[Congressional Record Volume 166, Number 43 (Wednesday, March 4, 2020)]
[House]
[Pages H1496-H1499]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




            SOCIAL SECURITY AND MEDICARE THOUGHT EXPERIMENT

  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, we are going to actually try to touch on 
3 or 4 different things this evening, and I am going to try to make it 
all sort of connect together.
  On a personal level, I was very pleased as we were doing the 
supplemental and the mechanism in regard to the coronavirus, a little 
widget of that was actually the telemedicine piece of legislation that 
I believe Mr. Thompson from the Ways and Means Committee and myself 
have offered. It is always nice to see some of these ideas you have 
been working on getting lifted up and moved forward.
  But this evening I actually want to sort of continue to talk about 
science, and the fact of the matter is, the impact it can have if we 
actually think forward on functionally our debt, our

[[Page H1497]]

deficits, and our ability to keep our promises.
  You know, I have been behind this mic dozens and dozens of times with 
my little boards, trying to demonstrate that over the next 30 years, 
functioning Social Security and Medicare, these are earned benefits, 
but they also are the primary drivers of U.S. debt. It is almost all of 
it. And a lot of it is just demographics, we are getting older as a 
society, and most of it is actually Medicare, it is healthcare costs.
  And it turns out that there are opportunities that, if we can embrace 
technology to actually disrupt some of those healthcare costs--and at 
the end, we always sort of talk about we need to grow the economy, we 
need tax policy, we need immigration policy, we need regulatory policy, 
we need incentives for labor force participation, there are all these 
things that make the economy grow so we have the resources, the 
receipts, revenues, tax revenues, and other things, to actually keep 
our promises. But one of the other things we could do is also disrupt 
the price of healthcare.
  So just as a thought experiment, except it is actually based in the 
living math--this slide is a little hard to deal with--but think of 
this, over the next 30 years--and this isn't adjusted for inflation--
but over the next 30 years, if you were to remove Social Security and 
Medicare, you would have $23 trillion in the bank.
  If you roll Social Security and Medicare back, you are $103 trillion 
in debt, and it is mostly Medicare, it is mostly healthcare costs. 
Well, 30 percent of that healthcare cost is just diabetes--and that is 
what this slide is sort of walking through--diagnosed, the individuals 
we know about, those we are expecting to come in the future years, and 
the cost curve.
  The fact of the matter is, our investments, our ability to build 
policy that gets us to solutions for diabetes--and diabetes is 
complicated, you know, there are autoimmune issues, there are lifestyle 
issues, some are just some genetic issues. It is complicated.

