[Congressional Record Volume 165, Number 58 (Wednesday, April 3, 2019)]
[House]
[Pages H3061-H3065]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                       AMERICA'S ECONOMIC FUTURE

  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. Mr. Speaker, I promise not to go 60 minutes.
  Continuing the series we have been trying to do on a much more, shall 
we call it, wholistic policy of how to get a sort of unified theory of 
what will make America's economy, opportunity, our ability to pay for 
our promises, particularly over the next 30-some years, when our baby 
boomers are in their retirement years.
  This is, actually, sort of just another module on trying to help 
sell, educate, convince, cajole, on that idea.
  We always start with this particular poster now that our belief is 
you sort of have five pillars on what we must do

[[Page H3062]]

almost immediately to have the economic growth and the mechanics to be 
able to keep our promises.
  Remember, basic math: We have 74 million baby boomers. We are now 
about halfway through that 18-year cycle turning 65.
  In 8\1/2\ years is the final portion of the baby boom turning 65. In 
8\1/2\ years, half the spending, less interest, coming out of this 
body, so 50 percent of the spending will be to those 65 and older. In 
8\1/2\ years, there will be two workers for every one person in 
retirement.
  Understand what this means: If we don't have substantial economic 
growth, substantial incentives to stay in the workplace, and also a 
really disruptive cost curve in parts of healthcare, I defy you to make 
the math work.

                              {time}  1945

  So we have actually sort of laid out five principles of policy, and 
within those policies, there are lots of moving parts. We are going to 
talk a little bit more of sort of the technology disruption, but we are 
going to talk the other half of it from what we did 2 weeks ago.
  But economic growth: What do you do in a tax system? What do you do 
with trade? What do you do with smart regulations?
  I have done presentations here about crowdsourcing data as a much 
more elegant way to regulate; using block chain to collect data in 
financial markets so you could actually have a much more rational, much 
more reactive, much faster regulatory environment.
  We also have on here, I use the term, ``population stability.'' 
Remember what has happened to the United States birth rates and where 
we are going and where we are predicted to go.
  In the last 10 years, there are 4 million children that we expected 
who are not here. That is functionally 4 full years of immigration in 
10. Are we willing to actually say it is time to go to a talent-based 
immigration system with some flexibility in there to maximize 
population stability? And on the other end, are we willing to also 
adopt public policy that encourages family formation?
  It is math, and it is math about the economic robustness of this 
society.
  Earned benefits: We are going to have to find ways that, as we keep 
our promises on Social Security, if we keep our promises on Medicare, 
are there inducements, incentives we can produce to say: Are you 
willing to stay in the workforce longer, part-time? If you are healthy, 
happy, capable, we want you. It makes a difference.
  Are we able to give you certain incentives to postpone taking 
benefits to actually help yourself, but also help the programs as they 
function?
  And then the last one under our five pillars is employment. How do we 
maximize, as a society, participation in the workforce?
  You know, we still have some data issues on millennial males. What 
can we do to help them get into the workforce?
  As you know, last December, we finally had a real breakthrough in 
some of the data--we call it the U-6--employment data on millennial 
females moving into the workforce. That is part of it.
  We also want to encourage older Americans to stay in the workforce if 
that is their choice.
  But we also are starting to see something that is really exciting in 
the labor statistics--I am sorry I am geeking out, and I know I am 
sounding like an accountant on steroids, but these things are really 
important--is our handicapped brothers and sisters. People who have 
actually had substance abuse and other types of issues are actually 
moving back into the workforce.
  Behind this microphone I have talked about even the things going on 
in Arizona right now, where we actually have private, paid-for job 
training in our prisons because there is such a labor shortage, there 
is such a skilled labor shortage in our community. That is actually 
wonderful.
  I mean, if you care about people, where we are at right now, our 
ability to draw our brothers and sisters into the labor force for that 
honor of work is an amazing thing.
  Mr. Speaker, I yield to the gentleman from Ohio (Mr. Stivers).


