[Congressional Record (Bound Edition), Volume 163 (2017), Part 5]
[House]
[Pages 7430-7435]
[From the U.S. Government Publishing Office, www.gpo.gov]




                             MATH AND FACTS

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 3, 2017, the gentleman from Arizona (Mr. Schweikert) is 
recognized for 60 minutes as the designee of the majority leader.


                             General Leave

  Mr. SCHWEIKERT. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days to revise and extend their remarks.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Arizona?
  There was no objection.
  Mr. SCHWEIKERT. Mr. Speaker, we have a whole hour here, and we may 
actually use the whole hour. This is an opportunity to actually walk 
through three areas that I care an awful lot about.
  One, I actually want to walk through something called math, and math 
in regards to health care. Some of this is actually to deal with--and I 
don't want to be mean, because I am going to try to do this in as 
nonpartisan a way as possible, but some of the things that we have just 
heard moments ago that lack just sort of basic roots in math and facts.

                              {time}  1700

  Let me move this easel back just a little bit so we can get this. We 
are going to do a little bit of show-and-tell here to sort of help.
  First off, a conceptual problem, since, I believe, it is 1986, we in 
the United States have had statutes that say, if a sick person walks 
into a hospital and they have cancer, they are bleeding, they are going 
to get health services.
  This is a really important concept for us all to get our heads 
around. There is no such thing as not receiving care in this country. 
It may not be the care you want at the place you want, but it is the 
law. It has been the law for 30 years.
  If we are going to be brutally honest, much of the debate and 
discussion we are having here, whether it be the ACA or prior to the 
ACA where it was uncompensated care, where it was disproportionate 
share within our hospitals, or our reform legislation, it is not 
whether someone gets coverage or doesn't get coverage; it is who and 
how it is paid for and where is it paid for.

[[Page 7431]]

