible without human-
    caused climate change.
        Higher temperatures also encourage smog formation and
    contribute to higher levels of airborne particulate matter and
    pollen. The combination of heat and poor air quality increases
    cardiovascular and respiratory risk, and the likelihood and
    severity of asthma attacks.
        Warming climates expand disease vectors northwards,
    particularly insects that carry disease like Lyme disease, West
    Nile virus, dengue fever and Zika. Indeed, there is evidence
    that climate shifts are the driving force behind more frequent
    disease outbreaks.
        Climate upheaval brings more frequent and extreme weather
    events, which bring their own health care costs. The news
    reports regularly how hurricanes, wildfires, floods and
    droughts lead to death, injury and illness. Hurricane Sandy is
    estimated to have cost $3.3 billion in health costs, including
    nearly 4,700 emergency room visits, over 6,600 hospital
    admissions and 273 deaths.
        The public health harms from climate change fall most
    heavily on the elderly, on children, on people of color, on the
    poor and on people with pre-existing conditions. Climate change
    is a multiplier, both of illness rates and economic
    disparities. As a result, it will worsen economic inequality
    and widen gaps in health outcomes and life expectancy between
    poor and wealthy.
        Federal programs like Medicare and Medicaid will be heavily
    impacted, given the populations they serve. In 2021, Medicare
    and Medicaid constituted almost 40 percent of all U.S. health
    care spending, and almost 20 percent of all federal spending.
    Of course, these climate-related health care costs come on top
    of the many other climate costs we've heard about at previous
    hearings.
        Witnesses have warned us of risks that could take down the
    economy. The risk of a coastal property values crash, the risk
    of a similar wipeout in property values in wildfire country,
    the risk of insurance collapse as unpredictability drives
    insurers out of markets, the risk of the carbon bubble bursting
    in a disorderly transition from fossil fuel.
        These are not alternative scenarios, they all could happen.
    We're playing with dangerous stakes. The consulting firm
    Deloitte has pegged the difference between getting climate
    right and getting it wrong at a more than $220 trillion swing.
    In a world in which those long warned-of evils have come to
    pass, the $8 trillion health care cost burden will likely grow,
    as a crashed economy and budget will shrink. Not a good
    combination.
        As this hearing will make clear, the effects of climate
    crisis on our nation's public health are dangerous and costly
    to families, to businesses and to the federal government, and
    this problem will only get worse and become more expensive
    unless we act now. I turn now to our distinguished Ranking
    Member, Senator Grassley.

               OPENING STATEMENT OF SENATOR GRASSLEY \2\
    ---------------------------------------------------------------------------

        \2\ Prepared statement of Senator Grassley appears in the appendix
    on page 38.
    ---------------------------------------------------------------------------
        Senator Grassley. Thank you, Senator Whitehouse, Mr.
    Chairman. I want you to know that last week's hearing on tax
    policy was really refreshing. Revenues are a critical part of
    the federal budget, and we should remain very focused on the
    pressing fiscal issues facing our country.
        My Republican colleagues in the other body introduced
    legislation to lift the debt ceiling and curb our federal
    spending. This week, I don't agree with every item in the bill.
    In fact, I have read only excerpts of it. But things are clear.
    America's fiscal problems are serious and Republicans are
    working to tackle those problems head on.
        The U.S. is facing public debt that in a few years will
    surpass record levels set in the wake of World War II. Even if
    we don't agree with all the contents of the House bill,
    Republicans are following through with concrete solutions to
    address our dire fiscal situation and to reduce inflation.
        It's been 88 days since President Biden and the Speaker of
    House McCarthy met down at the White House as an initial
    meeting to deal with these issues. No meeting has taken place
    since then. So I see President Biden refusing to even enter a
    negotiation room with Speaker McCarthy. Senate Democrats
    haven't lifted a finger to prevent us from going head-long off
    the fiscal cliff.
        The Budget Committee is currently holding its sixth hearing
    on climate change. Let's now work together to write a budget
    that has guardrails to rein in federal spending. I have a
    reputation for traveling to each of the 99 counties, holding a
    Q and A with my constituents in each of those counties 42 years
    in a row. 28 counties so far this year.
        Not every Iowan agrees with every decision I make as a
    Senator, but I'm always willing to have a conversation about
    the topics that matter most to them and our country. Health
    care concerns often come up. Now, however, the health effects
    of climate change isn't one that I've heard much, if at all.
        Our government health care programs, including Medicare,
    Medicaid and public health, are projected to spend $21 trillion
    over the next ten years. I do hear a lot from my constituents
    about preserving Medicare, and I agree that we should be doing
    that.
        We need to ensure that these taxpayers funds that we call
    Social Security, Medicare and Medicaid are used wisely to
    address pressing health issues facing Americans, and we should
    be doing that right now. If Members are really interested in a
    bipartisan conversation about public health challenges and
    health care financing, I suggest that we focus on the key
    health challenges facing Americans right now, and some of these
    are the 107,000 Americans that died from drug overdose,
    particularly fentanyl, killing 70,000 of that 107,000, how to
    lower prescription drug costs so patients don't delay treatment
    and save money, how to improve access to rural health care as
    hospitals and clinics are struggling to stay afloat, and how to
    address the leading cause of death in America, which happens to
    be heart disease.
        We have significant health care challenges right now. A
    climate change mandate from Washington, D.C. won't solve the
    public health and health care finance challenges that we face
    this very day. I look forward to hearing testimony of Mr.
    Shellenberger. He was invited to serve as an expert reviewer by
    the Intergovernmental Panel on Climate Change.
        He's also been recognized by Time magazine as quote-unquote
    ``a hero of the environment.'' The majority argues that climate
    change will catastrophically lead to more heat-related
    illnesses and deaths. They argue it will dramatically amplify
    global disease, damage respiratory health and harm more
    Americans from natural disasters. I'm confident that Mr.
    Shellenberger will be able to separate their alarm from
    reality.
        Dr. Schramm, I also welcome you back to the Committee. You
    remember when the Budget Committee focused on budgetary
    matters. You testified as a witness on the Reagan
    administration budget proposal in 1983.
        That year, the Committee held six hearings in one month as
    we prepared a budget resolution, and when Reagan and Tip
    O'Neill got together in 1983 to solve that problem, I doubt if
    they thought that they were doing it for a whole half century.
    But it works out that Social Security won't run out of surplus
    money until 2033, then afterwards we're in a crisis because
    people will only be getting 77 percent of what they're getting
    right now.
        Dr. Schramm, you founded the nation's first research
    organization dedicated to understanding health care financing,
    and I'm interested in exploring your current work to ensure our
    public health institutions focus on their core mission where
    they've been failing. I yield.
        Chairman Whitehouse. Thank you. We have five witnesses
    today, including a witness from Maryland, who will be
    introduced by Senator Van Hollen. I want to thank Delegate
    Stephanie Smith for being here, and turn to Senator Van Hollen
    for his introduction.

                    STATEMENT OF SENATOR VAN HOLLEN

        Senator Van Hollen. Thank you Mr. Chairman and Ranking
    Member Grassley. Welcome to all our witnesses today. I have the
    special honor of being able to introduce a colleague and friend
    from the state of Maryland, Delegate Stephanie Smith, who's a
    member of the Maryland House of Delegates representing District
    45.
        Delegate Smith was just reelected to serve a second term
    representing a part of Baltimore City. She serves on the
    Maryland House Appropriations Committee and chairs the
    Education and Economic Development Subcommittee. She's also the
    chair of the Baltimore City delegation in Annapolis, and I
    congratulate her on wrapping up a very successful 90 day
    session.
        But Delegate Smith is here not only because she's a skilled
    legislator, but more important for today's purposes she's a
    federal policy expert and an advocate on many of the issues
    that the Committee will cover today, especially her
    understanding and knowledge of the negative health impacts that
    climate change will have broadly, but especially in American
    cities and especially the rising health care costs due to urban
    heat.
        So Mr. Chairman, Members of the Committee, thank you for
    inviting her to be with us today. I look forward to returning
    to try to ask questions of both Delegate Smith and other
    members of the panel. But welcome and thank you Mr. Chairman
    and Members for inviting a very important witness today.
        Chairman Whitehouse. Thank you Senator Van Hollen and thank
    you Delegate Smith. Our other witnesses are Dr. Katelyn
    Moretti. She's an Assistant Professor in the Department of
    Emergency Medicine at Brown University, and a board-certified
    emergency medicine physician, practicing in Providence, Rhode
    Island.
        She founded and co-chairs the Rhode Island Medical
    Society's Climate Change and Health Committee. We look forward
    to her testimony and her unique perspective as an emergency
    medicine physician.
        Next we have Dr. Michael Greenstone, who is the Milton
    Friedman Distinguished Service Professor in Economics, as well
    as the Director of the Becker Friedman Institute and the
    Director of the Energy Policy Institute at the University of
    Chicago.
        His research focuses on uncovering the benefits and costs
    of environmental quality and society's energy choices. Dr.
    Greenstone, thank you for being here. We look forward to your
    testimony.
        Next we have Dr. Carl Schramm, who is a university
    professor in the School of Information Studies at Syracuse
    University. He previously served on the faculty of the Johns
    Hopkins School of Hygiene and Public Health, where he focused
    on public policy in hospital finance.
        Additionally, he has founded and co-founded several
    companies in health care finance and information technology. We
    welcome him and look forward to his testimony.
        Finally, we'll hear from Michael Shellenberger, who is the
    founder and president of Environmental Progress. He is also the
    co-founder of the Breakthrough Institute, where he served as
    president from 2003 to 2015. We welcome him as well.
        Delegate Smith, you have five minutes to deliver your
    testimony. Your full statement will be made a part of the
    official record. Please proceed.