Honoring the Life and Service of United States Army Sergeant Joseph P. 
                                Collette

  Mr. STIVERS. Mr. Speaker, I thank the gentleman from Arizona for 
yielding.
  I rise today to commemorate one of America's heroes, United States 
Army Sergeant Joseph P. Collette of Lancaster, Ohio.
  Sergeant Collette gave his life in the service of our Nation on March 
22, 2019, while serving in Afghanistan with the 242nd Ordnance 
Battalion, 71st Explosive Ordnance Disposal Group.
  Serving with the United States Army was a goal for Sergeant Collette. 
On September 11, Sergeant Collette was only 11 years old, but on that 
tragic day he felt the call of service. It is that bravery, 
selflessness, and commitment that Sergeant Collette will be remembered 
for.
  A man of many talents, he loved sharing his passion for cooking with 
others and challenging his friends to paintball matches and Pokemon 
battles.
  He loved spending time outdoors, but he loved nothing more than 
spending time with his friends and family, and his legacy will live on 
in their memories.
  As a brigadier general in the Ohio Army National Guard, I have been 
privileged to serve alongside men and women like Sergeant Collette. I 
can say without a doubt that Lancaster, Ohio, and our Nation is a 
better and safer place as a result of his service.
  I am honored to celebrate his life and legacy, and my heart goes out 
to his entire family.
  This country needs to recognize heroes like Joseph Collette, so I 
hope that we all will take a moment of silence to recognize the life of 
Joey Collette.
  Mr. SCHWEIKERT. Mr. Speaker, look, those are always hard to do, 
particularly, you know, when you want to reach out to the families in 
your community and deal with those really difficult moments. So I 
appreciate the gentleman, and I am always happy to yield. He has always 
been very kind to me here.
  All right. Back on to trying to help do our theme here. And I know it 
is a little sarcastic, but it is sort of meant to have a little impact. 
We often joke that we are operating in a math-free zone, and it is a 
great frustration.
  One of the neat things that has happened over these first couple of 
months as we have been doing this sort of unified theory pitch--and we 
keep trying to say it is not Republican or Democrat. It is math. A 
number of my friends from the left have actually started to stop by the 
office, particularly on the technology, which I am very excited, 
because there is a revolution happening around us.

  So let's actually sort of move on to one or two more boards just to 
make sure that we have built the argument.
  On this particular board--and I have shown this; I am going to keep 
showing it--2008 to 2028, 91 percent of the increased spending--so when 
you see that curve going up between that 2008 and 2028, 91 percent, 
Social Security, healthcare entitlements, and interest.
  Social Security, the healthcare entitlements, and interest--91 
percent of the growth in spending for those 20 years.
  So when we get here behind these microphones and we are often talking 
about this or that, understand the vast majority of what is driving our 
spending are our demographics. Our demographics are what drives Social 
Security, Medicare, and the borrowing within those drives a tremendous 
amount of the percentage of the debt.
  So how do you build a robust enough economy and then enough 
optionality in that growth with technology to also bend the cost on 
healthcare?
  So this particular slide is really important for us to get our heads 
around, and this is the other side.
  In the previous couple of weeks, we have done a series of 
presentations here on the floor about the technology that is coming on 
everything from wearables to autonomous healthcare to being able to 
instantly have your flu diagnosed, and can we build a system, if we 
would take down some of the legal barriers, where almost instantly your 
antivirals can be delivered to you.
  Think about blowing into something that looks like a flu kazoo. It 
diagnoses you. It pings off your personal medical records and instantly 
can order those antivirals.
  How much healthier, how much more time do you have for your life, for 
your family?

[[Page H3063]]