  Remember, these costs are already in the system. Does it go as a loss 
on a hospital balance sheet? Does it get pushed over to other 
populations within an insurance pool? That is the math we are actually 
working on.
  A couple of moments ago, you had a handful of Members come up and 
talk about preexisting conditions. If you hear someone use the term 
``preexisting conditions,'' they basically are years out of date. There 
functionally is no such thing anymore. There is guaranteed issuance of 
insurance.
  We are going to go through this in more depth.
  Someone like myself, I am a severe asthmatic. I walk around with an 
inhaler in my pocket. I can grab any insurance today and I get 
guaranteed issue.
  Whether it be in the current ACA--ObamaCare, as many know it--there 
are variations in what we refer to as community rating. There are age 
levels. If you are a smoker, you get a different pricing.
  Some of those same mechanics we are doing in our reform bill. We are 
going to walk through why the way we are doing it we think actually 
will ultimately lower prices. We are trying to get that efficiency of 
the young and healthy to participate in the insurance pool, because 
they are not participating today.
  We are going to keep this board close by because this is important 
for everyone to understand conceptually. I know the chart is hard to 
see, but 5 percent of the population is 50 percent of the healthcare 
cost.
  Think about this. Of our brothers and sisters who have chronic 
conditions, they are 50 percent of the healthcare costs, even though 
they are only 5 percent of the population. That is why we did the risk-
sharing model that is being attached to our legislation. We are going 
to walk more through that.
  If you start to think about this curve--for those who want to do some 
math--it looks like a hockey stick. The healthiest 50 percent only use 
3 percent of healthcare dollars. So 50 percent of the population only 
use 3 percent of the healthcare dollars. Then it comes along and 
explodes up like a hockey stick. The top part of this hockey stick, 
this 3 percent of the population up here, whether it be because they 
are hemophiliacs or uncontrolled diabetics or have other types of great 
difficulties, that population is 50 percent of the entire cost.
  What happened in the current ACA is, let's face it, the model did not 
work. You remember the whole discussion: keep your doctor; $2,500 
savings; fewer visits to emergency rooms, which, actually, emergency 
room visits have skyrocketed or gone up substantially.
  Their model did not work, and mathematically it is imploding. We are 
going to go through some data, particularly from my home State of 
Arizona, on how much trouble we are in.
  One of the reasons it has not worked is less than half the population 
of those buying in that individual market are buying. Particularly, if 
you look at our healthy 20-year-olds, our 30-year-olds, that 50 percent 
of the population that only uses 3 percent of health care, they are not 
participating in the insurance pool.
  Well, how do you spread risk when you have millions and millions and 
millions and millions of Americans who are choosing not to purchase 
because it is too darned expensive or, because the contribution before 
you receive health care is so expensive and the number of waivers, it 
is just cheaper to pay the penalty?
  So what happens when you are trying to do the math and you have your 
brothers and sisters here in this body on the other side who either 
make up facts or just say, ``Well, just keep it as it is''? I am going 
to make the argument that the cruelty of that is just stunning.
  We are going to start to walk through a little bit more of these so 
we can actually help folks sort of understand this is the underlying 
math, this is why we must have a substantial change.
  Let's go back prerecession, just before the recession. Let's go back 
here to 2007. We had about 14.6 percent of our population going 
uninsured. That is unacceptable. Today after having spent almost--as 
some data says, as much as $1 trillion, but we will stick with a half 
trillion because that I can absolutely document--$500 billion of 
subsidies, losses, if you actually add up the losses insurance 
companies have had, if you add up the copays individuals had, if you 
actually add up the money that has been spent through the 
bureaucracies, we have dropped, say, a half-trillion dollars, today we 
are at 10.9 percent.
  If you are on the left, this is the grand success of ObamaCare. The 
grand success of the ACA is that you have gone from 14.6 percent of the 
population is uninsured, and today it is 10.9? Where is some of the 
intellectual credibility around this place to at least tell the truth 
of the math?
  If you start to divide up how much we have spent--and we were just 
doing this on the back of a napkin a little while ago. If you add up 
the population that has now gained insurance through the exchanges that 
did not have insurance or access to insurance before, some of the math 
comes to around only 6 million people.
  If you divide that by a half-trillion dollars, that is $84,000 per 
life for 3 years of coverage. We could have bought them their health 
insurance and a really nice car. You understand how absurd the current 
model is.
  I am not questioning the good intentions of wanting to help our 
brothers and sisters have access to health coverage. Great. Now let's 
make the math actually work.
  This chart is really important. This is actually not coming from me. 
This one, I think, is from Gallup. Most of the other data we are going 
to get is going to come from Kaiser or the Congressional Budget Office.
  I want you to understand I am going to be Arizona-centric because 
that is my home State. I am blessed to represent the Phoenix-Scottsdale 
area. But let's take a look at my little State down here. We are going 
to burn through these fairly quickly.
  I have about 6.7 million residents in Arizona. Okay. There are 6.7 
million residents in Arizona. This is from Kaiser.
  Let's switch to the next board. Of that 6.7 million residents in 
Arizona, my citizens, how many buy their health care on that individual 
market? That is what we are talking about.
  When you keep hearing the grandiose ``the world is coming to an 
end,'' how many of my brothers and sisters buy on the individual 
market? About 278,000 people. That is a lot of people. But if you 
divide it by our population, it is 4 percent of my population. In my 
congressional district, it is somewhere around 2 percent of my 
population.
  The elegance of actually being honest about that piece of math is 
that it helps you understand we can fix this. This is the individual 
purchasing market.
  Let's take one step backwards.
  The majority of Americans receive our health care from our employers. 
Then we come over here: Medicare, VA, Indian Health Service, TRICARE, a 
number of these things. What we are talking about in the ACA and our 
replacement is that sliver of our population that is in the individual 
market and how to reform Medicaid. That is all.
  But often when something is complicated, it comes ripe for political 
hyperbolic language, acting like the world is on fire, instead of being 
honest and making the math work so we can serve our brothers and 
sisters with the health coverage we want.
  Remember, we have just come back here to Arizona. Only 4 percent of 
my population is in the individual market. In my congressional 
district, it is only 2 percent of the population.
  Now, you need to understand that when you hear many of us get behind 
these microphones and we talk about the system, the current ACA--
ObamaCare, as it is known; but I think that is unfair, so let's just 
call it the ACA--is imploding. For my State, it is. We are going to 
show you how few choices happen in my State. This is only between 2016 
and 2017.
  Do you see this blue right here? If you were in that county, if you 
were in that individual market, you would have three or more choices.

