[Congressional Record Volume 165, Number 45 (Wednesday, March 13, 2019)]
[House]
[Pages H2705-H2709]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
FIVE PILLARS OF WHAT WE BELIEVE SAVES US
The SPEAKER pro tempore. Under the Speaker's announced policy of
January 3, 2019, the gentleman from Arizona (Mr. Schweikert) is
recognized for 60 minutes as the designee of the minority leader.
Mr. SCHWEIKERT. Madam Speaker, what we are going to do right now is,
and we are going to hopefully only take about a half an hour, actually
walk through sort of the continuing theme of how at least our math--and
particularly in our office, we have been trying to put together sort of
a unified theory of how do we deal with the reality of what is
happening in our country with our demographics. We are getting older
much faster, and our birthrate has fallen dramatically.
Repeatedly, we have come up here with other boards that basically
show, over the next 30 years, the greatest threat to our economy, to
our society, to our country's priorities, is the fact that our
interest, Social Security, Medicare, healthcare entitlement costs
consume everything. The rest of the budget is functionally imbalanced.
I know this is uncomfortable because it is one of those things that
is hard for us to talk about. It is not Republican or Democratic. It is
demographics. It is math.
Part of that baseline, to understand 2008 to 2028, take those 20
years, 91 percent of the spending increase here in Washington, if you
remove interest, 91 percent of the spending increase is--actually, I
think it does include interest--interest, Social Security, healthcare
entitlements.
We need to understand the basic math. And now, how do you actually
deal with it?
How do you maximize economic growth?
How do you maximize labor force participation?
How do you encourage people, if we built the incentives, to actually
stay in the labor force longer?
How do you actually embrace technology, particularly disruptive
technology that crashes the prices and makes our society healthier and
more efficient?
And then, how do we have an honest conversation of those earned
benefits and build them so they have incentives in there that, if you
are fit and healthy and happy, you are willing to stay in the labor
force longer? Are there certain spiffs and benefits we can design into
these?
So those are sort of our five pillars.
Today, we are going to do something that is fun.
We just grabbed a handful of concepts that are about technology, and
the tough part--when you start talking about disruptive technology--it
makes you sort of giddy for what the future is and the opportunities.
But there is this thing we call incumbency, particularly in
economics--incumbency: the incumbent business; the incumbent medical
provider; the incumbent over here.
These technologies are going to be a real challenge.
{time} 1430
The running joke in our office is how many of us went to Blockbuster
Video last weekend. We sort of woke up one night and all decided to go
home and hit a button called HBO Go, Netflix, those things. We no
longer stood in line and got movie suggestions and went home with a
little shiny disc.
We are going to walk through, first, some of the healthcare IT and
why this is so important. I want you to first think about some of the
technologies that are starting to roll out.
If you got to take home or had in the back of the office or we had on
the back of the floor here something that looked like a gigantic kazoo
that you could blow into and it told you whether you had the flu or
whether you had a bacterial infection and, instantly, it could ping
your medical records that you are carrying around both on your phone or
in the cloud and instantly order your antivirals and they were
delivered to your house, did we just crash parts of the price of
healthcare? Of course we did.
Did we just make a lot of incumbent businesses? We are challenging
part of their business model because you used this technology instead
of going to the urgent care center or going to the emergency room or
going to the hospital or even going to the pharmacy. But we have to be
willing to think about these things. These types of technologies are
rolling out all around us.
An Israeli company--the picture over in the far corner--actually has,
and I guess it is being certified all across Europe right now, a
desktop blood test that actually does a whole plethora of different
blood tests with just a few drops. Remember, we talked about this 10
years ago. It turns out the technology now actually exists.
In a couple of blog posts, even the concept of going into an
autonomous healthcare center--and we actually have about 10 of these up
in the Phoenix area where you go in and sign up on an iPad. You take a
picture of your driver's license and a picture of your insurance card.
You go into a booth alone. You put your arm in this thing. It does
blood pressure and does a number of readings. You pick up this
particular tool, and an avatar on the screen says: Can you shine this
down your throat? Can you bend? Can you turn? Now do your ears, your
eyes. It actually does algorithmic healthcare.