    STATEMENT OF THE HONORABLE STEPHANIE SMITH, ESQ., MEMBER OF THE
     HOUSE OF DELEGATES, DISTRICT 45, BALTIMORE CITY, MARYLAND \3\
    ---------------------------------------------------------------------------

        \3\ Prepared statement of Hon. Smith appears in the appendix on
    page 40.
    ---------------------------------------------------------------------------
        Delegate Smith. Good morning Chairman Whitehouse, also good
    morning, Ranking Member Grassley and to all the distinguished
    Members of the Committee. For the record, I'm Delegate
    Stephanie Smith. I properly represent Maryland's 45th state
    legislative district in Baltimore City, and as you heard from
    my great Senator Van Hollen, I am honored to serve on the
    Appropriations Committee and also chair of the Baltimore City
    House delegation.
        But outside of my work as a legislator, I've spent my
    career for nearly two decades at the intersection of
    environmental health, urban planning and community development,
    and today I will share observations about the public health
    costs of climate change, and that will come from both my
    professional ends, as well as the experiences of my neighbors.
        Baltimore's average temperature has risen three degrees
    over the last century, nearly twice as much as the national, as
    the nation at large and beyond overall increases in average
    temperature. Baltimore is one of the leading U.S. cities rather
    for the urban heat island effect.
        Urban heat islands are hyper-local pockets of elevated
    temperatures within a city that can exacerbate adverse health
    outcomes for residents with diabetes, cardiovascular conditions
    and respiratory health challenges, just to name a few. A
    concentration of paved surfaces, buildings and industrial
    activities amplify rising temperatures, and Baltimore's urban
    heat islands make our city the ninth hottest urban hot zone in
    the United States.
        Residents inside Baltimore's urban heat islands are more
    likely to be people of color, low income and live shorter
    lives. My district is home to landmarks like Pennsylvania
    Station and Johns Hopkins Medical Center, as well as
    communities that have faced the policy harm of redlining and
    disinvestment.
        The top of my district boasts mature trees and significant
    green spaces like Herringbone Park. However, I live at the
    bottom of my district in East Baltimore, which is home to dense
    rowhome communities with the hottest temperatures in Baltimore
    City.
        As climate change delivers more extreme heat days,
    Baltimore is on pace to see a sixfold increase in these very
    hot days in the next 15 years. In East Baltimore, communities
    like Madison-Eastend and Mcelderry Park, this can mean more
    emergency medical calls for chronic conditions.
        As the heat index approaches 103 degrees, emergency calls
    for congestive heart failure can double. I personally live in a
    123 year-old rehabbed rowhome with my husband, my young
    children and my mother, who has a chronic heart condition.
    Thankfully, our home has central air conditioning that can
    maintain her comfort on the hottest days.
        All of my neighbors deserve to live with the dignity and
    the baseline resilience needed to survive extreme heat.
    Unfortunately, news reports have detailed some of the
    difficulties my neighbors face as extreme heat days multiply.
        In July 2019, the University of Maryland put sensors inside
    of Mcelderry Park homes and recorded interior temperatures as
    high as 97 degrees, with a heat index of 119 degrees. Parents
    are keeping children confined in hot homes or do not install
    window air conditioning units on the first floor, due to
    concerns about public safety.
        Tammy Jackson, a resident of Mcelderry Park lamented the
    interior temperature was 92 degrees on a 100 degree day. With
    asthmatic grandchildren, Jackson doesn't know where to find
    relief. She simply exclaimed ``This is too much! Lord, this is
    too much.'' Yes, the scope of this challenge can feel like it's
    too much, but I do have good news to share.
        While climate change continues to increase temperatures,
    there are investments that we can make at every level of
    government, including increasing the urban tree canopy,
    prioritizing green roofs and surfaces and construction,
    providing more accessibility to cooling centers, and
    proactively reaching out to our most vulnerable community
    members during Code Red days.
        While this problem is enormous, mitigating adverse health
    impacts of extreme heat can mean cost savings from reduced
    Medicaid claims, reduced emergency medical care for the
    uninsured, and increased economic productivity from improved
    healthiness.
        The state of Maryland through our Climate Solutions Now Act
    of 2022 invested in five million urban tree plantings and
    encouraged green infrastructure. But we will need local, state
    and federal strategies and investments to blunt the aggressive
    harm extreme heat poses to urban centers.
        I'm honored to have the opportunity to speak today, and to
    lift up the experiences of my neighbors, and thank you again
    for your time.
        Chairman Whitehouse. Thank you very much, Delegate. I
    appreciate you being here. Dr. Moretti, please proceed.

       STATEMENT OF DR. KATELYN MORETTI, ASSISTANT PROFESSOR OF
            EMERGENCY MEDICINE, BROWN EMERGENCY MEDICINE \4\
    ---------------------------------------------------------------------------

        \4\ Prepared statement of Dr. Moretti appears in the appendix on
    page 43.
    ---------------------------------------------------------------------------
        Dr. Moretti. Thank you Chairman Whitehouse, Ranking Member
    Grassley, and honorable Members of the Committee for this
    invitation to speak with you today. As an emergency physician,
    I see the impacts of climate change on my patients every day
    right now. However, the health consequences are so vast and
    varied that the role of climate change is often hidden.
        At times, the relationship is clear. For example, I treated
    a young man who suffered heat stress while working in
    construction. With his body temperature elevated to unsafe
    levels, he required rapid cooling through IV fluids. He
    suffered muscle breakdown and poisoned his kidney, requiring a
    hospital admission.
        But other times, this link is not as clear. Consider my 85
    year-old patient who presented with a heart attack. It was only
    because of astute EMS providers that we were able to connect
    her heart condition to an overheated apartment that lacked air
    conditioning, coupled with her inability to leave.
        Climate change is a threat multiplier, with health impacts
    happening through many different pathways such as temperature
    extremes, air pollution or disruptions in supply chains.
    Climate change is also a threat magnifier, worsening chronic
    diseases such as heart disease, and causing acute flares of
    other conditions such as asthma exacerbations.
        Because these effects are so widespread, it makes
    calculating the total magnitude of these impacts difficult.
    Therefore, the economic impacts are severely underestimated.
    Only easily quantifiable disasters and their infrastructure or
    crop damages are typically considered.
        Health-related costs are seldom if ever included in the
    math on climate change economic impacts. In addition, climate
    repercussions are not felt equally. When I come to work during
    a heat wave, I worry about the elderly. I worry about the blue
    collar workers outside, and I worry about my pregnant patients
    unable to regulate their body temperatures.
        I worry about their unborn children, as heat increases the
    risk of fetal death, premature labor and long-term health
    problems after birth. Similarly, when I consider the potential
    effects of a hurricane in my home state, I worry about my
    patients that lack the resources to evacuate.
        I worry about my patients with disabilities that rely on
    electricity for their health, those that need breathing
    machines or dialysis. Notably, the patients that are most at
    risk are the same patients most likely to be on Medicaid or
    Medicare and least able to afford these costs. While we may not
    know the total cost of climate change on health, we know they
    are immense and growing.
        Nearly every child in the world is at risk from one climate
    threat, and Medicaid covers almost 40 percent of children in
    the U.S. Children and infants have increased vulnerability to
    climate change. For example, smaller airways are more sensitive
    to swelling from air pollution. Children are at increased risk
    for mental and physical trauma from disasters, and they bear
    the consequences of these impacts for many more years to come.
        This spring, I have seen the same teen on multiple
    occasions for her asthma. On one visit, her breathing was so
    bad we needed to put her on a breathing machine, pushing air
    into her lungs. Her asthma is worsened by an extended pollen
    season, and her house close to the highway puts her at constant
    exposure to air pollution.
        Recently, there were brushfires in western Rhode Island,
    and I expect to see her again in the Emergency Department. In
    the Medicare population, chronic conditions such as
    disabilities, increased vulnerability to climate change, age
    and heart disease are risk factors alone. However, in addition,
    medications for chronic diseases can limit the body's ability
    to respond to heat stress. Mobility issues may limit access to
    cooling centers or safe evacuations during a disaster.
        Disruptions in infrastructure and supply chains limits
    these patients' ability to access the care they need to
    maintain their health. When we consider specific climate
    hazards, heat is often the first to come to mind. Where I live
    and work in Rhode Island, we are experiencing increasing use of
    hospital resources, emergency visits and mortality as summer
    temperatures rise, and these trends are nationwide.
        We also need to consider disruption in health care
    delivery. During COVID-19, I witnessed this firsthand. I cared
    for a patient, a young woman with COVID, who presented in
    decompensated diabetes because she could not access insulin. In
    the span of four hours, she went from speaking on the phone
    with her family to dead. I still think about her small children
    and how different their lives would have been if she had just
    had access to insulin.
        These similar barriers have been documented for both
    Hurricane Katrina as well as Hurricane Harvey. These health
    complications are not only tragic, but they are costly, and we
    have only scratched the surface. Consider worsening vector
    board diseases, wildfires, droughts, food security. The impacts
    are broad, substantial and worsening, and the economic impacts
    are immense.
        In 2008, the Congressional Budget Office presented this
    evaluation. For the federal government, rising health care
    costs constitute the principle challenge of fiscal policy. No
    other single factor will exert more influence over the long-
    term balance of the federal budget.
        In closing, I'd like to leave you with these two reiterated
    points. The economic toll of climate change health effects are
    immense, but under-recognized and under-quantified. Medicaid
    and Medicare recipients will bear the brunt of these
    consequences. My patients depend on your action. Thank you.
        Chairman Whitehouse. Thank you, Doctor. Now Dr. Greenstone.

         STATEMENT OF DR. MICHAEL GREENSTONE, MILTON FRIEDMAN
      DISTINGUISHED SERVICE PROFESSOR IN ECONOMICS, AND DIRECTOR,
      BECKER FRIEDMAN INSTITUTE, AND THE ENERGY POLICY INSTITUTE,
                       UNIVERSITY OF CHICAGO \5\
    ---------------------------------------------------------------------------

        \5\ Prepared statement of Dr. Greenstone appears on page 50.
    ---------------------------------------------------------------------------
        Dr. Greenstone. Thank you Chairman Whitehouse, Ranking
    Member Grassley and Members of the Committee for inviting me to
    testify today. I appreciate the opportunity to speak with you
    about the temperature-related impacts of climate change and
    public health and our economy.
        The health impacts are likely to be some of the dominant
    costs of climate change. So what impacts would temperature
    changes due to climate change have on public health? This is a
    topic of some research of mine that was done with the Climate
    Impact Lab that I co-founded. It's a team of about 30
    economists, climate scientists and computational experts.
        The headline finding is that the projected mortality risk
    from temperature changes due to climate change are at least in
    order of magnitude larger than has previously been understood.
    This finding holds whether one uses a high emissions scenario
    that likely overstates the future growth of emissions, or a
    moderate emissions scenario that likely understates it.
        As supported by recent work at the IPCC, the true impacts
    of climate change are likely to lie between the estimates based
    on these two emissions pathways. There are four main points
    that come out of my written testimony. First, global mortality
    risk is projected to increase by 85 deaths per 100,000 people
    by 2100, if the world is on the high emissions trajectory.
        This is larger than the current global mortality rate due
    to all infections and parasitic diseases. Under a moderate
    emissions trajectory, the increase in global mortality risk
    would remain significant at 14 deaths per 100,000, similar to
    the current global diabetes mortality rate. Some of this is
    illustrated in the slide that we've put up here.
        Two. Second, in the United States, the projected increase
    in mortality risk from higher temperatures under the high
    emissions scenario is about ten deaths per 100,000, about on
    par with the current fatality rate due to auto accidents.
        In contrast this change, and I'm going to come back to
    this, is roughly zero under the moderate emissions scenario,
    though this overall figure masks meaningful increases in some
    places and meaningful declines in others. I've included a table
    in my written testimony with data for each state under both
    scenarios, to give a sense of the risk that your constituents
    face.
        There are also global and domestic maps of projected
    changes in mortality risks that are displayed here. But some
    examples might be instructive. In my home town of Chicago, the
    mortality risk is projected to decline by about 35 to 40 deaths
    per 100,000 by 2100.
        Over time, we'll see fewer cold days, decreasing mortality
    risks during the winter, which will outweigh the risks of more
    hot days. However, other places will be harmed in that. Henrico
    County, Virginia, represented by Senators Warner and Kaine, has
    projected to experience is high mortality risk under both
    emissions scenarios, about 35 under the high one and 17 under
    the moderate one.
        Johnson County, Kansas, represented by Senator Marshall, is
    projected to see an increase of 31 deaths per 100,000 under the
    high emissions one, and about 11 under the moderate emissions
    one.
        The third main finding, and this is important, is that the
    level of emissions is not a law of physics. It reflects policy
    choices to restrict emissions and technical advances that can
    also be influenced by policy. It's therefore useful to consider
    what policy might be able to accomplish or unlock in terms of
    benefits.
        An illustrative example is that a policy moving the world
    from the high emissions scenario outlined on the graph there to
    the moderate emissions one, would reduce the attendant global
    mortality risk by about 84 percent at the end of the century.
    In the United States, temperature-related mortality risk due to
    climate change would be eliminated by moving from the high to
    the moderate.
        The point is that robust climate policy offers the
    potential for some of the most significant public health gains
    in human history.
        Fourth, following the National Academy of Sciences 2017
    recommendations, the Climate Impact Lab has developed new
    methods to estimate climate damages. A key output of these
    efforts is an estimate of the social cost of carbon or SEC,
    which is the monetary cost of the damages caused by the release
    of an additional ton of carbon dioxide into the atmosphere.
        The SEC provides a value which can be used in cost benefit
    analyses, regulatory policy and for determining efficient
    prices for market-based policies, such as a carbon tax or cap
    and trade system. The CIL's approach produces an estimated SEC
    of $190 per metric ton. This means that every ton of
    CO2 abated reduces climate damages by $190.
        The use of frontier climate--this use of frontier climate
    science in economics leads to a social cost that is
    significantly higher than either President Trump's estimate or
    President Obama's. Finally, in conclusion, given the scale of
    the climate challenge, I want to underscore that our nation
    would be well-served to seek out the least expensive reductions
    in greenhouse gases.
        Markets have been shown time and time again to be the most
    successful tool to find these opportunities. This means that
    markets would allow us to confront the climate challenge
    without imposing unnecessary costs in American families. Thank
    you for allowing me to speak today. I look forward to your
    questions.
        Chairman Whitehouse. Thank you very much. I turn now to Mr.
    Shellenberger, sorry Doctor. No, I'm sorry, I'm out of order.
    Dr. Schramm.