                              {time}  1700

  But understand just curing diabetes would be 30 percent of the 
Medicare costs we are projecting over the next 30 years. It is a 
demonstration, when we can get the incentives here correct, to push 
science for these little labs, for these really smart universities that 
actually will break off something and go set up and raise capital and 
do these high-risk experiments to produce disruptions, cures, how 
important that is actually to our society today but also into the 
future. Because if those little biologic labs can produce a cure, can 
produce new therapeutics, and change this cost curve, they also change 
the projection of U.S. economics, U.S. debt.
  I am trying to build an understanding here. So think about what we 
just did on the floor. We just moved eight-billion-something dollars 
working through the coronavirus, making sure there are supplementals 
and all these other things, and we also have had briefings, even 
earlier today, of some of the small labs and Big Pharma and little 
pharma that are desperately working to produce vaccines to also new 
therapeutics, antivirals.
  Yet, this same body in December moved a piece of legislation through 
here that would functionally crush, would functionally put those small 
biologic innovators out of business. It would destroy what is often 
called the ``capital stack,'' the ability to raise money for high-risk 
therapeutics that most of the time fail.
  If we care about drug prices, which both the Republican side and the 
Democrat side all focus on, can we make sure that, if you are going to 
move a bill like they did, H.R. 3, that--functionally you are going to 
get some price efficiency here, but you are going to wipe out the very 
innovation and the very biologics and small pharmas that we are relying 
on right now to produce some of the very disruptions for what is going 
on in the world right now.
  Understand, we have to be so careful that we don't satiate our 
current political desire--and it is a real one, to deal with the cost 
of pharmaceuticals--and end up destroying future innovation that will 
save lives, but also make sure we have the infrastructure for when we 
take on something like we are right now with the virus around the 
world.
  It turns out one of our greatest debt drivers is diabetes. It is 30 
percent of the cost of Medicare over the next 30 years.
  So why show this board?
  Just a couple days ago, I came across a series of articles talking 
about another example of a miracle that science is bringing us.
  This is a mouse experiment. And traditionally when you see a mouse 
experiment, we are still a decade away from the therapeutic. But this 
should be stunningly hopeful. They functionally found a way to put in 
living cells that associate as a pancreatic cell--and this just comes 
from reading three or four articles in some of the science journals--
that produced insulin in this mouse experiment.
  Is this the beginning of a therapeutic that is either a cure for part 
of the diabetic population, or a substantial portion of it, that also 
happens to have the economic benefit of dramatically changing the cost 
curve of healthcare, dramatically changing the cost curve of Medicare 
and Medicaid and so many other things?
  As we sit here and talk about everything from conversations around 
the coronavirus to debt and deficits, understand if the primary driver 
of our deficits are functioning healthcare costs--and really it is 
actually our demographics; we have 74 million of us who are baby 
boomers, and we are moving into our benefit years--how do we build 
policy around here that says this is potentially a miracle?
  If we can make this miracle work for our brothers and sisters across 
the country, how do we incentivize investment in this type of 
technology that not only may partially or substantially cure diabetes, 
but it also solves one of our greatest debt problems in the future? 
This is actually the sort of thing Republicans and Democrats should be 
embracing and the policy and ideas to move capital, to move incentives 
to make this work.
  If this body is going to even have a discussion saying, hey, the 
world economics are going to slow down for a little while because of 
what is going on and we want to do some stimuli; talk about doing 
stimuli that actually isn't just a momentary change, but actually would 
change our future debt curve because it provides cures for our brothers 
and sisters with diabetes, a chronic condition that is 30 percent of 
just Medicare's future spending.
  I am asking us to think not only strategically and creatively, but 
also incentivize the very science that actually helps change our 
future. And it is here. This is really exciting stuff.
  You know, you hope and pray that the continuation of the experiments 
and the science continue to go in this direction, this is a big deal. 
And it is not only a big deal from a science standpoint for our 
brothers and sisters with diabetes, but even from debt and deficits. It 
turns out you really can actually have that holistic circle come 
together if we can get our policies right around here.
  So another thing we spend a lot of time on is talking about energy 
policy. How do you deal with everything from the issues of greenhouse 
gases and how dysfunctional our actual policies are here?
  And I don't mean to get snarky, but on one hand people get behind 
these microphones, and we give these beautiful speeches about how much 
we care. And then we look the other way when the actual things are 
going on in our economy are actually making things worse.
  And let me give my example. Part of the thought experiment is to 
understand--do you see this multicolored layer? That is nuclear 
generation that is coming off-line. This is a 2017 slide. If you could 
see the slide--which it is very colorful--you would notice it is 
substantially taller than the yellow side. The yellow side is 
photovoltaic.
  I am from Arizona. I love solar. It is wonderful. But I also realize 
nuclear power provides this amazing baseload that is really clean. And 
we have actually been here and shown that.

  There is a gentleman with a Nobel Prize that wrote an article a few 
months ago thinking that in about 10 years they will actually have a 
way to break down nuclear waste with a type of pulse laser. The physics 
on that are a little beyond me, but this is sort of the point.
  So we get our policy wrong on trying to keep our nuclear generation 
up and

[[Page H1498]]