What if that few-drop blood test--actually, as a couple of blog posts
talked about, you put your hand on something and it pricks your finger.
It takes the blood test right there, and before you walk out the door,
5 minutes later, it is giving you a full blood workup.
What did you just do using technology to disrupt parts of healthcare
costs?
These things are real. They are rolling out right now. There are
amazing technologies in almost everything you can think of. But we are
going to have to think about both the ecosystem and the complications
of how it is paid
[[Page H2706]]
for--are these things that Medicare, Medicaid, and other insurers will
pay for?--and how we do it.
Also, the data. What happens in a society where you are now going to
be walking around with certain wearables?
You have the fancy watch that helps you manage your hypertension, the
patch that does your blood oxygen, the port that helps you actually
manage your blood sugar. There is lots of data coming off of those
wearables. We, in our office, call them digiceuticals. How does that
all tie into the rest of the ecosystem?
And that data, how do you actually get that data so a doctor or the
algorithm can see, when you open your pill bottle--because the pill
bottle has a sensor in it, we know when you took your pill, and 15
minutes later we see this on your EKG that is coming from your watch,
we see this reaction, can that data become incredibly usable? Can that
data be blinded from your own personal information and help all of
society get healthier because we gained more data in those algorithms?
This is cutting edge, but it is not utopianism. We actually have
those things right now today.
If you start to think about it, you can actually go to Amazon, or I
am sure others online, and see that it exists today. For under a couple
of thousand dollars, you can buy a handheld ultrasound. Think about
that.
Apparently, there are other versions, faster, better, even ones
coming in the future where the algorithm will actually read the
ultrasound. You hold it up on your iPhone, and as you are using this
handheld ultrasound to look at the picture, the algorithm is also going
to help you interpret it.
What did an ultrasound system cost a few years ago? You can buy this
online today. It exists, and we are doing experiments with it right now
in a VA, I believe, just right here in Maryland. Apparently, they are
having terrific outcomes because the doctor can walk up and check
something.
These technologies exist. How do we start to have these technologies
start to disrupt the price of healthcare? Because to be absolutely
intellectually honest, if you actually look at the Affordable Care Act,
ObamaCare, or Republican alternatives, we have spent a couple of
decades in this body having a debate on who pays, not how to disrupt.
With the ACA, we are going to have government pay a lot more. Over
here, in our version, we are going to try to create incentives to have
individuals actually get market competition.
They have been debates on paying. We have almost never stepped up and
said: What are our barriers at the State level? What are our barriers
at the regulatory level? What are the barriers at the HHS levels that
actually prevent the adoption of disruptive technologies?
These things do exist today. We need to actually embrace the concept
of rapid disruptive adoption of these technologies because, remember
our five pillars, if we do not have a disruption in the cost of
healthcare as we are getting older very quickly as a society, remember,
in only 9 years, we have two workers for every one person in
retirement.
In 9 years, if you pull interest out, half the spending here coming
out of Washington, D.C., will be to those 65 and older, and it is,
substantially, healthcare.
We all carry around these smartphones. Should our health records be
on those? Of course they should be, because they should be portable
with us because health data, health records are going to become
something dramatically different than the record that is sitting there
at the hospital. It is going to be living.
How many of you ever use something like Waze or a crowdsource on your
phone? You are going to be having these things on your body, or the
pill bottle that knows when you opened it. That data should be living
with you so you are constantly managing.
There is a debate going on with those folks who build these
algorithms. The fact that you had a surgery 7 years ago that is sitting
on your health record or the health data that is coming off your
wearables from the last 48 hours, which one is actually more valuable
to your healthcare? The living data has incredible value in keeping you
healthy. We need to find a way to embrace this and build this
ecosystem.
This next one I put up, even though there are a dozen, we are going
to show a couple of versions of this just for the fun of it. Think
about the debates we are having here in Washington, D.C., and for those
of us on the Ways and Means Committee in regard to drug pricing.