  These are the types of disruptions we as a body--and it is not 
Republican or Democrat. It is where technology is leading us, to make 
our lives more convenient. That precious commodity of time is given 
back to you, and we become healthier as a society while bending our 
healthcare costs.
  Well, this particular slide makes it very clear that we actually 
believe about 75 percent of all of our spending--and we get this, I 
believe, from the Centers for Disease Control. Seventy-five percent of 
our healthcare spending is for chronic conditions.
  Okay. So we actually know where our spending concentration is. So how 
do we start to have a disruption in that?
  And if you actually look at the growth of healthcare, this is 
basically our spending in 2001 to 2017. But you see that line just 
growing and growing and growing.
  Well, a lot of that, we will immediately get people who say: Well, 
that is pharmaceutical prices. Well, that is this. That is this.
  It is substantially our demographics and then the procedures that 
come along with that aging in society.
  We will actually, in the future, if there is a request for it, we 
will bring some of those boards and actually do more breakdown. But it 
is just understanding we cannot survive if this line continues to grow 
in that fashion.
  Additionally, and just understanding these categories--and I am going 
to push this back just a little bit because this particular board may 
be unreadable from a distance, but it is really important.
  What we are trying to explain here is, the green bars, the small 
bars, think of these as chronic conditions that have never been 
diagnosed; the blue are where they have been diagnosed; and the total 
cost in our society.
  When you look at this, what would happen if I could come to you and 
say, for a number of these, there are ways to manage hypertension. 
There are ways for someone like myself that is a pretty severe 
asthmatic to manage my asthma. There may be cures on the very short 
horizon coming for many of the diseases we consider chronic conditions.
  Part of what I want to talk about tonight is the second half: How do 
we finance the miracles that this body in previous years, when we did 
the CURES Act, when we actually did the specialty, the financing, the 
research resources for orphan diseases--it is starting to pay off. Many 
of the policies, actually, the Republican Members here did in previous 
years with the previous President are starting to pay off.
  So think about this--and I may have my date wrong; I am desperately 
hoping it is by the end of this year--a single-shot cure for hemophilia 
A. So our brothers and sisters, and there are only about 8,000 in the 
United States who have hemophilia, but it is a population that is very 
expensive for the blood clotting factor, for the other medical 
maintenance for that population, for our brothers and sisters.
  How about a single shot that cures? What would we, as a society, be 
willing to pay for that curative?
  How do we finance it? What if it is a $1.5 million a shot? Let's just 
sort of theorize here.
  But in about a 5-, 6-year period of time, it has actually more than 
paid for itself. Just, you know, the tyranny of basic accounting: How 
do we say today we want a system where we can finance these disruptive 
pharmaceuticals so we can start to change parts of these chronic 
populations so we do something that is curative?
  One of the discussions we have been working on in our office for 
almost 2 or 3 years now is the concept of, we will call it a healthcare 
bond that says we are going to reach out, do a census of the 
populations of, hey, these many individuals with this particular 
disease that this pharmaceutical would cure or dramatically improve 
their lives--some are on Medicare; some are on Medicaid; some are on 
private insurance; some are at the VA. We need to do that census and 
then do sort of an assessment over time to have what would have been 
their normal cost pay back that bond.
  The trickier policy set here--let's go back to our hemophilia 
example: 8,000 population, a single shot cures the disease. How do you 
price it?
  This is going to be an intellectually robust discussion we are going 
to have to have. We have other things in our society we price. A 
baseball player who is phenomenal, you would do certain types of 
arbitration.
  We could actually take a look at everything from the research costs, 
to the future benefits, to the incentives to continue this type of 
research, to the health benefits of having that population cured.
  There has got to be a formula we can come up with as a society where 
we continue to encourage these incredible miracle disruptions that are 
on the horizon. We need more of them because they start to solve this 
chart's problem.
  Remember the previous one, the pie chart. Seventy-five percent of our 
spending, functionally, is within those chronic conditions. What 
happens if we start to cure them, or at least a portion of them?
  It is time this body stops having the crazy debate we have had here 
for the last 10 years, which is the ACA. It is even our Republican 
alternative, which I believe had some great things in it.
  But we have been having this debate about who gets to pay. We have 
not been having the discussion, the intellectually honest discussion of 
what do we do to pay less and provide more?