running, and then we run around giddy that we have had so much 
photovoltaic hit the market, but you do realize what the slide is 
telling you? We actually went backwards, because that differential had 
to be made up by other types of power generation. We fell backwards 
because we didn't find ways to keep this nuclear power in production.
  If we are going to talk about things, I just desperately wish we 
would get our math right.
  Another thing, this one is optimistic, and this one actually is 
touching on a piece of legislation from Ways and Means. It is a 
bipartisan number of Republicans and Democrats trying to push an all-
of-the-above-type of model. For those of us in the desert southwest in 
the afternoons we produce a lot of photovoltaic power, solar power. And 
then the Sun goes down and we are still running our air conditioners.
  We actually have incentives for solar, for wind. Why wouldn't you 
actually design something that is a little more egalitarian in 
understanding the technology? And this charge is about batteries. And 
what is really amazing here is--see if I can bend over and read this 
line--battery prices have had an 85 percent fall in price per density 
in the last decade. When you see that curve going down, those little 
black lines, that is actually the falling price of battery storage.
  Well, if you are going to have in the tax code an incentive for wind 
generation and solar generation, why wouldn't you have it, also, for 
battery storage? Why wouldn't you have it for a type of technology that 
we haven't even thought of that some freaky smart person is working on 
in their basement or their garage or in a fancy lab right now that they 
may be about to bring out?
  So I am going to encourage Members to think about that as we are 
working on some of these packages, and it is often referred to as 
extenders and those issues. Why don't we get this right and incentivize 
those things that actually are the next disruption? Because for us in 
the desert southwest, incentivizing that power storage actually creates 
the mechanisms of photovoltaic and other types of generation and 
smooths it out so it actually works for us. So, please, for anyone that 
is listening, let's pay attention to that tax legislation.
  The other one I want to touch on is another piece of legislation I am 
sponsoring and working on.
  A couple years ago, we passed something called Q45. No one knows what 
Q45 is, but it is actually really important. It was everything in the 
tax reform data spot. It is the concept of a tax credit for capturing 
carbon. And then the other part of it for sequestering it or using it 
in other fashions. Wonderful.
  We have a piece of legislation to take that and make it permanent 
because, as we have learned, the capital expenditures for the 
technology to be on top of a smokestack or even the ambient air capture 
where it is on top of a building and it is just pulling carbon right 
out of the air, those sometimes are very large capital expenditures. 
They need a longer time to amortize out their costs.
  Well, it also turns out there are disruptions in that technology. 
This is a clip from an article back, oh, let's say, last October, and 
anyone that is tracking this just basically grab your phone, go to your 
search engine, and search ``MIT ambient carbon capture.'' They actually 
even have a little video to show you how it works.
  What the researchers say on this technology is overnight they may 
have just cut the cost in half. Cut the cost in half for functioning, 
just pulling carbon right out of the air, let alone on top of a 
smokestack.
  So it turns out that the technology of carbon capture and then the 
ability--if we could fix some of what we call that Q45, that tax credit 
that is already on the books, we are just trying to work out its 
timing--for sequestering that carbon in concrete or using it for 
enhanced oil recovery or--a couple researchers have been in our office 
and talked about--they can take that pure carbon with a little bit of a 
chemical treatment and turn it back into a clean burning hydrocarbon 
fuel. The technology is here.
  How do you ever take a body like this, where you have a lot of smart 
people, but we have lots of different specialties, and keep up to date 
with the fact that we live in a time of miracles? And if you are one of 
the people who truly cares about greenhouse gases, carbon in the 
atmosphere, then you also have the obligation to keep track of the 
disruption in technology because I will make you the argument, if the 
underlying math in the article behind this MIT carbon capture is true, 
it is a miracle, they may have cut the costs of capturing in half.

  So another one, and this has just been a project of mine for almost 5 
years here. I can walk through the concept, and I actually even have a 
YouTube video. I think if you search ``Schweikert environmental 
crowdsourcing,'' I have a 90-second YouTube video trying to explain 
this concept.
  We all walk around with these super computers in our pockets. We call 
them a smartphone. What would happen in your community if you had a 
couple thousand people in your community that had these new little 
sensors that have hit the market? They are here, they are now. And you 
can be driving around, it could be your Uber driver, your Lyft driver, 
your UPS driver, the person driving the kids to soccer practice and 
every few minutes it is taking a sample as you go through the 
neighborhoods. You would actually have crowdsourced environmental data. 
Because today, what we do is we put up these towers, and those towers 
cost about a million dollars a year just to maintain, but they lack so 
much of the community information you actually need. And I will get to 
my punchline here where this makes sense.
  How do you know that the business over here is a good camper, but the 
folks down the street are painting cars in their backyard? Well, the 
fixed tower never tells you that. If you actually have a crowdsourced 
model of collecting air quality samples, you know the business is a 
good actor over here, but you have clowns over here breaking the law. 
Capture them.
  It turns out if you built an air quality crowdsourcing model in your 
community--the world we have today, where you fill out lots of 
paperwork, then shove it in file cabinets, do the papers and file 
cabinets actually make the air quality cleaner in your neighborhood? Of 
course not. It is a 1938 regulatory model. We document things, and then 
when someone screws up, we know who to sue.

                              {time}  1715

  I will make you the argument that if you could crowdsource air 
quality samples in your neighborhood, you don't need the businesses or 
the others who are licensed today to fill out paperwork every quarter, 
every 6 months, every year, because if they screw up, you capture them 
immediately.
  Think about it. You could crash the bureaucracy. You could crash 
filling out paperwork to shove in file cabinets and keep the air 
quality much, much healthier because you capture when there is a bad 
actor or when something has gone wrong. And you capture it instantly.
  That community science, that citizen science, that crowdsourcing is 
here. It turns out that lots of smart people around the country are now 
producing products that will let you do this.
  I am ordering a couple different ones, but this is one version we 
pulled off the internet just the other day. What they are trying to 
point to here is that this is how we do it today. We put up a single 
tower. It costs a million dollars a year. The technology is great. It 
has great sensitivity, but it doesn't tell you where the bad actor is.
  In a crowdsource model, you instantly find out where the bad actor 
is.
  In my State, in my county, Maricopa County Air Quality, instead of 
them being collectors of paperwork, they would have the data come in. 
They could see it on the heat map and immediately know where to go take 
a look to see if there is something wrong happening.
  I am trying to make the argument--do you remember what I was saying 
earlier?--that we have to grow the economy rather vigorously to be able 
to have the resources to keep our promises. One of the things on that 
list, besides a tax policy that works and an immigration policy, was a 
regulatory policy.
  I have never been thrilled when people walk around and use the term: 
``Oh, we are going to deregulate.'' I beg of