                   STATEMENT OF DR. CARL J. SCHRAMM,
             UNIVERSITY PROFESSOR, SYRACUSE UNIVERSITY \6\
    ---------------------------------------------------------------------------

        \6\ Prepared statement of Dr. Schramm appears in the appendix on
    page 65.
    ---------------------------------------------------------------------------
        Dr. Schramm. Thank you, Mr. Chairman, and thank you Ranking
    Member Grassley for inviting me to come and speak with you
    today.
        I am pleased to speak about the implications of climate
    change that may be imposed on the nation's public health. Much
    of my career has been devoted to studying health care costs,
    especially in the context of how these expenditures may or may
    not be proportionally related to improvements in the public
    health.
        In the interest of time, I'll skip over much of my
    biography only to point out that the last time I was here Mr.
    Grassley, I was running the Johns Hopkins Center for Hospital
    Finance and Management. I served on the faculty of the Public
    Health School there for 16 years.
        I left Hopkins for a career focused on health insurance,
    including being president of the Time Insurance Company, now
    known as Assurant, headquartered in Milwaukee. For the last few
    years, my research has been focused principally on the question
    of COVID and the performance of the Centers for Communicable
    Diseases.
        I've been a member of the COVID Crisis Group and only
    yesterday we published our final report, which is called the
    Lessons from the COVID War. At this very moment, the report is
    being debuted at the National Academy of Sciences.
        As the Committee considers the question of public health
    implications of global warming, I want to emphasize two issues.
    First, the efforts to expand the idea of what public health is
    and why it is seen by many to be failing. As most of us would
    agree, the CDC, the nation's principal agency charged with
    protecting public health, failed to effectively control the
    COVID pandemic.
        I believe the principal reason is that both the CDC and the
    country's larger public health establishment, including the
    public health schools, have expanded the scope and definition
    of public health such that its boundaries are nearly
    meaningless to the public.
        Consider that the CDC currently deals with a wide range of
    problems that are not encompassed by traditional definitions of
    public health, the science and art of preventing disease,
    prolonging life and promoting health.
        Instead, the CDC deals with a long list of ``epidemics''
    that are not related to communicable pathogens, and cannot be
    corrected by traditional public health tools. Among these are
    epidemics of gun death, traffic fatalities, obesity, domestic
    violence, workplace accidents and a long list of issues
    distant, far distant from traditional public health threats.
        In addition, we find the CDC working on problems that again
    cannot be solved by the traditional tools used to prevent the
    transmission of communicable disease. Two of the newest involve
    the CDC's attempt to ameliorate the ``social determinants of
    health,'' and its commitment to promoting health equity.
        Simply, the CDC is the archetype of an agency beset by
    mission creep. Thus, even if global warming presented a clear
    and present danger to the health of every American, there is
    little that the CDC can do to mitigate such a threat.
        Among other things, the agency's managerial focus is so
    diffused it is unlikely that it could effectively absorb
    another issue, particularly one in which the correlation
    between global warming and the public's health is so ambiguous.
        My research on the CDC budget suggests that only about one
    in seven of its employees work or are engaged in traditional
    efforts to identify and control contagious pathogens. Far more
    CDC professionals work on international health issues that may
    or may not be related to protecting the U.S. population from
    communicable threats.
        Now on the brighter side, I've included two charts, one
    that shows that we have continuously grown GDP rather
    extensively over the last 50 years since the passage of the
    Clean Air Act, and at the same time reduced virtually all of
    the noxious particulates that we breathe, showing that we can
    in fact grow the economy and make the entire society and our
    nation much healthier at the same time.
        Similarly, important to global health and the argument that
    we are witnessing the implications of global warming on global
    health, I'm including a chart that shows that over the last 50
    years, we have been on a course of making virtually all of our
    GDP growth with much less fossil fuel burn.
        This is a huge achievement. It's an achievement of
    engineering, among other things, and this is a time to salute
    the engineers in public health that have brought us clean
    water, clean sanitation and clean air. Thank you.
        Chairman Whitehouse. Thank you, Dr. Schramm. Next, we'll
    hear from Mr. Shellenberger.

                  STATEMENT OF MICHAEL SHELLENBERGER,
           FOUNDER AND PRESIDENT, ENVIRONMENTAL PROGRESS \7\
    ---------------------------------------------------------------------------

        \7\ Prepared statement of Mr. Shellenberger appears in the appendix
    on page 69.
    ---------------------------------------------------------------------------
        Mr. Shellenberger. Chairman Whitehouse, Ranking Member
    Grassley and Committee members, thank you for requesting my
    testimony. I'm honored to be able to provide it. High per
    capita use of cheap and abundant energy is essential to lifting
    people out of poverty. There is no rich, low energy nation and
    no core high energy one.
        Adapting to higher temperatures, excuse me, adapting to
    higher temperatures requires cheap energy so people and nations
    can afford air conditioners, irrigation, desalination and other
    technologies. The bottom line today is that cheap and abundant
    energy is the key to a better future, including reducing deaths
    from heat waves, disease and pollution.
        The good news is we know how to do this. Between 2005 and
    2020, U.S. carbon emissions declined by 21.5 percent, which is
    4.5 percentage points more than what the U.S. promised to
    reduce as part of the United Nations Paris Climate Agreement,
    and 4.5 percentage points more than what was promised under the
    2009 Waxman-Markey Cap and Trade legislation.
        61 percent of those reductions were due to the shift from
    coal to natural gas, and 39 percent came from intermittent
    renewables backed up by natural gas, which was required in most
    situations. The relationship goes in the opposite direction as
    well. Thanks to natural gas shortages and higher costs in 2021,
    coal-fired electricity increased 22 percent as compared to
    2020.
        Carbon emissions are thus following the same trajectory as
    other air pollutants. As a result of cleaner-burning coal, the
    transition to natural gas, cleaner vehicles and other
    technological changes, developed nations have seen major
    improvements in air quality. Between 1980 and 2018, the U.S.
    carbon monoxide levels decreased by 83 percent, led by 99
    percent, nitrogen dioxide by 61 percent, ozone by 31 percent,
    sulfur dioxide by 91 percent.
        While death rates from air pollution can rise with
    industrialization, they declined with higher incomes, better
    access to health care and reductions in air pollution.
        Contrary to the assumptions of people who want to make
    energy more expensive, we moved towards cleaner energy sources
    by making them cheaper and more abundant. Thanks to fracking,
    natural gas became cheap and abundant during the first decade
    of this century. The same has been the case with nuclear.
    France and other nations built large, standardized nuclear
    plants, reducing the construction times and bringing the cost
    down.
        Better nutrition, better health care, more air conditioning
    massively outweigh climate change as factors determining
    health. Over a decade ago, the World Health Organization
    predicted the global burn of disease will have declined by 30
    percent between 2004 and 2030, which is amazing news, and we
    are on track to do that, and said the WHO ``Mortality rates
    will continue to fall in most countries, so long as economic
    growth continues.''
        In its report last year, IPCC noted, the Intergovernmental
    Panel on Climate Change, noted that nations have adapted well
    to heat, thanks to ``heat warming systems, increased awareness
    and improved quality of life.'' That included particularly air
    conditioners.
        Quote, this is from the IPCC, ``Evidence suggests a general
    decrease in the impact of heat on daily mortality,'' as well as
    ``a decline in the relative risk attributable to heat,'' and
    ``an increase in the minimum mortality temperature.'' We should
    be celebrating this.
        It's true there have been more heat waves in the United
    States since 1960, but what determines whether people die in
    heat waves is primarily whether they have air conditioning.
    Proof of this comes from the fact that heat-related deaths in
    the United States declined by between 50 and 75 percent since
    1960, thanks almost entirely to air conditioning, even as heat
    waves grew in frequency, intensity and length. Kind of amazing
    that I'm the first speaker to even mention that.
        I want to now point out something. This is profoundly
    misleading, and I want to explain why. This picture, this map
    combines two things that the IPCC says not to combine. It's the
    shared socioeconomic pathway 3--I may need my glasses now to
    read the fine print, and RCP 8.5.
        Those two things are not supposed to be combined. Look,
    this is the IPCC combination of these two different scenarios,
    RCPs and SSP. In SSP 3, there is no 8.5 combination because
    it's so implausible to have a situation of low economic growth
    and high emissions, unless you were somehow using all of your
    GDP to produce emissions deliberately, which is so ridiculous
    the IPCC doesn't conclude it.
        It's been stated that we're somehow between RCP 4.5 and
    8.5. That's not what the IPCC says. This is the most recent
    report that came out last November, and you can see here it
    shows that we're on track to be below RCP 4.5. So I think it's
    very misleading to suggest we're somehow between RCP 4.5 and
    8.5.
        I will just end by saying I think we all agree that the
    future is not written, that we decide what will occur based on
    our actions. That means we need abundant natural gas to
    continue to transition away from coal, and we need a national
    nuclear power buildout based on what we did in the 1960's and
    70's, and based on France, Sweden and other nations have done
    since then. Thank you very much.