                              {time}  2000

  That is my goal here. If these miracle biologicals, if these miracle 
genetic treatments, are coming, how do we get them adopted into our 
society as fast as possible?
  In many ways, as we saw in the first phase of the hep C cure--what 
was the drug, Sovaldi? In that first year, year and a half, it cost 
$84,000, I believe, but it cured hepatitis C, meaning you did not need 
a liver transplant. But what happened? We had a number of our State 
Medicaid systems that were on the verge of going bankrupt.
  The difference in that sort of pharmaceutical is you had time before 
someone became symptomatic where liver transplant was indicated. And 
then we knew there was a second pharmaceutical with some of the same 
efficacy coming.
  What happens when there is not going to be a second drug, because it 
is a small population or it had such stunning research costs?
  We need to think through how we finance disruptions of those 
pharmaceuticals and how we also get a fair pricing so the research 
continues. We incentivize that, but also a fair pricing to society, 
which is willing to put on debt for a quick adoption and then use the 
future savings.
  So understand, what is neat about this, if you actually look at these 
diagnoses with serious chronic conditions, a number of them can be 
partially benefited by technology.
  Once again, I am a pretty severe asthmatic. We have played with a 
couple of contraptions that help me manage my blood oxygen.
  What happens if that contraption can talk to my phone and say: ``Hey, 
David, this morning, you really need to take two puffs of your inhaled 
steroid.''
  ``Hey, David, we are doing some calculations. Today, you don't.''
  As you have already seen, you may even have family members who are 
now reading off their phones about their diabetes, because they have a 
port that is reading their blood glucose.
  Technology can help us manage a number of these chronic conditions to 
make them so they don't crash, so they are not catastrophic for the 
individual and not expensive for society.
  If you have hypertension, how many of you may have an arrhythmia that 
you now have a watch that will help you manage? Those are on the 
technology side.
  On some of these, it is the curative that I really wanted to get into 
our understanding, the other half of the miracle disruption that is 
coming in healthcare.
  We need, as policymakers, to understand these are the benefits we are 
now yielding because of a lot of really good policy decisions this body 
made over the last few years.
  Let's move on to a couple more boards to try to help this argument 
become a little more robust.
  This was the best one I had, but let's go back to the hemophilia 
discussion. Can we use this example that is on our immediate horizon?
  I believe they are already well in or through their phase III. They 
have had,

[[Page H3064]]

apparently, just from even the latest article I pulled up a couple days 
ago, amazing efficacy. It is curative for the vast majority of the 
population, something we never really thought of.
  Are we ready as a society to say: Can we build the box of how we 
finance these disruptions?
  Let's walk through a couple others.
  How many of you have heard of some of the gene therapies where we can 
turn on your immune system, but we turn it on in such a way--well, the 
medical researchers, by understanding the type of cancer you have, 
looking at that cancer and saying, hey, here are the receptors that 
your immune system would do the most efficient--how do I describe it?--
the most efficient method of killing those cancers. What if that costs 
$250,000, $500,000, but it cures?
  How about in some of these cases? Now we are looking at this 
particular one. This is from earlier in the year or late last year, a 
pharmaceutical biological that changes a genetic form of blindness. You 
are born with this blindness on your DNA, and it recodes your DNA and 
brings back a substantial portion of your sight. What is the value of 
that?
  There are some unique things. I believe it may be within this gene 
editing. Actually, it is really expensive. I think it may have been 
$400,000 or $500,000 for a certain number of the patients. It was 
almost you only paid if we hit a certain level of returning your sight.
  What happens when we are able to do more of this, that it is more 
than just a disease you have developed, and we are actually recoding 
parts of your own personal genome to deal with a genetic blindness that 
you were born with? How much does this help society? How much, as a 
society, are we willing to pay?
  When we pay it, is there a way we can have a financing mechanism that 
the adoption of such miracles happen quickly, and we can reap the 
benefits in future time? That is the concept for the healthcare bond.
  Let's take one that actually is near and dear to me. I am from the 
desert Southwest. I am from the Phoenix-Scottsdale area. I live in a 
little community called Fountain Hills, a wonderful part of the 
country. I am incredibly blessed for the community I get to represent 
and live in.
  But from the desert areas of California through Maricopa County, 
Phoenix, Pinal, all the way down to the Tucson area, we have fungi in 
the soil. We call it Valley Fever.
  We believe one out of three people who go to a hospital believing 
they have pneumonia actually have the fungi, have Valley Fever in their 
lungs.
  For a small fraction of the population, they don't just feel like 
they have pneumonia for a week or 2 or 3. They get something, I believe 
the term is ``undifferentiated,'' where it breaks out and ends up in 
your bones.
  I have a neighbor, a former Vietnam helicopter pilot, one of the 
greatest human beings you can ever meet. His hands have been carved up 
from when they have had to go in and remove the fungi that is growing 
in his bones.