We need to fix many of the incentives. We need to actually deal with
the fact that some of the games that are played on patents and other
things--okay. That is an honest debate. But understand, the data says
that half the pharmaceuticals that will be picked up at pharmacies
today or delivered in the mail today, half of them will either not be
used or will not be used properly.
Think about that just conceptually. Half of the pharmaceuticals that
will be taken home today aren't going to be used properly. Is there a
data solution?
We have everything from just the pill bottle top that lets us know
that you opened it and when it opened and would tag your healthcare
record, hopefully, be portable with you on your phone so we know that
you actually took it, to actually, now, for those who may be on the
severely mentally ill side who have certain maintenance medications
that are providing miracles--they actually have a super small tiny chip
that is actually in the pill itself that we can actually read that we
know you are digesting it, that we know you took your meds.
Think about it. We need to embrace these types of technologies, even
down to this type of pill dispenser for someone who may have a little
more complicated issue where they take some of their pharmaceuticals
either at multiple times during the day or they have certain
complications.
Here is one that was shown at the Consumer Electronics Show in Las
Vegas about 6 weeks ago. You put your cup under it and it automatically
dispenses at a certain time and tells us what pharmaceuticals were
delivered to you. It is technology dealing with the fact that we have
documented that half the pharmaceuticals aren't properly used or used
at all.
It turns out the data that will flow off of these things actually
will help us. When you have a wisdom tooth taken out, do you really
need 30 pills or do you need 3? It turns out, the data from this may
actually help us dramatically change the way we do prescriptions in the
first place.
So I am making the argument, it turns out that data and technology
are also one of the solutions as we talk about pharmaceutical pricing.
Now we are actually going to move on to something else we, as a
body--and this is going to take my brothers and sisters on the
Democratic side and Republican side. We need to have a very, hopefully,
math-based, honest conversation about how we are going to finance
miracles that are coming, and some of them are going to be here before
the end of this year.
We just put up this slide as part of the thought experiment. In
America, we have about 8,000 Americans who have hemophilia A. The price
range, we have actually found some documents that say the blood
clotting factors and those things may be a half million dollars a year
to keep that American stable.
What happens this November or December--which we are actually very
hopeful is about to happen--when a single shot cures hemophilia A? How
do we pay for it? What are we willing to pay for it? How do you value
that in society? It is a single shot of a very small population so it
is not like the next day there is going to be a competitor drug in the
pipeline like we had with other drugs. In this case, it is a single-
shot cure.
But we actually know that over 50 percent of all of our healthcare
expense is to 5 percent of our brothers and sisters who have chronic
conditions. What happens when we start having miracle drugs like a
genomic biological like this that is curing diseases that are part of
our brothers and sisters, that 5 percent who actually have the chronic
conditions that consume over half of our healthcare dollars?
We are actually, as an office, proposing ideas of a type of
healthcare bond so you can actually finance the adoption of the
distribution of these disruptive, revolutionary drugs and then pay for
it using some of what
[[Page H2707]]
would have been the future costs, pull those forward so you get the
disruption of the future savings.
These individuals are out of that chronic condition, but we are going
to have to have a very tricky conversation. How do you price it? What
is the value of a pharmaceutical that is functionally a miracle that
cures something like hemophilia A? How do you price it? There is only
going to be one producer of it, would be my guess, because there is
such a small population. There are only 8,000 Americans with hemophilia
A. Is it worth $1.5 million an injection?
There is actually a math way to get there dealing with the reality of
this is a population that costs us a quarter of a million dollars a
year to keep them healthy, and this is the life expectancy. What was
the research cost, because we want these miracle drugs as part of our
society to help us have that disruption as part of the holistic theory
of technology, these new miracle drugs that are coming, to disrupt the
future healthcare costs.
Now, I want you to take this concept a bit further and spread it
beyond healthcare. Think of some of the crazy debates we have actually
had here on the floor in regards to--forgive me--environment. I want to
argue with you that there is a technology disruption that can make our
environment cleaner but we don't actually hurt the economy. We can
actually help it grow.
So here is my first thought experiment. This has been a fixation of
mine for a few years here.