                      STATEMENT OF SENATOR PADILLA

        Senator Padilla. Thank you Mr. Shellenberger, and to all
    the witnesses for your testimony. We now turn to questions from
    the Committee, and as I've been asked to sit in as chair until
    Chairman Whitehouse returns, that means I get to ask my
    questions first.
        Dr. Moretti, take a deep breath, because I'm going to tap
    into your experience and expertise here on a couple of topics.
    I want to discuss the increasing risks to the health and safety
    of workers who are exposed to dangerous heats and conditions,
    and the absence of adequate workplace protections.
        And despite Mr. Shellenberger's testimony, not all career
    paths enjoy the luxury of air conditioning. Farmworkers are
    disproportionately at risk and die from heat-related illness at
    a rate 20 times greater than the average worker. That's why
    last session I co-led the legislation with Senator Brown to
    direct OSHA to more swiftly establish a national standard to
    protect workers and ensure common sense workplace protections
    during extreme heat conditions.
        Farmworker is just one example. A lot of times truck
    drivers, warehouse workers, others are exposed to extreme heat.
    This and other efforts to protect workers are critical policy
    components of climate adaptation. So Doctor, as global
    temperatures continue to rise, what impacts should we expect to
    see on workers and what additional steps can we take to protect
    the vulnerable individuals, especially those in agriculture?
        Dr. Moretti. Thank you very much Senator for the question.
    I think you hit on a very important point, which is that there
    are certain populations that are very vulnerable, outdoor
    workers in particular. When they show up to the Emergency
    Department with heat stress or heatstroke, we treat them with
    IV fluids and we cool them down.
        But then we discharge them home, and they go home and they
    go back to work, and they're put at the same risk. The problem
    is is that adaptation only gets us so far. We can only adapt to
    a certain level before those adaptation mechanisms start to
    fail us, and here's a prime example. The way that we protect
    those workers is that they don't work on really hot days where
    our bodies are not safe.
        That means they're not working. That means they're not
    earning a wage, and it hurts our economy. So that's a severe
    limitation as our temperature starts to rise.
        Senator Padilla. And if you can just expand on that for a
    second. Outside of mortality cost, that's what people tend to
    focus on, can you just speak for a minute on the economic
    impacts or lost labor productivity as a result of unsafe
    working conditions?
        Dr. Moretti. Correct. So there--I don't have exact numbers,
    but I am happy to find them for you. But these are patients
    that I would tell not to work. I tell them not to work on
    certain heat days if possible, and I will tell you that there
    is a subset of my population that will not be able to listen to
    me, that will go to work regardless and that will come back to
    the Emergency Department with the same problem I sent them out
    with.
        This is a huge actually example. Out west, I was speaking
    to a college of mine during the wildfires, who was treating
    asthmatics as a revolving door. He would treat them, they would
    get better, he would send them back out into the smoke, and a
    day later they would come back, because he couldn't treat the
    underlying cause. He couldn't get to that root cause to treat
    them.
        So we (1) have increasing health costs, because a lot of
    them are covered on Medicare and Medicaid, (2) we have their
    lost labor and they're unable to work, out with sick days. And
    so we're losing, we're losing economic drive on multiple
    fronts.
        Senator Padilla. You're such an expert, you anticipated my
    next question, which is this, you know. Fire, excuse me,
    extreme heat often leads to fire.
        Along with fire, we get a lot of smoke, and Californians in
    the fire-prone areas of this state are exposed to smoke for an
    average of about three months per year, resulting in poor
    health outcomes that you've begun to describe in addition to
    the economic losses and a reduced quality of life.
        As climate change continues to increase, the frequency and
    severity of wildfires, more and more communities beyond just
    the western United States are impacted by these harmful
    effects. I know the last couple of years, I'll get occasional
    calls from colleagues in the Midwest complaining about the
    smoke emanating from large fires in California, even the
    colleagues on the east coast.
        A recent study in Nature suggests that wildfire particulate
    matter may be ten times more harmful than other sources of
    pollution. So given that wildfires are only growing more
    extreme and frequent, how can we better mitigate the impact of
    smoke-related health risks for underserved and rural
    communities that are often most at risk?
        Dr. Moretti. So we talk about mitigation and we talk about
    adaptation. To mitigate these risks, we need to mitigate
    climate change, and we need to limit our fossil fuel combustion
    and that which is emitted.
        As an adaptation mechanism, we need to identify these at-
    risk populations and we need to start to put in public health
    policies that protect them, such as allowing them to be indoors
    with air conditioners when it's safe, air purifiers when PM 2.5
    levels get to dangerous levels. But these treatments happen
    before they get to me in the Emergency Department.
        Senator Padilla. Thank you very much. Senator Grassley.
        Senator Grassley. Thank you Senator, Mr. Chairman. I'm
    going to read to Mr. Shellenberger three or four sentences from
    a July, 2021 Wall Street Journal op ed, and ask if you can give
    a short answer that it's right or wrong from your point of
    view.
        ``Heat deaths are actually a bigger problem than the news
    reports would suggest. Most heat deaths happen without a news
    crew to document them. Studies show that heat kills about 2,500
    people every year in the United States and Canada. Each year,
    more than 100,000 people die from cold in the United States,
    and 13,000 in Canada, which is more than 40 cold deaths for
    every heat death.
        ``On a worldwide basis, cold deaths vastly outnumber heat
    deaths.'' The last sentence says ``Globally every year, about
    300,000 deaths are caused by heat, whereas about 1\7/10\
    million people die of cold.''
        Mr. Shellenberger. Yes sir, that's accurate.
        Senator Grassley. Okay. Then I want to--I was going to ask
    Dr. Greenstone a question, but I'm just going to make a
    statement about some testimony that he gave in 2020 before the
    House Oversight Committee. He claimed that the mortality rate
    under a quote-unquote ``high emissions scenario'' will be ten
    deaths per 100,000 Americans by 2100, similar to today's
    mortality rate from car accidents.
        The CDC recently published this graph for the ten leading
    causes of death in America, and as you can see, each of the ten
    deadliest public health conditions currently have mortality
    rates above your worst case scenario for climate change.
        Now to Dr. Schramm, let me read you a few headlines of the
    past six months from the New York Times. ``Deaths from
    substance abuse rose sharply among older Americans in 2020.
    Following a two year decline, suicide rates rose again in 2021.
    Alcohol deaths claim lives of working age Americans. These are
    real public health challenges. However, many on the left have
    become accustomed to labeling everything from sexism to gun
    violence to President Trump somehow as a public health
    challenge.
        So Dr. Schramm, what sort of data framework or methodology
    should policymakers use to determine what is or is not a public
    health challenge?
        Dr. Schramm. Senator, thank you. I think perhaps the best
    way to approach this to think about whether or not public
    health can intervene in those problems. So for example, the
    question of elderly drug abuse or substance abuse, how is that
    they can be dealt with by the CDC or by public health
    officials?
        It's not clear that traditional methods of intervention,
    that is case finding and case tracking, can modify or mitigate
    this problem. The real issue has to go to denying our
    population these drugs. This is a huge issue and that's where
    the real costs are imposed on the public budget.
        Secondly, it goes in the same direction for suicide. It's
    very difficult for the CDC to effectively mount a program that
    would reduce suicide. The tools of public health just don't go
    there. Suicide reflects much larger conditions in the society,
    some of which actually Dr. Moretti points to in terms of the
    implications of disease on emotional stability and emotional
    security.
        These are difficult issues, and they are really difficult
    when we consider them in the context of the federal budget,
    because we spend huge amounts of money needlessly and without
    any effect, and don't point to the issues that could really be
    changed if we could in fact mitigate these by the control of
    substances.
        Senator Grassley. Thank you. Mr. Shellenberger, in your
    testimony, you say ``Poor people and people of color are
    disproportionately impacted by climate policy restricting
    energy consumption.'' Could you elaborate on how climate
    policies implemented in the name of disadvantaged groups often
    harm more than help such groups?
        Mr. Shellenberger. Yeah, absolutely. I mean one of the main
    ways is just by making electricity more expensive, which makes
    it--which means that people use air conditioning less. So one
    of the ways that people end up dying is that they, they can't
    afford to turn on the air conditioner or they can't afford air
    conditioning. So anything that makes electricity expensive is
    going to result in less air conditioning and higher deaths.
        Senator Grassley. Thank you, Mr. Chairman.
        Senator Padilla. Thank you. Senator Johnson.