[[Page 7432]]

  Do remember that, when this law went into effect, we were promised 
dozen of choices. Should we hold the left to their own promises? It 
hasn't happened.
  What is happening now, if you take a look all over the country, when 
you see this chart, county after county after county now has one 
choice. I want you to see what has happened in my home State.
  First off, statewide in my State, if you were buying the mean 
exchange plan, that Silver plan, statewide, last year, a 116 percent 
price hike. That is if you are in Maricopa County and you are buying 
the mean Silver plan.
  Maricopa County is the fourth most populated county in the United 
States, so it is not just a little outlier. It is the fourth most 
populated county. It is 64 percent of my State's population in one 
county.
  If there were ever an example of a county that should have had health 
care efficiency and pricing, it is Maricopa County. It is a large 
population. If you were in that mean Silver plan, you had a 145 percent 
price hike last year.
  How can I see people get behind these microphones and act like this 
system is working? Do you understand the crushing you are doing to 
people in my State, hardworking people who just want to say: I am the 
neighborhood plumber; I would like to buy health care?
  Either the deductibles have gotten so huge or the underlying price 
has gone up so high, we are actually seeing something fascinating in 
the uninsured curve. The uninsured population has now moved into our 
hardworking middle class because of the number of them that work for 
themselves that can no longer afford to participate.
  We will just say it was one of the unintended consequences of the 
current ACA. But it is one of those occasions we all see the data, and 
yet how many people get behind these microphones and tell the truth 
about how many people we are crushing from these deductibles to the 
current pricing?
  You saw the previous chart. We have gone from 14.6 percent of our 
population uninsured before the ACA to, now, 10.9 percent. We dropped 
about a half-trillion dollars. That is $500 billion. That is not 
counting Medicaid expansion. That is just the numbers over here.
  We have had testimony in the Ways and Means Committee that we believe 
only about 6 million Americans were newly insured, newly covered for 
that half-trillion dollars. Look, it is great they have coverage, but 
the math doesn't make sense. We could have done this so much more 
elegantly.
  So let's actually take a look at Arizona. This is 2014. If you go 
before that, it was even bigger, but take a look at my county. See all 
those little squares? Those were health insurance providers that were 
available to you in 2014.
  If you go a couple years before that, we had counties that had 15, 18 
different possible insurance choices, companies who would provide; 
today, 2017, you see one little blue square.
  We are being told that we are going to have entire counties in my 
State--and Arizona is unique in that we have only 15 counties in the 
entire State. We are going to have entire counties with no insurance 
provider to that individual market. This is a system that is working?
  Take a look at my State. This is one of the reasons we have been 
working so hard, why we did the risk-sharing model. This is reality. 
This is Arizona. This is my home. My folks have had these massive, 
triple-digit price hikes. Now they have a single choice, and they are 
being told next year they may have no choice. This is the reality we 
are at.

