[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




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                            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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