                      STATEMENT OF SENATOR JOHNSON

        Senator Johnson. Thank you Mr. Chairman. Dr. Moretti, in
    your testimony you said that the health consequences are so
    vast and varied that the role of climate change is often
    hidden. Then you go on to say ``but sometimes, the relationship
    to climate change is very clear.'' Then you talk about a
    construction worker who was overcome by heat.
        Well, I think it's very clear that that construction worker
    was overcome by heat, but as Mr. Shellenberger talked about, a
    heat wave that tops out at 110, is it going to be that much
    more threatening than a heat wave that tops out at 109?
        And then you go on. Again, you just made it seem like
    climate change is causing all these things with such certainty
    it kind of amazes me. I'm not a climate change denier; I'm just
    not a climate change alarmist. You seem to be an alarmist.
        Dr. Moretti. I think that's because I've seen it. We've had
    seven years in Rhode Island of worsening, record-setting heat.
    We know that temperatures are rising because of climate change.
    We know that the main----
        Senator Johnson. But that's actually disputed, okay? I mean
    I know you know it, but it's disputed. Let me ask you a
    question. Do you know how many deaths have been reported
    worldwide on the Vaccine Adverse Reporting System related to
    the COVID-19 vaccine? Do you know how many worldwide deaths are
    reported?
        Dr. Moretti. I do not, Senator.
        Senator Johnson. You should, but let me tell you. It's
    35,152. Now most people don't know that because it's been
    largely suppressed and censored. 8,743 of those deaths have
    occurred on either day of vaccination or within one or two
    days. That's 25 percent of those 35,000 deaths reported on
    VARS, associated with COVID-19 vaccines.
        Now our federal health agencies, who have not been honest
    and transparent with us, they've not made the correlation. As a
    doctor I want to ask you, would you be--are you concerned when
    you hear, you weren't aware of those statistics and I'm just
    giving them to you.
        Would you be concerned if there is any kind of drug
    intervention where you have reported to our federal health
    agencies 35,000 deaths and 25 percent of those occurring within
    two days of the administration of that drug? Would that concern
    you? Would that be something you'd want to investigate?
        Dr. Moretti. I would need to understand more about the
    statistics of where those numbers came from.
        Senator Johnson. Okay well----
        Dr. Moretti. I do know that we're seeing rising
    temperatures in Rhode Island, increasing heat waves with
    increasing frequency, and increasing stress on the Emergency
    Department with worsened outcome.
        Senator Johnson. So now I'm aware there are all kinds of,
    and you know, climate change alarmists are leaping to all kinds
    of conclusions to scare the you know what out of the American
    public, to spend trillions of dollars, money we don't have that
    are much better spent in other ways.
        Mr. Greenstone, I actually found that chart of yours
    somewhat comforting for at least America. When you take a look
    at the mortality, and again these are all projections. I don't,
    I don't put any stock in them whatsoever.
        But by your own projections, throughout the United States
    because of climate change, we're going to actually have a
    reduced risk of mortality overall in the United States, and
    wouldn't that be a tie-in with what the study from Lancet in
    2021 said, that we suffer about 600,000 deaths due to heat
    every year, but 4.5 million deaths because of cold?
        So in terms of excess deaths, a warming globe is actually
    beneficial. In my own state, your study shows that we would
    have a reduction in mortality of somewhere between 54 and 56
    people per I guess it's 100,000. Why wouldn't we take comfort
    in that?
        Dr. Greenstone. So thanks for the question, Senator
    Johnson, and what the work shows and the chart is that the
    effects of climate change are going to very unequal, and
    absolutely Wisconsin, Chicago where I live, the reduction in
    cold days, the benefits from that will outweigh the damages
    from the hot days.
        But if you look more carefully at that, there's large
    swatches of the country where the damages will be much larger,
    and in fact----
        (Simultaneous speaking.)
        Senator Johnson. But again do you want--if you want to
    balance, if you want to balance--if you want to balance it all
    out globally, if you're trying to mitigate harm globally, isn't
    it true that the number of deaths, according to this Lancet
    study, the number of deaths caused by heat are 600,000 per
    year; deaths caused by cold are 4.5 million annually?
        In terms in global health, in terms of excess death, we're
    actually--you're in a better position to prevent death by
    having the climate increase in temperature a little bit, right?
        Dr. Greenstone. So Senator, I'm not familiar with that
    study. What I am familiar with is my study. Your
    characterization of it is incorrect.
        Senator Johnson. Well your study is very favorable to my
    state. Our mortality----
        (Simultaneous speaking.)
        Dr. Greenstone. Wisconsin will benefit in terms of
    mortality. There are 49 other states in the United States. Many
    of them will suffer. Many of them will suffer more than
    Wisconsin will gain, and that is--that is the nature of climate
    change. It's very unequal.
        Senator Johnson. According to your study, you're concerned
    if you're in the hot region of Africa, but in terms of the
    United States and most of Europe, we're in pretty good shape.
    We're all blue. We have reduced risk of death.
        Dr. Greenstone. If you look carefully at the top of that
    figure, a large section of the country is not blue. Those are
    the areas where some of your colleagues represent people, and
    those people are going to face increased risk of mortality.
        Senator Johnson. Thank you, Mr. Chairman.
        Chairman Whitehouse. Thanks Senator. Delegate Smith, the
    effect you mentioned of the three percent increase in
    temperature, 3 degree increase in temperature in Maryland being
    exacerbated by urban heat islands, do you have any rough
    quantification of how much beyond the 3 degrees the urban heat
    island effect can take a neighborhood?
        Delegate Smith. Thank you so much for the question. So the
    City of Baltimore has over the past century seen a 3 degree
    increase, but that's larger than the average across Maryland as
    a state, and also it's about double the national average for
    the country.
        And so that's pretty alarming for the communities I
    represent, particularly because as you've noted from some of
    the other testimony and responses, when you do not have a lot
    of green space nearby, it makes it very difficult to cool.
    Personally, when I lived at the top of my district, I did not
    have central AC. I was in another home almost 100 years old,
    but the trees were mature, there was grass all around, and I
    could just put a fan on and be relatively comfortable.
        But one of the things that makes rowhomes great in the
    winter is that they trap heat, which is good in the winter.
    However in the summer, and now that I live in a row home, it
    can be incredibly hot and these are communities quite frankly,
    there's been research to show that the same communities that
    were impacted by redlining are disproportionately the
    overheated parts of the city presently that are experiencing
    the urban heat island effect, and my communities are no
    different from that.
        So communities that were redlined are less likely to have
    trees in them, and as many of us know it takes a while for a
    community to get the full benefit of a tree, right? And so we
    need to make these investments yesterday, and I know that just
    in the past few years and we've seen tree plantings in my part
    of East Baltimore, you're seeing more comfort for those that
    are situated nearby.
        But quite frankly, if we do not simply provide more green
    attributes to communities like the ones I represent, you can
    have all the AC you want, but you're really not getting to the
    root of the problem. We can't be resilient and we can't reduce
    emissions if we're not looking at some new avenues.
        Chairman Whitehouse. And your constituents in urban heat
    islands are likely to turn where for health care, to federal
    programs?
        Delegate Smith. Absolutely. As a city, approximately 60
    percent of residents in Baltimore City are on Medicare and
    Medicaid, and particularly the communities that are closely
    situated near me in East Baltimore. These are some of the
    communities that have some of the lowest life expectancies in
    the city.
        So even though they have proximity to world class health
    care at Johns Hopkins, it doesn't mean they always have access.
    And so yes, federal programs are instrumental and often under
    strain when extreme heat and other challenges present.
        Chairman Whitehouse. As we saw in Oregon and Washington,
    where they've had to actually revamp Medicaid programs to
    address with the risk after the heat waves out there, the
    deadly heat waves out there.
        Dr. Moretti, last summer was the hottest August on record
    in Rhode Island. How did that play out in your emergency room?
        Dr. Moretti. So thank you Senator for the question. We are
    struggling. Health care is tenuous and has not recovered since
    COVID. I think that we saw how fragile our health system can be
    with COVID-19, and I am concerned as we continue to see more
    climate hazards, to what this will do to the health care
    system.
        Last summer, the Emergency Department was full. My bosses
    were on local television asking patients to seek care elsewhere
    whenever possible because we were struggling to treat the
    patients that showed up to our door. We were seeing patients in
    waiting rooms, we were seeing patients in hallways.
        (Pause.)
        Dr. Moretti. This was exacerbated by the heat, and it's
    worsened by poor staffing since COVID. I am concerned what will
    happen as we continue to see increased climate hazards. In
    emergency medicine, we define a disaster as an event, such as a
    climate hazard, whatever it may be, that overcomes our
    resources. Right now, the health care system nationally is
    perpetually on the edge of a disaster.
        Chairman Whitehouse. There have been roughly speaking two
    ways that the reporting about health harms from heat have been
    quantified. One has been to look at the actual diagnosis or the
    cause of death report, and pick out the causes that reference
    heat.
        Separate from that, in Rhode Island, by Brown University as
    I recall and also out in California and perhaps others, there
    have been studies that looked at the statistical coincidence of
    various morbidities and mortalities during heat wave events,
    and then looking at those additional deaths and illnesses, and
    going back and seeing could that correlated.
        Could you talk a little bit about what that second round of
    inquiry has established, and then I'll turn to Senator Van
    Hollen it looks like.
        Dr. Moretti. Yeah, thank you Senator. So because heat
    impacts health through many different mechanisms, we cannot
    only look for heat stress or heatstroke within the medical
    records. Similarly, the patient I talked about who suffered
    heat stress working in construction, it's very likely that in
    his hospitalization, his diagnosis was coded as rhabdomyolysis
    and acute kidney injury, with no mention of heat.
        So even as clinicians when we know heat is playing a
    factor, it may not be coded correctly within the medical
    records. So when we do the second methodology that you're
    talking, when we look at a population level and look for
    increasing, increases in hospitalizations over all diagnoses,
    we see much greater effects, up to 37 percent increase in
    visits, which is missed in that first mechanism of only pulling
    out diagnoses of heat illness and heatstroke.
        Chairman Whitehouse. So the statistical method is more
    reliable?
        Dr. Moretti. It captures a larger patient population.
    However, that does not allow us to look at individual patient
    characteristics.
        Chairman Whitehouse. Senator Van Hollen.
        Senator Van Hollen. Thank you, Mr. Chairman. Good to be
    back. So Delegate Smith, I do want to follow up on some of the
    points you made in your testimony regarding the impact of
    climate change and how it's affected temperatures in Baltimore
    City, and the heat islands that it's created, and measures that
    we can try to take to mitigate that, right, even as we also try
    to address the overall issues.
        Can you speak to some of the issues the Chairman raised,
    and I appreciate him talking at the outset about the House
    Republican plan that may be voted on this week, that would
    essentially undo entirely the climate benefits of the Inflation
    Reduction Act, including investments in energy efficiency and