                              {time}  1715

  So let's actually talk about solutions. How do you deal with this? 
How do you actually help our brothers and sisters be able to afford 
insurance? How do you encourage providers to come in and actually 
participate in providing coverage to that individual market so there 
are options, there is competition, there is choice?
  If you actually think about what drives that price, so why the 
explosion in price? Well, the current ACA, because of the way it has 
these three tiers within, we will call it, the community rating--that 
is where you take all the people in your community who are 
participating in this insurance population, and say: You don't all get 
the same price. There are certain adjustments, and some of the 
adjustments were for age.
  So the ACA, ObamaCare, the current law, had three adjustments plus 
adjustments for smoking and a couple other externalities, and it made 
the concentration of cost and risk so expensive that--remember our 50 
percent of the population who only use 3 percent of health care--they 
have chosen not to buy, which, in some ways, is a perfectly 
economically logical reaction to the current cost, to a world where it 
is so expensive it is cheaper to pay the penalty, so we have to find a 
way to drive down that cost for that population so they participate.
  When you were in school and you would hear the story in your 
economics class of there are occasions where by lowering the price you 
make more profit because you sell more units? The concept is pretty 
much the same here in insurance. If we can lower the price for our 
healthy population, more participate; we spread the risk over a larger, 
healthier population; we lower the price for that 5 percent of our 
brothers and sisters who are in that chronic category; plus we are 
going to overlay a couple other things to help mitigate that cost to 
get the price efficiency for everyone. It is important.
  I know some of these slides are a little hard to get our heads 
around, but we have put together something called an invisible risk 
pool. If you are that American who has bought, who is participating in 
this individual market but has a chronic condition, you never do a 
traditional risk pool today because what we learned from the data over 
the last 30, 40 years of risk pools, there have been a couple 
successes, but most risk pools, hey, the cost goes up, you hit that 
sort of threshold, and you dump that person, saying: Hey, you are now 
the risk pool's problem, or you are the State's problem.
  We wanted a continuity of care. We wanted the sick person to receive 
services where the medical provider, the insurer, and the patient 
themselves all have skin in the game. They all have a need to 
participate, to manage, whether it be the individual's diabetes or some 
other ailments. That is the beauty of sort of this risk-sharing model, 
that for the population that is our sickest brothers and sisters, as 
their cost graduates up, there will be participation from this risk-
sharing pool.
  Why is this absolutely fair? Remember how we talked about how most 
Americans receive their health care in the employer market? Well, your 
employer gets a fairly substantial tax deduction for providing that 
health care. They get to take it off their taxes. Well, we don't do 
that for when you are in that individual market. When you are in that 
individual market, for you to be able to take it off your taxes, so we 
have tried to come up with this methodology to make it fair, so we have 
come up with this tax credit. But we want you to have the money to help 
purchase your policy in the beginning, so there is this whole term, 
sort of this made-up new language that says a prefundable tax credit so 
you can buy your health insurance in that individual market. So that is 
on the front end. On the back end, to make sure the premiums, what we 
call premium efficiency, have stayed low and affordable, we are 
actually doing this risk sharing up here to help mitigate that spiking 
of cost so we can lower the prices for everyone so we maximize 
participation.
  There is some elegance in the math, and I think actually there is a 
great love for our brothers and sisters who have preexisting conditions 
up here because it is an invisible risk pool. They never know whether 
their cost is being subsidized by this pool, nor should they. We made a 
societal decision 30 years ago that someone walks into an emergency 
room, someone walks into a hospital with a condition, they get 
services, so the cost is already in the population.
  What we have been debating now for years is how do we pay, how do we
  
  
[[Page 7433]]  
  