Think of the community you live in. What if tomorrow, instead of
today's current model--you want to open up a paint shop or you want to
open up a bakery or this and that. You go out and fill out forms. You
send them down to the local environmental regulator. You may also file
them with the State. If you are doing certain types of volatile
organics, you may have to file with the EPA. You are basically filling
up file cabinets. Do filled-up file cabinets make the environment, the
air quality in your community cleaner?
{time} 1445
It is an honest concept because we functionally have a 1938
regulatory model of file--lots and lots of paper--maybe even do
quarterly audits, maybe annual audits, fill out more paper, and fill up
file cabinets full of paper that functionally a lawyer gets to come and
look at a couple years later.
Does that make the environment in your community cleaner?
What would happen if you had a few hundred or a few thousand people
traveling around in your community that actually just had the little
sensor traveling with them that they were collecting data on
hydrocarbons, on volatile organics, and on ozone, and you could
actually see the map of your community? If all of a sudden you had a
hot spot over here because you find out you have clowns painting cars
in the backyard of their house, you would know about it instantly, and
the environmental regulator, instead of putting paper in file cabinets,
they would get in, hopefully, their electric vehicle, and go over and
actually stop the clowns from painting cars in their backyard.
Which made the environment cleaner?
The trade-off here is actually very elegant because I don't need you
to file lots of paperwork. I don't need you to actually be doing
quarterlies and annuals because if you screw up, we catch you
instantly.
What made the economy grow, what reduced the bureaucratic burden in
our society, and what actually made our communities healthier and
cleaner?
It is just technology.
Mr. GAETZ. Will the gentleman yield?
Mr. SCHWEIKERT. I yield to the gentleman from Florida.
Mr. GAETZ. Madam Speaker, I thank the gentleman for yielding.
With all due respect to the gentleman from Arizona, he is very weird
in that he runs his congressional office like a think tank where people
contemplate the ways that technology can improve healthcare and the
environment in a nonpartisan way, because these are not issues that
have anything to do with whether someone is a Republican or a Democrat.
But so many of these ideas that the gentleman and I have discussed
for years fail to make their way into the most dynamic economy and
marketplace in the world, which is the United States of America.
So my question for the gentleman is: How do we go from the innovative
space of great Americans coming up with sensor technology to action in
the Congress or within our government that is worthy of the great
people we serve?
Mr. SCHWEIKERT. Will the gentleman enter into a colloquy?
Mr. GAETZ. I will.
Mr. SCHWEIKERT. The gentleman is one of my buddies from Florida. He
actually gets this, but he also knows I actually love the technology
disruptions, because none of us has figured out if it is Republican or
Democrat yet, which actually makes it possible for us to do it. Now,
eventually, we will break it into partisan because everything has
become weaponized and partisan around this body.
But, right now, think of this: this is a natural gas electric
facility. It can power 5,000 homes. It is up and running outside
Houston. It doesn't have a smokestack. All the ACO2, so all
the carbon is captured. They actually came up with this brilliant
technology that the carbon actually flows through. My understanding of
the engineering is it helps spin the turbines, and then the excess
carbon that is generated is safe and sold.
We actually have a tax credit that we adjusted that hopefully made it
more robust as we did tax reform that if you want to take some of that
carbon you can put it in concrete, or a piece of plastic, or do it for
certain types of oil recovery.
Mr. GAETZ. Was it a refundable tax credit or was it an upfront
credit?
Mr. SCHWEIKERT. It is actually a tax credit according to the amount
of tonnage you produce of ACO2.
Mr. GAETZ. So it is a production tax credit?
Mr. SCHWEIKERT. Yes. But the beauty of it is that model has said that
we have actually already created a value on this carbon, and if you
don't put it into the environment but actually use it for other things
as a filler in plastics, as a filler in concrete, in putting it back in
to the ground to enhance recovery, we are already doing it. This
technology isn't utopianism, it exists. It is already running.
How many times around here have we talked about that we can actually
have a hydrocarbon generation without a smokestack?
The technology exists. If we are going to talk about a green agenda,
then we actually all need to sit down and actually meet with the really
smart researchers and scientists and actually understand the math and
science. That science is way ahead of where our heads are.