    providing rebates for homeowners to make their homes more
    energy efficient, which not only has air quality benefits but
    also saves people in their pocketbooks.
        If you could just talk to the role of federal investments
    in trying to address some of the issues that you've raised?
        Delegate Smith. Thank you Senator for the question. The
    investments that are in peril that you've highlighted are
    incredibly important to the people I represent. So you know
    that in many instances, seniors are over-represented in the
    vulnerable groups that we've been discussing today as we--in
    regards to heat.
        And so having some of those energy efficiency rebates made
    available means so much to legacy residents that want to be
    able to age with dignity and comfort in the homes that they're
    living in.
        But also in Baltimore City, it's the most transit-dependent
    part of the state of Maryland. So many people, roughly a third,
    do not have access to a vehicle. So the investments we're
    making in just infrastructure to be safer for pedestrians and
    bikers, those are also relevant to people I represent, because
    we want to ensure that we're doing things that allow people to
    move safely, but also reduce emissions that bring them harm.
        From my residents that have to stand at bus stops, it's
    going to be advantageous to have buses go by that are not
    emitting the same amount of pollution as others. So it's been
    critical to see that investments in green infrastructure and
    having community-led initiatives around climate resilience that
    are also going to create jobs in communities.
        So the same communities that are most exposed to the harm,
    could also be at the forefront of the remedies. I know we have
    great organizations like the Baltimore Tree Trust and Civic
    Works that are at the forefront of, you know, planting trees
    and also doing other installations related to climate
    resilience that the Inflation Reduction Act are making
    possible.
        And so I want to thank this body. It was a bipartisan
    effort that made that Act possible, and it's going to have real
    benefits for the communities I represent, and other communities
    across this country that bear a disproportionate burden because
    of heat exposure.
        Senator Van Hollen. Thank you, Delegate Smith. So there
    have been a number of studies obviously that look into the
    health impacts of climate change. There was a study done by
    Johns Hopkins in our state of Maryland and MIT's Laboratory for
    Aviation and the Environment, indicating that Baltimore's
    asthma hospitalization rate is one of the highest in the
    country, and that the city's premature death rate due to air
    pollution is also one of the highest in the country.
        Dr. Moretti, can you discuss that link between climate
    change and how it acts as a threat multiplier and threat
    magnifier for communities like Baltimore?
        Dr. Moretti. Thank you Senator for the question. So we see
    climate change acting to impact our health through many
    different mechanisms. It's a threat multiplier in that regard.
    So increasing temperature in and of itself has increasing
    health harms.
        But at the same time, it increases levels of PM 2.5 air
    pollution, which are toxic when we breathe them in and cause
    airway inflammation. Secondarily, we can see other effects as
    we see disasters that affect supply chains, disrupt health care
    systems and those affect health.
        We see decreased number of days for growing and so we see
    increasing food insecurity globally, as we're having increasing
    droughts. So through all of these different mechanisms, we see
    climate health impacts. However, certain populations are more
    at risk for these, and so we get risk upon risk upon risk for
    vulnerable populations.
        For example, heat is a risk. That heat risk is magnified in
    an urban heat island. At the same time, that urban heat island
    is next to a highway, where you have increased air pollution
    and increased PM 2.5 levels. Moms were exposed to that level,
    which means that transmit that risk to baby, who has an
    increased risk of asthma before birth. Then at birth they live
    in an environment which augments this risk even further.
        Senator Van Hollen. Thank you. I appreciate your testimony.
    Thank you all for being here.
        Chairman Whitehouse. I'm going to do a quick second round,
    since I haven't had the chance to speak with all of the
    witnesses yet.
        Dr. Greenstone, your testimony I believe was that some of
    the dominant economic impacts from climate change occur in
    health costs. I observed the fossil fuel industry's latest
    strategy to argue that climate safety policies are too
    expensive, that studiously ignoring the climate harm side of
    the balance sheet. What does your research say about the
    economic costs of ignoring climate harms?
        Dr. Greenstone. Thank you for the question Senator, and
    again for the invitation. So I do think it's worth saying that
    climate policy will have costs. There's no question about that.
    But what comes out of my research, as you were suggesting, is
    the other side of the ledger, the benefits.
        And what my latest research is indicating is that we had
    and the U.S. government had been grossly understating the costs
    of or the benefits of reducing greenhouse gas emissions. And so
    I think a clear way to think about the problem is that every
    ton of CO2 that gets reduced, it will cost
    something, but it's going to generate benefits of $190 per ton.
        And we know from the operation of the RGGI greenhouse gas
    market along the Atlantic coast and in California, it's quite
    possible to get reductions in CO2 at much lower
    prices. So the price in RGGI is maybe $15; in California it's
    20-30 dollars. So you can get benefits that exceed costs by a
    factor of six or seven to one. That's kind of the bottom line
    for my research.
        Chairman Whitehouse. Thanks, and with respect to Dr.
    Moretti's observation about the difference between the two
    methods of determining health-related harms, do you agree that
    that's a cause of the understatement of the health harms?
        Dr. Greenstone. I absolutely agree with that, Dr. Moretti.
    The evidence is very clear. The challenge if you're trying to
    count up deaths from heat waves is it's not written on the
    death certificate, and it actually doesn't just lead to
    premature mortality the day of the heat wave, but can take a
    couple of days or even a week.
        And so you have to use statistical methods to add all that
    up, and that is why we end up with much larger numbers from the
    second approach.
        Chairman Whitehouse. You closed your comments with an
    affirmation of the importance of markets in making these
    decisions. You're also the Milton Friedman chair I think is the
    right term. My recollection is that it was Milton Friedman's
    teaching that you didn't get a proper market signal if you
    didn't put the costs of pollution into the price of the product
    that was causing the pollution.
        Is that a correct layman's summary of the economics of
    market pricing and negative externalities?
        Dr. Greenstone. Yeah. So Senator Whitehouse, you've far
    surpassed being a student at the University of Chicago, but
    that would certainly be an A at the University of Chicago, and
    I think the broader point, which I'd like to pick up on is--
    which I actually found quite interesting in Mr. Shellenberger's
    testimony, is that he ended with a call for there to be a use
    or reliance on lower fossil fuel, energy sources that lower
    fossil fuels, and I want to connect it to your question.
        You know, I personally don't believe in fairies and I don't
    believe in unicorns, and I don't think rainbows happen just
    because you want them. And so in order to make the transition,
    there has to be, and in a reliable way there has to be a market
    signal exactly along the lines that you suggested Senator.
        And that will unleash the creativity and the
    entrepreneurialism of people in the energy industry, and
    produce exactly what Mr. Shellenberger was asking for, and lead
    to lower emissions, benefits at $190 per ton and minimizing
    costs for American families.
        Chairman Whitehouse. Just to put a bit of a quantification
    out there, my recollection is that the latest study on the
    effective subsidy supporting fossil fuel consumption in the
    United States, which was performed by the International
    Monetary Fund, which I think you'll agree is a credible
    economic agency.
        Dr. Greenstone. Yes, I do. It would not be an A like you,
    but A minus we'll say.
        Chairman Whitehouse. Great, is that the subsidy, the
    effective subsidy for fossil fuel runs to $660 billion just in
    the United States annually, and that the bulk of that subsidy
    comes from this point that we were talking about, which is that
    they get to pollute for free, and don't have to put the cost of
    the harm quantified in my opening statement at $800 billion per
    year in health care costs, into the cost of their product.
        And around here, there's an entire political party
    dedicated to protecting them as they pollute for free. I'll
    turn it back to Senator Johnson, if he wishes to have another
    round. But before I do, let me just be clear. Does anyone on
    this panel contend that there is not a reliable correlation
    between carbon emissions and increasing global temperatures?
        (No response.)
        Chairman Whitehouse. Zero for five. No one contends that.
    Okay. Senator Johnson, you wanted to take another round.
        Senator Johnson. Thank you, Mr. Chairman. Dr. Greenstone, I
    have to admit I was surprised you've done all this research and
    you weren't aware of the Lancet July 2021 article comparing
    deaths caused by heat versus cold. But let me give you another
    question here.
        In a previous hearing, I asked the witnesses whether they
    knew how much we had already spent on climate change. You're
    saying there's a, you know, six or seven dollar benefit for
    every dollar spent. So first of all, do you know how much we've
    already spent combatting climate change globally? Do you have
    an estimate for that?
        Dr. Greenstone. I'm unaware of a reliable estimate,
    Senator.
        Senator Johnson. Okay. Anybody here? I'll tell you, we had
    a witness that says about $5 trillion. So if your multiplier is
    accurate, we should have already seen about a 30 to 35 trillion
    dollar economic benefit from that $5 trillion.
        By the way in the Inflation Reduction Act here, supposedly
    we got a little under $400 billion of energy credits and
    dollars going to what I would call green energy boondoggles.
    Goldman Sachs estimated that cost about $1.2 trillion. So you
    directly understate how much we're going to spend on this, in
    what I would say is a futile effort to try and hold back the
    tides.
        Dr. Shellenberger, I read your book, Apocalypse Never, and
    I don't want to summarize it for you but I will. Seemed like
    you were making the point that economic progress and having a
    strong economy is probably the most important thing to
    concentrate on and spending like $5 trillion, to apparently
    have no impact on our environment because they're still, you
    know, people are still saying it's going to--the world's going
    to end in 12 years. It's wasting limited resources. Does that
    pretty well typify your views?
        Mr. Shellenberger. Yeah, that's definitely one way of
    describing it. I think the way to think about this issue in
    general is around energy transitions, and we go from wood and
    dung to coal, hydro, oil and gas, to nuclear. Each step along
    the way, those transitions are made by the new fuel becoming
    cheaper and more abundant than the older fuel.
        It's simply not the case that we got a transition from coal
    to natural gas by making coal expensive. We didn't have a
    carbon price. I mentioned that we did not pass Waxman-Markey
    Cap and Trade, and yet we reduced our emissions by almost 22
    percent.
        That's the story everywhere in the world. So these economic
    models are very misleading in that sense, and just to make one
    other point here, the Chairman--Chairman Whitehouse mentioned
    this IMF study. That is an absolute garbage study, and I assure
    you that Mr. Greenstone, I do not think that he agrees with
    that study.
        That study counted as a subsidy for fossil fuels the
    externalities of fossil fuels. It counted externalities and
    relabeled them ``subsidies,'' and it did not count the
    benefits. So it was a cost analysis, not a cost-benefit
    analysis.
        Senator Johnson. So let's talk about the costs of green
    energy. Let's talk about the cobalt mining in the Congo
    utilizing child labor. Let's talk about the mining of other
    rare earth minerals. We don't even have close to enough
    currently to produce what's being envisioned. Can you just kind
    of speak to I would call it the fantasy nature of what is being
    proposed right now and what's being imposed on our economy?