move the chairs around? But if we are going to get efficiency in 
lowering premiums for everyone, remember, we need our healthy 
population over here to participate in this, and then there is a couple 
other things we are going to talk about.
  So functionally what we have done with the risk sharing, it actually 
accomplishes a couple really great things. One is the obvious part, if 
you are the insurer, and let's say you are the actuary at the insurer, 
and you are doing your math, you actually know what your risk exposure 
is on each life. Why that is important is you don't have to build what 
is often referred to as a shock absorber in your rates, saying: Dear 
heaven, what happens if tomorrow I get a handful of folks with a very 
difficult chronic condition that blows the cost off the charts? I have 
to build cushion into my rates.
  Well, with the risk-sharing model, they no longer have to have the 
rates padded for that externality that might happen. It becomes this 
multiplier effect where if I don't have to put that in the rates, I 
have lower costs over here. If I have lower costs over here, the model 
says I get a lot more participation in the health care pool, and 
everyone benefits. That is what we are trying here.
  So what do you actually do, if the argument I am making, whether it 
be the ACA, whether it be our replacement, in many ways what we are 
discussing is how to pay for the health care that is already in our 
society. Remember, as we have been talking, there is no such thing, if 
you are going to be completely honest, as a preexisting condition 
denying you coverage. There are some cost stratas, but that is in the 
current ObamaCare ACA, just as in our replacement, but some of that is 
by age or if you smoke or other things.
  How do you actually lower costs? Some of that comes in the next piece 
of legislation because, as you all know, in the bill we are trying to 
move now, we have to deal with the rules of we have no one on the left 
in the Senate who is going to work with us. We are on our own. So we 
have to find a way to do this with 52 votes in the Senate. We don't 
have eight Democrats who are going to work with us. That means we have 
to do it through reconciliation. Probably those of you who are 
interested in this stuff, you have read how reconciliation limits the 
things we can put into a piece of legislation. If you would like us to 
have more things, go find us eight votes on the Democratic side in the 
U.S. Senate.
  So what do you do to lower costs? We all know information. How many 
of you can grab your supercomputer you carry in your pocket right now, 
log into the hospital surgery center--your doctor--and immediately hit 
a button and say, Hey, the retina detachment, the cataract, the kidney 
problems I have, here is my cost for the services, here is my cost for 
the procedure?
  We need information. That is going to come, I believe, later this 
year.
  The next thing is, with that information, you create competition. 
That is incredibly important. Competition in health care comes as much 
from the price as it does the quality. We have done some great things 
in collecting quality data. With quality data and price information, we 
are hoping there becomes now this incentive to actually compare and 
move around. But what is the next revolution? I am going to make you 
the argument--and this is one of the elegant things I believe that is 
also now happening on the Medicaid side of our piece of legislation, 
and that is to allow creativity at our State levels.
  Arizona may have one of the most creative Medicaid systems, we call 
it AHCCCS in Arizona. We buy functionally capitated HMO policies for 
our indigent population. But every time we want to make a change, every 
time we want to try something new to service our brothers and sisters 
in Arizona, we have to march over to the Federal Government and get a 
waiver. We have to get permission from the Federal Government. Well, 
here is my question to you: Does a poor person--as a matter of fact, 
anyone, if you are in the individual market, if you are on Medicare, 
Medicaid, do you have the right to talk to your primary care physician 
on this? Of course you do. Do you have the right to wear the sensor on 
your body that helps you manage your high blood pressure? How about 
this contact lens that is going to be out probably next year that will 