  Leader McCarthy, Kevin McCarthy, because of the community he 
represents, and myself in the Scottsdale-Phoenix area, a few years ago, 
we started a Valley Fever Caucus for those of us who live in the desert 
Southwest. We have had some amazing success.
  We have been able to move some resources. We have gotten the folks 
back East here to understand this very unique regional disease we have. 
We were able to move some money, and all of a sudden, we now are 
hearing that we may be 3 years from a vaccine for animals.
  This particular disease killed my dog, Charlie, a few years ago.
  But after the vaccine for our canines and our pets, it is only a 
short time after that, maybe just a handful of years, that we will 
collect enough data that we will have fungi vaccine for something 
called Valley Fever for those of us who live in the desert Southwest.
  These are examples. We believe a disease like that ultimately costs 
billions in our communities for hospital visits, for sick days, for all 
the things that go with that.
  What is the value of a vaccine that is being developed for an orphan 
disease like that that most folks back East have never even heard of?
  We have succeeded at moving the resources around here in Congress 
over the last few years to start these miracles of the genomic and the 
other types of research that are bringing these miracles here.
  Back to our primary conversation. As we age as a society, our biggest 
cost driver, particularly over the next 30 years, is healthcare. We 
have done presentations here the last few weeks on the technology 
miracles that are coming, where you can manage your own health. You 
don't have to be part of the collective. You can manage your own health 
and have incredible data. But we are going to have to break down some 
of the old silos, some of the old legislative barriers, some of the 
barriers to entry.
  The other half of that is how we continue to encourage these 
disruptive biologicals, these disruptive genomics, these disruptive 
drugs that are curative.
  The one that was in our office a couple weeks ago, talking about ALS, 
it is probably going to be a couple shots a year, but it will freeze. 
You will hold steady. So it is not curative, but it stops the 
regression and the progression of the disease. What is the value to 
that in our society?
  These are big deals. As I reach out to my Republican brothers and 
sisters and my Democrats, help those of us who understand these cures 
are not Republican or Democrat. We as a society must come up with the 
mechanisms that bring them out, finance them, and then understand the 
debate here must be about what we are doing to change the price curve 
of healthcare at the same time our demographics are getting much older 
very, very, very fast. We can do that.
  It is a much more elegant discussion than the absolutely ridiculous 
discussion that continues to go on here because it works in our 
partisan format where everything here has been weaponized now 
politically of let's have a fine debate on who gets to pay, how much 
government subsidy should you receive.
  Let's do something really creative. Let's start lowering the price by 
bringing technology, by bringing other channels of exciting new 
pharmaceuticals, and even down to things that are affecting the folks 
in my neighborhood, a disease like Valley Fever, where I now get to go 
home and say we worked on it a few years ago. We were not optimistic, 
but we kept working and we kept working and we kept working. There are 
brilliant people down at the University of Arizona Center for 
Excellence on Valley Fever. There are researchers at NAU. There are 
researchers in California who are now almost there.
  There should be joy in this body when you start to think about the 
cusp we are on. Will Congress be looked at by someone 10, 20 years from 
now, saying they did policy that actually made these things happen 
faster? Or will we continue to exist in a world where the way we 
reimburse, the way we finance, the way we regulate, the barriers to 
entry of the technology, we slowed down the disruption that could have 
helped us lower healthcare costs?
  These are the things we are fixated on, because remember our five 
points: We must have the robust economic growth. We must have the labor 
force participation. We must do the incentives to, if someone wishes to 
stay in the labor force and delay parts of their retirement, how do we 
reward that? We must do these others, but we also must push these 
technologies, because our biggest fragility is the healthcare costs.
  I think there are some great things about to happen. Look, that is a 
portion of the presentation. Hopefully, in a couple weeks, we are going 
to come back and we are going to do something much more technical--I am 
sorry; I know that is really exciting--on some of those incentives to 
stay in the workforce. But we need to understand, if you have a 
complicated problem and someone walks up to you and gives you a really 
simple solution, it is absolutely wrong, because complicated problems 
require complicated solutions.
  That is where we are headed.
  Mr. Speaker, I yield back the balance of my time.

[[Page H3065]]

  

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