        Mr. Shellenberger. Absolutely. So the supply chains for
    renewables and batteries are a total human rights and
    environmental nightmare. Starting in the Congo with cobalt
    mining, which is absolutely barbaric. Many people have seen the
    videos of people being buried alive.
        Ensuring that the solar panels being made predominantly by
    Uyghur Muslims in concentration camps. That's a part of China
    that the Biden administration says the Chinese government is
    committing genocide against the Uyghur Muslim minority there.
    That's how our solar panels are being made.
        The calculations and the carbon intensity of solar panels
    appear to be totally incorrect, because they're based on a
    cleaner European grid rather than the coal-based China grid. So
    a total nightmare, and then the other final problem with
    renewables is because sunlight and wind are energy dilute. It
    requires three to eight hundred times more land and a
    significantly higher number of projects to produce the same
    amount of energy as you would from a nuclear natural gas plant.
        That's why there's 8,000 solar, wind and battery projects
    in the United States right now that are not hooked up to the
    grid, because they can't get enough transmission because of all
    the different land use problems and regulatory and cost burdens
    associated with moving from energy dense to energy dilute
    fuels.
        Senator Johnson. So I'm highly concerned about the
    corruption of scientific inquiries, scientific studies, because
    they're being funded by organizations, sometimes government
    that know what they want in terms of result. Can you just kind
    of speak to the problem that we're experiencing in terms of,
    for example, scientific studies that can't be repeated?
        Mr. Shellenberger. Yeah.
        Senator Johnson. The corruption from medical journals,
    these other scientific journals?
        Mr. Shellenberger. Absolutely. I mean we need evidence-
    based policymaking, not policy-based evidence making, and yet
    that's what we've seen here. We've seen it with the IMF study,
    seen it in many other studies where people have an outcome in
    mind like 100 percent renewables, and then they proceed along a
    course to do things like shutting down nuclear power plants,
    increasing carbon emissions, making electricity expensive,
    preventing poor people from having access to air conditioning.
        So you're absolutely right. We need to have evidence-based
    policymaking, not policy-based evidence making.
        Senator Johnson. Thank you Mr. Chairman.
        Chairman Whitehouse. Mr. Greenstone, you seem to be wanting
    to respond.
        Dr. Greenstone. Oh, there's--thank you, Senator. There's a
    lot to unpack here. I think I would just say I'll return to the
    peer-reviewed scientific literature that I've participated in,
    and the evidence is quite clear that reducing carbon emissions,
    and I think Senator Johnson makes an important point.
        Climate change isn't going to just go away. It's a massive
    problem. The whole world is contributing to it. So if the test
    is will X dollars cause climate change to forever more
    disappear, the answer is always going to be no. But what the
    evidence is clear about is that policies have reduced
    emissions. There's a wide berth for them to have benefits that
    are many times larger than their costs, and I think that's
    the--you know, God grant me the wisdom to know the difference
    between the things I can control and the things I can't.
        The things I can control or the things that the United
    States can control are its emissions, and those reductions in
    those emissions have the potential to be one of the largest
    public health benefits in human history, and have the potential
    to have benefits that would vastly exceed their costs.
        Chairman Whitehouse. Thank you. Mr. Shellenberger, first
    thanks for being here. It seems that there are some areas where
    you and I agree, so let's start with your assertion that
    climate change is happening. Is that correct?
        Mr. Shellenberger. Yes sir, and I think we also agree on
    the importance of nuclear energy. So I'd like to acknowledge
    that agreement as well.
        Chairman Whitehouse. And you believe that humans are
    contributing to climate change?
        Mr. Shellenberger. Oh absolutely.
        Chairman Whitehouse. Through carbon emissions.
        Mr. Shellenberger. I have for 30 years sir.
        Chairman Whitehouse. And to quote you the cause of climate
    change is rising energy consumption using fossil fuels;
    correct?
        Mr. Shellenberger. Correct.
        Chairman Whitehouse. And you also argue in your testimony
    that ``It would be best for global temperatures to remain
    stable''?
        Mr. Shellenberger. Yeah.
        Chairman Whitehouse. And that's because there are risks and
    dangers associated with rising temperatures globally?
        Mr. Shellenberger. Any, really any change. It would be risk
    of global cooling as well.
        Chairman Whitehouse. Yeah, but that's not the risk we're
    presently facing, is it?
        Mr. Shellenberger. Correct.
        Chairman Whitehouse. With respect to the IPCC, do you
    consider their work to be solid and reliable?
        Mr. Shellenberger. Yeah absolutely for the most part, and I
    rely almost entirely on it.
        Chairman Whitehouse. You claim that renewable energy is
    always expensive. One of your critiques is its cost, yet I
    repeatedly see studies that renewable energy is now less
    expensive, less costly than various fossil fuel sources, and
    that comparison showing clean energy to be less expensive does
    not even take into account the question of the negative
    externalities.
        Are you sure that it is true that renewable energy is
    always expensive compared to fossil fuel?
        Mr. Shellenberger. So my claim is that renewable, that
    intermittent renewables, excluding hydro, make electricity
    expensive. But let me ask you sir, if solar and wind are so
    much cheaper than existing energy, why did the Congress approve
    $370 billion to subsidize solar and wind?
        Chairman Whitehouse. I would argue because it's such a tiny
    fraction, to give it half a chance against the $660 billion
    subsidy for fossil fuel.
        Mr. Shellenberger. But if it's already cheaper, then why
    would you need any subsidy?
        (Simultaneous speaking.)
        Chairman Whitehouse. It's pretty basic economics that
    negative externalities belong in the price, and therefore are a
    subsidy, everything from Milton Friedman to the IPCC to the
    IMF. So you and I are just going to have to disagree on that.
        You have expressed skepticism about the relationship
    between climate change and various extreme weather events.
        Mr. Shellenberger. Skepticism wouldn't be the word I would
    use.
        Chairman Whitehouse. What word would you use? I want to
    make sure I say it right.
        Mr. Shellenberger. Evidence-based. I mean everything that
    I--every statement I've made is either in the IPCC or peer-
    reviewed scientific literature. So it depends on the extreme
    weather you're talking about.
        Chairman Whitehouse. So you have former colleagues and
    collaborators who are actual climate scientists, which you are
    not, who have said some things about these claims of yours.
    Zeke Hausfather----
        Mr. Shellenberger. He's never been a colleague of mine.
        Chairman Whitehouse [continuing]. Who worked at the
    Breakthrough--you worked with him at the Breakthrough
    Institute, did you not?
        Mr. Shellenberger. He was never a colleague of mine.
        Chairman Whitehouse. Okay. He wrote ``Shellenberger's
    claims that climate plays no role in natural disasters and
    wildfires fly in the face of a large peer-reviewed scientific
    literature showing clear links between climate change and
    extreme heat events, drought and extreme rainfall, as well as
    links between hotter and drier conditions and wildfire areas
    burned in many regions of the world.''
        And Kerry Emanuel, professor at MIT who provided you a
    blurb for your book, wrote ``The cleanest way to look at
    climate effects on natural phenomena is to look at the
    phenomena themselves. Here, there is strong and mounting
    evidence that climate change is increasing precipitation
    extremes, floods and droughts, conditions for wildfires and the
    incidence of strong hurricanes. Whichever way one looks at it,
    Shellenberger's statement is not defensible.''
        Mr. Shellenberger. Do I have time to respond, or are you
    not going to let me?
        Chairman Whitehouse. Well, I'll give you a minute to
    respond.
        Mr. Shellenberger. Okay. So first of all Tom Woodley, the
    co-founder of climate science modeling called Apocalypse Never
    ``perhaps the best environmental book ever written.'' Kerry
    Emanuel, as you mentioned, also blurbed the book and I've been
    working with James Hanson to save nuclear power plants around
    the world for the last several years.
        (Simultaneous speaking.)
        Chairman Whitehouse. I didn't say you were wrong about
    everything. I just said you were wrong about that.
        Mr. Shellenberger [continuing]. Natural disasters, there's
    a single--there's a single source of data on natural disasters
    globally called the EM-DAT Data Center in Belgium. It shows
    natural disasters going down over the last 22 years. Do you
    know why that is? It's because what we classify as disaster's
    costs and deaths, and those have been going down because human
    resilience has been going up.
        So the conflation of extreme weather and natural disasters
    is extremely misleading. Yes, I agree with more heat waves,
    greater temperature extremes, greater precipitation,
    absolutely. But no increase in landfalling hurricanes in the
    United States. Anybody who claims different is lying to you.
        Chairman Whitehouse. Isn't that truly the measure, when you
    count the actual harm from the hurricanes like----
        (Simultaneous speaking.)
        Mr. Shellenberger. Yeah, because when you factor in--when
    you factor in more--when you factor in more wealth and more
    people in harm's way, you do not see an increase. In fact,
    we're seeing a decline.
        Chairman Whitehouse. Did you factor in increased rainfall
    and increased wind speed?
        Mr. Shellenberger. Yeah, absolutely. I mean look, there's a
    single source of data on it. You can check it yourself. I'm
    sorry, what is the question?
        Chairman Whitehouse. Do you factor in increased rainfall
    and increased wind speed in your analysis?
        Mr. Shellenberger. It's not in my research. There's only
    one--I mean there's only--and we're looking at landfalling
    hurricanes, is that what we're talking about? It's flat, okay.
    So it's not like there's--it's not like there's multiple
    studies. There's just counting landfall, and the best study is
    by NOAA. NOAA predicts----
        Chairman Whitehouse. Well, you keep changing the subject
    back to landfalling hurricanes.
        Mr. Shellenberger. What do you want to talk about sir?
        Chairman Whitehouse. I asked you about increased
    precipitation from those hurricanes and increased wind speed?
        Mr. Shellenberger. Yeah.
        Chairman Whitehouse. With more wind speed and more
    precipitation, you get more damage, even if it were correct----
        Mr. Shellenberger. No, not if you have rising resilience
    you don't sir. In other words, and if you look at NOAA, they
    predict five percent increase in intensity of hurricanes, 25
    percent decline in frequency, both of which are predictable by
    the physics. There's not really a debate. But I agree. We will
    see more precipitation because of climate change.
        Chairman Whitehouse. Correct. Senator Kaine. Saved by the
    bell.
        Senator Kaine. This is one of these days where I have made
    four committee hearings between 9:30 and 11:45, and when I do
    that, my staff rewards me by allowing me to start tomorrow at
    6:45 a.m. instead of 6:30.
        But I'm sorry that I've missed the entire discussion. I'm
    very, very interested in this topic, and I guess maybe----
        Chairman Whitehouse. On that subject Senator Kaine, if you
    don't mind I will--I have another meeting to get to.
        Senator Kaine. Oh okay.
        Chairman Whitehouse. If you don't mind closing is up, we
    have the closing materials.
        Senator Kaine. That's what I'll do.
        Chairman Whitehouse. Finish your questioning, and then
    we're ready to go.
        Senator Johnson. Well, I do get another round here, correct
    Mr. Chairman?
        Senator Kaine. Yes.
        Chairman Whitehouse. You did.
        Senator Johnson. No. You've had three now. I'm going to
    have--I get another round of questions, especially after you
    badgered our witness. We'll talk a little bit of reality when I
    get around to it.
        Chairman Whitehouse. I'm going to add these documents to
    the record.\8\
    ---------------------------------------------------------------------------
        \8\ Documents submitted by Chairman Whitehouse appear in the
    appendix on page 92.
    ---------------------------------------------------------------------------