actually sit in your eye and manage your blood glucose? No more 
punching a hole in your finger and doing a blood test to check for your 
blood sugars, your blood glucose. It will be constant, talking to your 
phone, talking to your pump. If that keeps some of our brothers and 
sisters with diabetes from crashing, it is great for all of us. It is 
great for society. It is great for them. It is great for healthcare 
costs.
  There is a revolution coming technologywise. One of the things I 
found fascinating is they actually have a little thing now where you 
can put your fingers on it and it does a full EKG. There is disruptive 
technology that is now available and is rolling out. How many of us now 
wear a Fitbit that helps you manage parts of your health care? This 
right here is about to bring a revolution in health care.
  A simple example, just a thought experiment for anyone who actually 
cares about these things: In Arizona, the majority of babies are born 
in our Medicaid system. Even my little girl who we adopted a year and a 
half ago, I believe she was born in my State's Medicaid system. Most 
perfect little girl ever.
  We know we have a problem in this country and in Arizona, a 
substantial number of the moms don't show up for their prenatal visits. 
When we have surveyed them, we get information back that says: It is 
hard waiting for the bus. It is hot out. Dial-a-Ride makes me wait. Why 
wouldn't you allow that poor person to hit a button on their phone and 
have ridesharing pick them up? There are solutions. If we could get our 
brothers and sisters on the right and the left here to actually talk to 
each other about solutions, but instead right now health care is such a 
potent political issue, I can show you article after article after 
article where the facts that are being disseminated to the American 
public are completely wrong. We heard some of that just minutes ago 
behind these microphones where the facts are absolutely made up. It is 
just incredibly cruel.
  Let me explain the cruelty. A couple weeks ago, we were doing just 
coffees with residents. A group of my constituents who are on the left 
brought a woman, and she has tears running down her face. She is 
standing in front of me wanting to know why we are about to take the 
health care away from her husband who is across the street in the 
hospital. How cruel does the left have to be to lie, to say something 
like that to someone because none of that was true. Our bill, their 
bill, that just can't happen in the language that if you are already in 
the hospital, if you have a preexisting condition, these things are 
covered, whether it be from the right or the left's language. But to 
manipulate someone who is already suffering like that, what sort of 
cruelty is in someone's soul to get a political advantage to manipulate 
a wonderful woman who is already suffering with the difficulties of her 
husband in the hospital?
  I beg of you, whether you be on the right or the left, actually read 
the amendments, actually read the language, understand what reality is, 
understand we live in a society now where all preexisting conditions 
have coverage. We already live under a law that has age brackets, if 
you smoke, variances, but very small variances. Even in the latest 
amendments, the discussion is, if your State wanted to do a statewide 
prenatal program, or my State where we have a disproportionate share of 
our population with diabetes, particularly with my Native-American 
population, if my State wanted to get everyone together, whether it be 
Indian Health Service, the VA, private insurers, our Medicare, Medicaid 
system wanted to try to put together a statewide program to reach out 
to our brothers and sisters with diabetes, that would be--if the 
actuaries and the math works--maybe wonderful. That would be an 
occasion where my State would reach over to the HHS Director

[[Page 7434]]

and say: Can we have a waiver? We no longer need to have this type of coverage 
mandated in these individual policies because we are going to do it at 
the statewide level. I beg of you, think creatively.
  How do we cover our brothers and sisters? How do we deal with the 
reality that a huge number of our population right now is choosing not 
to buy because of price or have been able to receive waivers 
substantially because of price?

