[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.

                          ____________________