The gentleman from Florida has some amazing technologies coming out
of his State right now on everything from biogeneration to the ways to
manage the environment.
Mr. GAETZ. I would ask the gentleman, as we try to take these good
ideas that seem to not be emerging from the Federal Government but from
several States and from local communities that are doing some of their
own great work, I feel at times like you have got one party here that
thinks that Big Government is always the answer, and you have another
party who thinks that big business is always the answer, and at times
these technological solutions come from neither. They come from the
creative class, the innovative class.
Mr. SCHWEIKERT. That is actually a brilliant way to phrase it.
My continuing thought experiment, and this is a little beyond where
we were going, but it makes the point, visit Washington, D.C., or a
bunch of other locations now. They are not going to give you a straw or
they are going to give you a paper straw.
The math is--and this actually, I believe, comes from the United
Nations--90 percent of all the plastic in the ocean--and, look, it is a
big deal. I am looking at my data here, roughly 8 million tons a year
of plastic goes in to the ocean. The gentleman is from a coastal
State--comes from 10 rivers, eight of them in Asia, two of them in
Africa.
If you actually really cared about plastic in the ocean, that 8
million tons, we would actually take our environmental policy, our
trade policy, and
[[Page H2708]]
our foreign aid policy and say that we are going to actually help these
10 rivers that are responsible for 90 percent of the plastic in the
ocean and work on those. But instead we do these feel-good, absurd,
theatrical things of ``my community isn't going to do straws, don't we
feel better that we did something for plastic in the ocean?''
It had nothing to do with plastic in the ocean. It is these 10
rivers. Let's grow up and stop the political theater.
Mr. GAETZ. So what is the get-out-of-jail-free card so that we can
liberate ourselves from a policymaking climate that seems to be more
robust in virtue signaling than in actually following data?
Mr. SCHWEIKERT. I knew you were going to say virtue signaling.
This is a little bit sarcastic, and I mean it to be slightly on the
humor side, one of the first things every Member of Congress should put
into their budgets is the ownership of a calculator, because we
functionally work in a math-free zone where our feelings become public
policy instead of the baseline data where we can actually have an
impact of making our society and the world healthier and more
economically prosperous. If you actually, genuinely cared about plastic
in the ocean, we have 10 rivers, 90 percent of the plastic, we know
exactly where they are; focus there, instead of the absurdity of the
straw at your local whatever.
Mr. GAETZ. I appreciate the gentleman mentioning our oceans. As
someone from a coastal State that means a great deal to me.
Mr. SCHWEIKERT. Coming from Arizona we have sort of this utopian view
that one day Arizona may become a coastal State.
Mr. GAETZ. Based on the current rate of climate change you may get
your wish.
Mr. SCHWEIKERT. Or an earthquake.
Mr. GAETZ. It doesn't strike me as an enviable outcome. I do thank
the gentleman again for yielding for this discussion.
It is my sincere hope that this is a discussion that we can have with
Members of Congress from urban districts, rural districts, liberal
Members, and conservative Members, because as the gentleman correctly
points out, these are actually solutions that do not lend themselves to
a partisan tilt.
I am sincerely hopeful that the gentleman will continue to lead on
this subject, and I thank the gentleman for yielding.
Mr. SCHWEIKERT. You are very kind, and I thank you for the colloquy.
Look, many of us just want to solve the problems. I have the best
little girl in the world sitting in the back right now. She is 3 years
old.
What does her future get to be like?
We have a demographic crisis. It is just math. We are getting older
very quickly. If we don't grow the economy, if we don't have lots of
labor force participation, and if we don't use trade and tax policy and
innovation, we need these things to grow.
But instead, Madam Speaker, if you listen to the speeches that often
end up behind these microphones, it is an absurdity that is partisan
because we care about power more than actually doing those things that
are so important for our future of this society.
So I want to give you one last, ultimate thought experiment. I am
still just stunned this article hasn't gotten more coverage around the
country, but it is going to require many of us to actually deal with
some of our political constituencies that have lots of folklore built
into their belief systems.