                              {time}  1730

  And if we succeed here at driving the price down by our actuarial 
efficiency, the risk sharing up here, and spreading out, a couple of 
years from now, we are going to be standing behind these microphones 
and saying math won out over hyperbolic rhetoric.
  So can we talk about a couple of other things that are really, really 
important?
  I am blessed to be on the Ways and Means Committee. So why is tax 
reform so incredibly important to all of us?
  Understand, those of you who want to see Medicare, those of you who 
want to see Social Security stay solvent, do you understand what is 
happening with economic growth and the pressures right now and what is 
going on?
  So this little pie chart up here is functioning 9 years from now. You 
have got to understand, in 9 years, only 22 percent of the spending 
will be what we call discretionary, stuff I really get to vote on, 
stuff that is not in the formula. Eleven percent will be nondefense. 
Everything you sort of think of as government--the Park Service, FDA, 
Education--those things where moneys come to the Federal Government 
that go to these things is only going to be 11 percent of our spending. 
Another 11 percent will be defense. Everything else is either Social 
Security, Medicare, Medicaid, interest on the debt, or some of the 
other unearned entitlement programs.
  This is substantial because we are graying. You all heard of baby 
boomers. But the reality of it is, in less than 9 years, every dime of 
Federal revenues--and we are going to be taking in $1 trillion more. We 
are going to go from $4 trillion to $5 trillion of revenue. Every dime 
of Federal revenue will be consumed by what we call mandatory spending, 
entitlements. Military and every other part of government is going to 
exist on borrowed money.
  So if you are someone who really likes education, if you are someone 
who really thinks drug research is important, if you are someone who 
thinks NASA is important, if you are someone who thinks the parks are 
important, you should care about this.
  The reality of it is the math curve, even with a substantial growth 
in the economy, we are going to have to look at entitlement reform. And 
I know that sets people off because they are fearful, but it is a lot 
better than hiding from it.
  The thing that makes it less painful is a growing economy. Tax 
reform, we know, is the single greatest engine, the single greatest 
lever we have here as Members of Congress to get the economy growing. 
Fixing the healthcare issue will go a long way to help. Dealing with 
regulatory, dealing with immigration, dealing with embracing technology 
into our society and government can all be very powerful for economic 
growth, because our future does not have to be one buried in debt.
  But without a revolution in the way we think around here and a 
willingness to do tough things--and tax reform is going to be hard, but 
without it, you are basically sentencing my little 18-month-old girl to 
a future buried in debt, buried in slow growth.
  For those of you who may be my age, who are hoping to receive 
Medicare and Social Security, you are putting those programs at 
financial risk, and it doesn't need to happen. We can fix this, but you 
have got to move it away from the hyperbolic politics and actually 
start to be willing to own a calculator and start looking at the math.
  Why this is so important, right here on this chart, is start to 
understand, as you get down here--remember, 2027 is functioning 9 years 
from now, and, actually, only 8 budget years from now. One more time, 
every dime is consumed by Social Security, Medicare, Medicaid, interest 
on the debt, and the other handful of mandatory, what we call, 
entitlements. This is your future. It happens in less than a decade. It 
is here.
  Please, big, bold, dynamic tax reform is the first thing we can do 
this year, and then we are going to have to continue to move on to 
technology and everything else to sort of do whatever is necessary to 
get this economy growing.
  This one is a little more difficult, but we wanted to actually hold 
it up just so that there is an understanding of how fast we move from 
right now. Today, in 2017, about 7 percent of our total spending is 
interest. In a couple of decades, we start getting up to where it is 20 
percent, a quarter of all of our spending.
  And this chart, think of this. In 9 years, interest is 19 percent of 
the budget. Okay. In 9 years, Medicare is 22 percent of our budget, of 
all of our spending; Social Security is 29. Just add that up. Think of 
that. Interest, Medicare, Social Security, the three of those start to 
consume the majority of this institution's spending.
  And then you add in what we call mandatory spending, other 
entitlements, and you start to see, in 9 years, it consumes every 
dollar of tax revenues. That is really, really important to understand 
why we need to have this two-phase approach.
  Right now we do everything that we can to maximize economic growth 
and opportunity. And when we talk about economic growth, this isn't 
just for the top line, big corporations. We need that economic growth 
of those people that pay the FICA tax. Our brothers and sisters that 
pay Social Security, our brothers and sisters that pay the unemployment 
tax, our brothers and sisters that pay into Medicare, we need their 
jobs to pay more. We need more of them. We need them to have more 
options in the workplace.
  So this is a tax design of how you maximize economic growth not just 
for big corporations, but for everyone. That concept of: Remember when 
we were all in school, that sort of velocity of economic opportunity, 
that mobility? We have been stagnant for a decade. We must, must, must 
bring it back.
  And why these numbers become so difficult--and this chart is a little 
hard to understand at first. These are the predictions of what economic 
growth was going to be this year, to understand how much trouble we are 
really in.
  In 2013, the brilliant--excuse me. Yes, let's just make fun of them. 
The economists around this town were saying: Hey, it is 2013; but by 
the time you hit 2017, all this stimulus, all this spending, all this 
debt, you are going to get a 4 percent GDP growth.
  You all saw what we had last quarter. What was it, 0.7?
  Now, honestly, first quarters the last couple of years have had a 
distortion, I think, in the seasonally adjusted numbers. But do you 
think we are going to hit 4 percent GDP this year? Because that is 
actually what a lot of the budgets were projected on.
  So sometimes we will be here in a debate with my brothers and sisters 
on the left, and they are holding up these charts saying: Well, it is 
2013; we are going to be just fine over the next 10 years. And you get 
into those next 10 years, and you start to realize we are going to be 
lucky to hit 2 percent.
  So much of what we have shared with the American people in the 
previous decade, the numbers were blatantly wrong, and not to the good 
side, to a much more difficult side. So when we start to look at this 
chart--and, once again, 2026 isn't that long from now--you start to 
realize we are going to be approaching $30 trillion of debt. Why this 
becomes incredibly important, once again, for all my Keynesian 
economists out there who think we should just go more into debt, spend 
and we will get stimulus, now we have built up so much debt that the 
ratcheting effect you get if you start to raise interest rates and half 
your debt needs to be refinanced within a 5-year period--they call it a 
weighted daily 