[[Page H1499]]

you to think about ``smart regulations.''
  This requires a dramatically smaller bureaucracy, dramatically less 
burden on those who are creating productive capacity in our 
communities, yet it would keep us healthier and would show us where the 
bad actors are.
  I beg of this body, think forward. We keep designing pieces of 
legislation around here that might have been brilliant if it was still 
the 1980s or early 1990s. How do we push the way we think of 
everything, from the environment to environmental protection all the 
way down to creating the next generation of pharmaceuticals that cure 
us?
  I truly believe we live in a time of miracles. I also believe that 
our inability to be forward-thinking in this body is one of the biggest 
problems we have in these sorts of technologies reaching our 
communities.
  We always start with this slide, because, one more time: What is the 
greatest fragility, long term, to this country? I am going to argue it 
is debt, but that debt is driven by our demographics.
  Our birth rates have collapsed over the last couple of decades, 
particularly these last few years. There is a large number of us who 
are baby boomers; we have our earned benefits coming to us. If you look 
at the debt accumulation that is about to happen, it is stunning.
  How do we build a path that makes it so that we can keep our promises 
and still have a growing economy so that my 4-year-old daughter has the 
same opportunities I have had?
  My brothers and sisters on the left will often come up with: ``Well, 
we will tax rich people.'' My brothers and sisters on the right will 
often say: ``Well, we are going to find waste and fraud.''
  You do realize that is mathematical lunacy? None of that works 
mathematically.
  You have to grow the economy. You have to have a disruption in 
healthcare prices. You have to have a disruption of how you incentivize 
people to stay in the labor force.
  That is why we put up this slide, because we believe there are these 
five pillars that if we get the economic growth; the labor force 
participation; the adoption of disruptive technology; the population 
stability of encouraging family formation; and if you are going to 
change the immigration system, you actually incentivize more of a 
talent-based immigration system, because you need the economic 
velocity.
  Now, a lot of this is really politically uncomfortable. I mean, some 
of these things, when you go talk about it, people get really mad 
because they are not comfortable with it. But it is almost the only 
way, at least in our little office, that we have been able to build a 
model that we can have enough economic growth, enough tax revenues, 
enough change in the price of what our promises are that we end up 
having a pretty amazing future as a country.
  How do you ever get a body like this, where you have lots of smart 
people, to act when a lot of what we know is long since out of date and 
when the math is really, really uncomfortable to deal with and talk 
about? When you show up in front of an audience at home and say, ``You 
do understand the biggest driver of debt is Medicare?'' you will get 
booed, hissed at. But you need to understand, if you don't talk about 
it, how do you save it?
  Remember, the Medicare trust fund, which is the part A, has only a 
few years left, and then it is gone.
  We need to step up, both Democrats and Republicans, and start telling 
the truth about the math, maybe invest in that crazy thing called a 
calculator and start to build a model of how we disrupt the prices, how 
we grow the economy, how we create the velocity that makes this work 
and provides hope and opportunity.
  My thesis is very, very simple: It is here. There is a way to do it. 
And the biggest barrier to it happening is this body here. We need to 
change the way we look at the disruption of technology.
  The last one I will give you is just this simple example. I have come 
to the floor multiple times and sort of done a thought experiment: the 
technology of something that looks like a large kazoo that you can blow 
into and instantly tells you that you have the flu, that instantly can 
bounce off your medical records on your phone, that knows you are not 
allergic to a certain antiviral, and that orders your antivirals.

  Isn't that wonderful? Think about just the cost disruption that 
technology would have, particularly with what is going on right now.
  It turns out that technology exists, yet the professor who was 
working on it had incredible difficulties raising capital, being able 
to get investors to move it forward. You know why? Because it is 
functionally illegal. It would save lots of money, but the algorithm 
for being allowed to write a prescription is functionally illegal. It 
is illegal under State licensing laws, the Social Security Act, the way 
we reimburse.
  We need to become much more forward-thinking because it is the way we 
save ourselves. If we stay the way we are, we do nothing but bathe in 
debt and stagnation.
  But there is a path.
  Mr. Speaker, I yield back the balance of my time.

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