About 6 weeks ago, an article came out. University of Illinois U.S.
Agricultural Research Service published a paper saying--now, you all
remember your high school or your first botany class or when you were
actually learning about cell biology--there is actually a weird
inefficiency in plant cells on how they grab a carbon molecule or
oxygen molecule--we won't geek out too much--but they found a way
through a bit of genetic engineering to make the cell wall
superefficient.
They basically believe that they have broken the Holy Grail that
plants, commodity crops--right now they did it on tobacco plants,
because the reason they do research on tobacco plants is we have known
the genome of tobacco plants for quite a while now--40 percent increase
in efficiency.
We have got to think this through. Now, there is a really disruptive
side of that. Forty percent, tomorrow if you could plant a corn seed or
wheat or something else, and it had 40 percent more yield, what does
that mean to feeding the world 50 years from now?
Yay.
What does that mean to commodity prices?
Scary.
But you need functionally now 40 percent less land, 40 percent less
water, 40 percent less fuel, and we actually have some data here from
the IPCC 2014 report which is from the United Nations that just a
little under one-quarter of all the human emissions, functionally
greenhouse gases, come from agriculture.
If you do the math--think about this--this 40 percent increase in
yield for agriculture would functionally equal removing every car off
the face of the Earth.
Think about the conversations we have here talking about the
environment. Here is a miracle. And the reality we know from other
disruptions in seeds that it can be rolled into society very quickly as
these new seed stocks, except we are going to have to deal with our
brothers and sisters saying: well, that is a genetically modified seed.
Yes, but it has this amazing disruption in the world. If you truly
care about greenhouse gases, if that is your fixation, just moving to
this new disruptive technology that I hope is real, I hope the research
continues to demonstrate a 40 percent production increase, this here
could be the fastest, biggest disruption in greenhouse gases in the
world because you could actually adopt these seed crops within just a
few years.
That is an example of technology not just bringing a small
improvement or even a disruption, in many ways it is a major
disruption, but you have to deal with the politics of belief systems.
It is genetically modified, but it is not a genetically modified seed
stock to deal with pests or this and that, they just dealt with the
inefficiency of the cell wall. It is a miracle. If it is true, it is a
miracle. Think about it, though, but understand the disruptions that
are going to roll through our society.
What happens to the value of agricultural land?
What happens to the ability of nations to ultimately feed themselves
if all of a sudden they had a 40 percent increase in productivity?
But also what happens in our world if I come to you right now, Madam
Speaker, and say that agriculture produces functionally, by my math, a
bit more than 2\1/2\ times the amount of emissions of every car on the
Earth?
So this technology would be as if you just removed every car off the
Earth.
How come we don't have these types of conversations here on the
floor?
It is because it doesn't fit our political folklore model of what has
become just a stunningly partisan gotcha weaponized body.
As we go through our five pillars for the future one more time, the
reason for the fixation on this, we have 74 million of our brothers and
sisters who are baby boomers, the last baby boomer hits 65 in 9 years,
many of the things we should have done we should have done a decade or
two decades ago, and we didn't have the political appetite. We have to
deal with the reality that we have this population bubble that is
getting older and our birthrates have substantially collapsed.
If we are going to keep our promises to those folks who have worked
their entire lives who will be moving into their benefit years, we have
to think disruptively. We have to be willing to do everything from tax
policy, trade policy, and regulatory policy that we have talked about
here using technology, to labor force participation, encouraging people
all up and down the spectrum to actually enter the labor force.
We have to be willing to talk about redesigning some of the programs
to incentivize, if you wish to work, you get to work. We are going to
have to actually also embrace the miracle of these disruptive
technologies and not be scared of them.
But this body is going to also have to deal with something that is
very difficult for a political body, and that is a lot of our friends
are going to either have to change their economic models and a lot of
our States are going to
[[Page H2709]]
have to change their regulatory models just as we will. But it is these
disruptions that give us the economic robustness to actually keep our
promises over the next 30 years.
Madam Speaker, I yield back the balance of my time.
____________________