[[Page 7435]]

average--all of a sudden any new revenues you may be 
getting from that Keynesian stimulus are being consumed by interest.
  Every day we wait to deal with this we lose options on how we can 
protect Medicare, on how we can protect Social Security, and on how we 
can protect our economic future. The sooner we do what is necessary in 
tax reform and all the other reforms and stop some of the crazy 
squabbling--I am sorry the left lost; well, actually, I am not, but I 
am sorry it hurt their feelings so much--and maybe come to the table 
and prove to the American people you actually care about them in a 
fashion where you are being honest with the math, hold up a calculator 
and demonstrate that we actually are going to do what is right.
  Back to the last part. We are going to do this slide over again 
because this is really important. Remember, we said part of this is 
just math.
  The economic growth. The part of our society that uses 50 percent of 
the healthcare dollars is 5 percent of our population. It is all 
fixable.
  So there are two themes here on the first parts of this. In health 
care, the expense, the cost is already in the system. Whether it be our 
reform, whether it be the ACA, whether it be before the ACA, the total 
cost is already there.
  What we have been working on are two things. How do you move the cost 
around so that we can actually lower the cost for that 50 percent that 
only uses 3 percent so they will actually participate in the insurance 
market, lowering everyone's rate, instead of what is happening today 
where they just don't participate?
  Remember, you saw the slide. 10.9 percent of the population is not 
buying health insurance today. They don't have coverage. They are 
uninsured. Some of that is because of the cost; some of that is because 
of the waivers. The only way you get them in is that thing we call 
premium efficiency. We have got to drive down that cost. But if we do 
that, I am actually pretty optimistic good things are going to happen.
  Now, I want to actually take you to something that there really are 
bipartisan solutions. I am going to make you this argument that 
technology is the great optionality around this, it is the great 
unifying thing. I am going to walk you through something, and later I 
want you to tell me whether this is Republican, Democratic, right, or 
left. I am going to make the argument it is data.
  I live in Maricopa County, the fourth most populous county in the 
United States. It is what we call a nonattainment county. It means 
certain types of pollutants are in excess, and on occasion it spikes 
up. In the past, we would get a phone call from EPA saying: Hey, one of 
our monitors shut off. We think we are going to shut down your building 
permits.
  Well, remember how we were just talking about we live in a society 
where we must have economic growth if we are going to be able to 
finance and pay for our promises? So I came to you and said there is a 
much more elegant way to keep the air clean and actually have economic 
growth: reward those who are following the rules and catch those who 
are breaking the rules when it comes to polluting our air quality. And 
it is data.
  So right now, here is how we regulate.
  You want to open a business. Let's say you want to do a powder 
coating business in Phoenix. You have to go out and get a bunch of 
permits from the county, from the State DEQ. You also submit to the 
EPA. Depending on the types of volatile organics and other things you 
are using, you may have to file reports every quarter. You have to do a 
major audit every year.
  Does filling up file cabinets full of paper make the air quality 
cleaner in your community? Seriously, because this is our regulatory 
model. We basically have a 1938 regulatory model where we make people 
fill out lots and lots of pieces of paper. We send them in. We hire 
lawyers and auditors, and we hire consultants to help us fill out this 
paper, and we shove it in file cabinets down at the air quality 
regulator or environmental quality regulator. Do full file cabinets 
make the air quality cleaner in your community?
  It is an absurd model when we are all walking around with 
supercomputers in our pocket. There is now technology coming on the 
market where you, through Bluetooth, through an actual plug-in, you can 
actually be walking around with your own air quality monitoring system.
  Well, think about my community. If I could have a couple thousand 
people driving around, traveling around, walking around, hiking around 
my community getting air quality samples every 5 minutes, at the end of 
the week I have a couple hundred thousand data points. You put it up on 
a GIS map, and you catch those who are sinning.
  Think about it. It basically is a combination of crowdsourcing 
citizen science. And the tradeoff is don't make that company fill out 
lots and lots of pieces of paper or that organization over here fill 
out lots and lots of pieces of paper and fill up a file cabinet, 
because if I have enough monitors and sensors moving around the 
community, if they screw up, you catch them instantly.
  It is not like today's world where a couple of years later maybe an 
auditor catches them; you go to the file cabinet and use the file 
cabinet as a tool to sue them, but yet you have had 2 years of 
pollutants in your air. Let's catch the bad guys immediately and leave 
the good guys alone.
  We can do that by this sort of crowdsource data model, the idea that 
the entire community gets to participate in the collecting of the data. 
You get to look on the GIS map. The air quality regulator gets to look 
and say: Hey, we have a hot point over here. Let's go find out what it 
is. Hey, we found some clowns painting cars in the back of a lot.
  Are those clowns out there getting air quality permits to do it? The 
folks down the street that are using the filters and are in the booth, 
if they are following the rules, they get left alone, but you catch the 
ones that have been escaping. It is a use of crowdsource data. We 
actually have a whole video of this on our website.
  We now have introduced a piece of legislation that is over at Energy 
and Commerce. This should be a bipartisan piece of legislation because 
that Republican or Democrat--it uses data to let you know what is 
happening in the air quality in your community. It uses data to catch 
bad actors, and it uses data to let you know you can leave good actors 
alone so they can grow their businesses, so they can pay people more, 
so there are more job opportunities, instead of spending the money 
filling up file cabinets and hiring consultants. It is an elegant 
solution.

                              {time}  1745

  Is that Republican or Democrat? I will make the argument it is data. 
There are solutions that both sides around here can use.
  So the next time you have someone getting behind these microphones 
and saying, well, we are deregulating this--no. It is time for a 
revolution in the way we think.
  We are all walking around with these. With the new sensors, you can 
manage your health care, you can test your water, you can test your 
soil, you can check the ambient sound, but you can also do the air 
quality in your community.
  I am going to make you an argument there are actually solutions 
moving around here, and if I can get beyond the hyperbolic rhetoric, 
maybe we can start to move some of these solutions forward.
  Mr. Speaker, I yield back the balance of my time.

                          ____________________