                       STATEMENT OF SENATOR KAINE

        Senator Kaine. You will get more questions and out of
    delusions of grandeur, I've decided to move up to dais, to take
    advantage of Sheldon Whitehouse's departure. Virginia's a state
    that really sees a lot of climate effects, and it's interesting
    that over my time in public life, the dialogue in Virginia has
    gone from likely effects in the near future to today.
        And the two areas of the state that are seeing it the most,
    but not only these two areas of the state, are the Hampton
    Roads area, which is so vulnerable to sea level rise, and the
    Appalachian area, which because of the narrowness of the
    valleys is really vulnerable to intense flooding. The rainfall
    in some of these areas in Virginia is not changing over time.
    You can look at annual rainfall.
        It's not changing very much, but it's just being produced
    in fewer extreme storms, and the infrastructure that we have,
    schools, roads and health care infrastructure frankly in a part
    of the state where people often have less access to
    infrastructure, including health care. The infrastructure just
    isn't suited for it.
        I think there has already been some testimony from Delegate
    Smith about this issue of urban heat islands. I live in the
    city of Richmond, and we're a pretty green city compared to
    many but--in terms of tree cover. But I wonder if as we look to
    the future in your experience, what more can local, state and
    federal agencies do together to deal with this heat island
    issue, which would have a whole range of health effects on
    people's livelihoods?
        Delegate Smith. Thank you Senator for the question, and
    actually there's been a lot of coverage about Richmond and
    Baltimore specifically in the heat and rising heat and
    temperatures. So I know that there are pockets of both cities
    that have great tree canopy, right, but there are still parts
    that are lagging far behind.
        I want to lift up--I know you're just coming into the
    hearing right now, but I think we've talked a lot about the
    seriousness of premature death because of heat, but I think we
    need to lift up the fact that quality of life. Sometimes people
    are merely surviving, they're not thriving, and I think that as
    policymakers we don't want people to simply be existing in our
    jurisdictions and states. We want them to be living their
    optimal life.
        And so what heat islands can really mean in an urban
    context is if you already have a pre-existing condition like
    asthma, who wants to have more asthma attacks than you need to
    because you're constantly being triggered right? We also know
    for families of school-aged children, asthma is the number one
    reason for chronic absenteeism from schools, right?
        And so as we have rising temperatures, there's not just an
    impact to the mother or father or the guardian's ability to
    work in a healthy manner; there's also implications for the
    young people in the home to be able to thrive as students and
    learners in the community.
        So some of the things that we can do at the local and state
    and federal level with strategic investments is improve tree
    canopy. Also, painting roofs white. Sometimes these are simple
    things we could be doing to reduce the absorption of heat into
    some of these areas of the city. And then also I know that
    there's a lot of conversation about where do you put solar
    energy, right?
        And so one of the bills I was successful in passing was
    really just reducing some of the tax implications for using the
    unusable, parking decks, other compromised lands, you know,
    installing solar.
        Senator Kaine. Rooftop spaces.
        Delegate Smith. Absolutely, yeah.
        Senator Kaine. Uh-huh, and the nice thing about these is
    they can help you on the health side, but they also are income
    producers. Somebody with a parking deck that has a roof that's
    not being used, you can do solar. Somebody can paint a roof
    white.
        They're going to find that not only might that have a
    positive health effect, it would have an effect on the utility
    bills as well.
        Delegate Smith. That's right.
        Senator Kaine. Dr. Moretti, I want to ask you about one
    topic, and then I'm going to come to Senator Johnson. As I
    interact with young people, you know, and I've stopped just
    thinking of myself like a young person when I got a Medicare
    card six weeks ago, and when I interact with young people,
    there is a palpable sense of anxiety among many, dread, fear,
    kind of an existential one.
        Earth Day was Saturday, and I noticed that in my--I live in
    Richmond, the large public university, Virginia Commonwealth
    University, had a very sizeable student Earth Day activism, and
    you know, we have these every year. I see the messaging and it
    might be pro-recycling messaging or----
        But I see some of the messaging getting more and more
    distraught and more and more anxious. We're living in an
    anxious time. COVID was tough. Young people in particular, I
    think, have had a challenging last few years. It's been a time
    of isolation, COVID, and that's not good for young people or
    seniors.
        But talk a little bit about mental health impacts. As we're
    talking about COVID effects on health care, I want to make sure
    we give enough attention to mental health issues, and
    particularly mental health issues with young people. So what
    are you seeing in your practice?
        Dr. Moretti. So we're seeing--thank you Senator for the
    question, and I think you've done a very nice summary of how
    people feel and how young people feel. We're seeing rising
    depression and rising anxiety levels in our youth, in our
    teens, and I think that this is multifactorial.
        I think as you pointed out, COVID has had a huge impact and
    I think that climate change and this recognition of climate
    change, concerns about the future, add a baseline depression
    and anxiety to our population. But similarly as we've talked
    about today, climate change acts through many different
    mechanisms.
        So we have this baseline concern about climate change and
    rising overall mean temperatures, but on top of that we have
    mental health outcomes from disasters. So wildfires,
    hurricanes, etcetera.
        Senator Kaine. Yep, shootings.
        Dr. Moretti [continuing]. That augments this. We also see
    increasing depression and suicide attempts with heat waves and
    temperature. So there's a physiologic link between these
    changes as well. So we're seeing changes in mental health
    through many different mechanisms.
        Senator Kaine. And before I turn to Senator Johnson, I
    guess the other thing I would say is while there are
    challenges, there are also some upside opportunities in the
    mental health space being involved as part of solutions,
    knowing that there are some solutions you can do in your own
    house, in your own neighborhood, being able to take part in
    solutions can have a positive impact on mental health because
    people don't just feel helpless and that it's beyond them.
        They believe that they in fact can have a hand in solving
    it. In Virginia, we've seen this in a significant way. We were
    never a big producer of alternative energy, low and no carbon
    energy. Coal yes, natural gas yes, but we were bottom ten solar
    and no wind compared to other states.
        And so when we talk about climate in Virginia, we tended to
    talk about what I led with, which was the challenges of climate
    change. Now we've moved into the top quarter in the nation in
    deployment of solar, and we are going to be the east coast
    center of excellence for offshore wind, and that is producing
    not only some jobs; it's also producing a little bit of a
    positive, you know, kind of can-do attitude.
        We're not just a climate change problem child; we're also
    going to be an innovator. It's going to help not only
    Virginians and others, and there's a positive mental health
    side to being a problem solver in something like this. I will
    yield to Senator Johnson and note that I do not believe I
    badgered any witness.
        Senator Johnson. I appreciate that. Here's one proposed
    solution, by the way, if you want to decrease the stress level
    in our children. It would be nice if climate change alarmists
    would stop scaring the you know what out of our children by
    telling them that the world is going to end in a dozen years,
    okay. It's not.
        But let's talk about some realities. Does anybody here
    expect either India or China to quit trying to drive, bring
    their people out of poverty and stop using fossil fuels?
    Anybody here think that's going to happen?
        (No response.)
        Senator Johnson. Does anybody dispute that by their own
    models, if we were to eliminate all CO2 in America,
    it would have a negligible impact on global temperatures.
    Anybody want to dispute that one?
        (No response.)
        Senator Johnson. Can somebody explain to me--you know, I
    look at just some basic facts. Again, this is--I don't deny
    climate change. I'm just not an alarmist. I look at the Vostok
    ice core sample, and I see we're in the fifth cycle now. Very
    consistent, 22.7 degree temperature variations over the span of
    440,000 years.
        The Greenland ice core sample, the number of them. About
    6.7 degrees over the last ten to twenty thousand years since
    the last glaciation period. This is the one that always shocks
    audiences, it shocked me, because we're always concerned about
    sea level rise.
        But the increase in sea level in the Bay of San Francisco
    since that last glaciation period, 390 feet. So any of our
    witnesses think that there's anything mankind could do or could
    have done to hold back the tides?
        (No response.)
        Senator Johnson. The answer is no, there's nothing we could
    have done. So again, like Bjorn Lomborg talks about, is we have
    limited resources. Dr. Schramm talked about we've been very
    effective at reducing some of these noxious pollutants that
    obviously impact health. Spend money on that, you know. Spend
    money on cheaper energy, nuclear, right? I totally agree.
        But the environmental left generally has shut down nuclear
    plants. So if you're really concerned about CO2 and
    I'm not; I think it's a plant food, we'll adapt. But there's
    far better ways of spending money. Mr. Shellenberger, would you
    like to comment on that?
        Mr. Shellenberger. Yeah. I mean absolutely. I think that
    the nuclear issue just shows that maybe the people that are
    raising the alarm about this, there's an ulterior motive going
    on here. Something else is going on. I mean we've got some big
    problems with renewables that we need to deal with.
        I mean we have Steve Hayes from NOAA, who is a top
    scientist at NOAA that said that you can't have any more
    industrialization of the eastern seaboard without threatening
    the extinction of the North Atlantic white whale. It's
    extremely troubling. We're seeing a high number of dolphin and
    whale strandings, beachings since industrial wind activity
    occurred.
        So you know, I know that many people here support nuclear
    power, but we still don't have a plan to expand it, and that's
    the easiest and fastest way to transition away from fossil
    fuels without increasing electricity prices.
        Senator Johnson. What big wind towers are ever repaired and
    put back in service, and what is the life of one of these wind
    towers? And how much copper goes into that, and what do we do
    with them? Again, we're just ignoring. There was a really good
    hearing, I saw a clip of it, talking about these large trucks
    need two batteries. Each weigh 8,000 pounds.
        Mr. Shellenberger. Absolutely, I mean these--we talk about
    the externalities of fossil fuels, but what are the
    externalities of renewables? It's not like you can put solar
    panels on a compost bin and hope that they'll, you know,
    decompose. There is no end of use for solar panels.
        Europeans dump them on African nations. Ours go to
    landfills. Same thing with used wind turbine blades. It's
    because it's not cost effective to recycle them. So you have a
    huge waste problem from these solar panel and wind turbines and
    batteries that nobody's talking about.
        Senator Johnson. So Dr. Greenstone, that would be a really
    good analysis for your research, is again, take a look at the
    externalities and the cost of all this green energy, what's
    being proposed. Have you looked at that?
        Dr. Greenstone. That's an excellent question, and I think
    one thing that I'm a little confused about the exchange with
    Mr. Shellenberger here is I don't--the planet doesn't care if
    we run solar or if we run wind or nuclear for that matter. The
    planet only cares about CO2, and so I think that's
    why many climate, people interested in climate, certainly
    including myself, advocate for a market-based solution that
    penalizes the release of CO2 is causing damages.
        So I find the debate about particular technologies a little
    confusing, and then I just want to add one point that--where I
    feel like there should be some agreement with Mr. Shellenberger
    and I, but I'm a little perplexed by it.
        He seems to be a big proponent of nuclear, and was engaged
    in a kind of heated exchange with Senator Whitehouse, well if
    solar and wind are so great, they would--the market would just
    adopt them. Well the same challenge applies to the advocacy of
    nuclear. Nuclear is not--nuclear plants aren't running, they're
    not being built because they're out of the money. The reason
    they're out of the money is they cost more than fossil fuels
    and so fossil fuels have this kind of free subsidy.
        So I've just come back to we should aim for a level playing
    field that does not treat any technology better than the other,
    and stay focused on what the planet cares about, that's
    CO2. It's not a particular technology.
        Senator Johnson. But nuclear, we kind of regulated up the
    cost of that. Mr. Shellenberger, you should be able to respond
    to that.
        Mr. Shellenberger. Yeah. I mean look, the planet does care
    if you use three to eight hundred times more land for producing
    energy from solar and wind than you do at a nuclear, the planet
    does care. The North Atlantic white whales do care about that.
        If you produce solar panels in China with coal, those are
    high carbon-intensive solar panels in contrast if you made them
    in a place and you made them in France, which is mostly
    nuclear. So of course it matters. So these--as nuclear as you
    mentioned.
        I mean California was shutting down a nuclear plant not
    because it was expensive, but because of anti-nuclear phobias
    that date back to the 60's. So nuclear is fundamentally just an
    issue of public concern. We over-regulated it.
        The people that pushed for that over-regulation were
    pushing for it because they were ostensibly scared of it, but
    they really favored renewables. There's a whole regulatory
    paradigm here that has to be taken into consideration.
        Senator Johnson. And what about the economic or the
    environmental impact of mining?
        Mr. Shellenberger. Massive. I mean that's why--that's why
    you look at what's happening in the Congo. I mean just go
    online and look at cobalt mining in the Congo. It's a shame.
    What's happening in China, it's an absolute travesty. We should
    not be importing any more solar panels or batteries produced in
    China to the United States. It's just a fundamental human
    rights issue.
        Senator Johnson. Thank you very much. Thank you, Mr.
    Chairman.
        Senator Kaine. Well, I'll just conclude. When I have a
    Republican witness who suddenly seems to be against all of the
    above, I'm curious. And to have a Republican witness take up
    for the whales, it's the first time in my career in public life
    where someone has done that.
        So I'm assuming it's a Road to Damascus experience. I come
    from----
        Mr. Shellenberger. I've been interested in conservation my
    entire life, with all due respect.
        Senator Kaine. Right, that's great. That's great. I'm from
    a state that's 35 percent nuclear, probably double what the
    national average is. We're perfectly fine with it. Helps us
    with climate and we're really proud to be producing more
    battery-powered heavy duty trucks than any state in the
    country, and doing offshore wind and growing in solar.
        So I--look, American innovation is again rocketing us
    forward on clean energy. That's such an exciting thing. It's
    creating jobs, creating opportunities, going to lead to a
    cleaner planet, gonna lead to better health care and that's
    exciting.
        We've got, you know, we have policy challenges we have to
    work out around regulations, statutes, taxes, benefits,
    etcetera. But I kind of go back to Dr. Greenstone. We're
    probably approaching a point where we could, within a few
    years, the histories of subsidies of one form of industry over
    another, we may be nearing the end of that and we may be able
    to just have complete even playing field on energy, removing
    all subsidies and tax breaks.
        And as you say, let innovation and the market drive where
    we go. I have a pretty strong feeling if that were to happen
    where we would go.
        Well, I want to thank the witnesses for appearing before
    the Committee. Full written statements will be included. As
    information for all Senators, questions for the record would be
    due by noon tomorrow, with signed hard copies delivered to the
    Committee Clerk in Dirksen 624. Email copies also accepted.
        We ask witnesses to respond to questions for the record if
    there are within seven days of receipt. With no further
    business of the Committee, the hearing is adjourned.
        (Whereupon, at 12:03 p.m. Wednesday, April 26, 2023, the
    hearing was adjourned.)

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