[Congressional Record Volume 167, Number 193 (Wednesday, November 3, 2021)]
[House]
[Pages H6174-H6176]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                         AMERICA'S BUDGET WOES

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 4, 2021, the Chair recognizes the gentleman from Arizona (Mr. 
Schweikert) for 30 minutes.
  Mr. SCHWEIKERT. Madam Speaker, as we get ourselves sort of organized, 
last Monday, I did an entire hour here on the floor--55 minutes--and we 
actually did a presentation up and down the budget. Not this budget 
cycle, but basically what does our country look like over the next 30 
years? What is driving the projections of $112 trillion of debt 29 
years from now?
  Look, it is one of those presentations that is rather uncomfortable 
for most of us because the punch line is demographics, and that is not 
what we typically do here. But the reality is, we have a real issue. We 
are getting old very fast as a society.
  Let's do a bit of a reminder here and actually look at the math. We 
are going to walk through a couple of these that are the same as last 
week, but the difference tonight is we are going to try to talk about a 
handful of solutions. There is a big package of solutions, and most of 
them are really hard and are really going to be cantankerous around 
here, but there are solutions to deal with.
  Let's actually first walk through where we are at today. Once again, 
I won't worry about 1965 in the mix. It is important that anyone 
watching this, fellow Members of Congress, understand.
  Today, 2021, 77 percent of all the spending that will come from 
Washington is mandatory. Only 10 percent is defense; 13 percent is 
functionally what we vote on. I think there is a huge misunderstanding 
in the public that we march off to Congress and are voting on these $4 
trillion budgets. We are not. We are functionally voting on this little 
green wedge here that is discretionary spending.
  So if I came to you right now and said, okay, what is driving the 
debt over the next 30 years? I am going to show you a number of slides 
that are going to show the budget is in balance except for two things--
Social Security and Medicare. And it is mostly Medicare.
  Social Security is actually quite fixable. There is a number of 
levers. None of the levers will make anyone particularly excited or 
happy, but we once calculated we had 24, 26 different levers to make 
Social Security solvent and keep our promises.
  Remember, Social Security and Medicare are earned benefits. It is a 
societal contract. We have an obligation to be there.
  But Medicare is a really tough one, and we need to actually go back 
to having the honest conversation about what drives much of this debt. 
Well, if you see here, this is taxes paid in, benefits out for Social 
Security. You notice they are pretty much in balance. Social Security 
is a fairly square deal. You get a little bit of a SPIF, on average, 
for the average American.
  Where the numbers get really difficult is the average American couple 
is going to put in about $161,000 into the part A Medicare, which is 
only the trust fund for just the hospital portion. The pharmaceuticals, 
the other doctor visits, the other things are general fund. So when you 
are paying your FICA tax, you are paying this here.
  But that average couple is going to get $522,000 in benefits. So the 
differential from $161,000 to $522,000 is the driver of the vast 
majority of U.S. sovereign debt over the next 30 years. It is this 
differential here. It is not that complicated.
  One of the great frustrations here is my brothers and sisters on the 
left will come behind the microphone and say things like: Well, if we 
had Medicare for All, or we expanded the ACA, ObamaCare. That is not 
true. If anyone just takes a quick breath and steps back--and, look, 
Republicans are guilty on part of this, too. Those are financing bills. 
The ACA was financing it, who got subsidized and who has to pay. 
Medicare for All is just a change of who pays. None of that is about 
what we pay. And the Republican alternative was the same. It was about 
who got subsidized and who had to pay.
  So what we are going to talk about are some of the revolutions in 
what we pay, changing the cost of healthcare. But we first need to 
understand the scale of these. Look, this is functionally the same size 
as we just had, but it is important to understand that for every dollar 
in, particularly on Medicare, we get $3 in benefits back. And now you 
start to do that with the demographics of the country.
  This is just a graphic. So you see the orange here. That is us just 
getting old. That is just simply us moving into our benefit years. The 
green is healthcare costs. We have known people were going to turn 65 
for how many years in this country? And we are still avoiding the 
issue.

[[Page H6175]]

  But you start to see, when you start to get into the 2050s, this 
here, your country has $112 trillion of publicly borrowed debt, and 78 
percent of that is just Medicare.

  This is one of the slides that I actually see in my dreams because, 
if you understand math, if you are willing to own a calculator, this 
slide should scare you to death. The purple is functionally the 
borrowing of Social Security and the interest on it. This is the 
spending of Medicare and the interest on that.
  You will notice in this board here $112 trillion of borrowing, and it 
is mostly the cost of Medicare and the financing of that. The rest of 
the budget, if you remove Social Security and Medicare, is actually in 
balance.
  Just a quick aside before the next board. How many times today behind 
these microphones did anyone come up and say that functionally the 
greatest threat to the stability of the country is the fact that we 
have waited so long? We are well into the baby boom moving into 
retirement, and you start to see the debt curve just explode on us.
  So take a look at this board. Now, if you remove the pandemic years 
here and just functionally look at this 10-year cycle, why this is 
important--I know there are a lot of numbers and a lot of colors here. 
This board is basically saying one very simple thing. The vast 
majority, matter of fact, almost the entire debt for this decade and 
the decade after that and the decade after that, but for this decade is 
driven solely by Social Security and Medicare.
  Think of that. In functionally 9 budget years, your country is 
scheduled to have functionally about $2.2 trillion of borrowing, just 
borrowing every year, and almost all of that just came from Social 
Security and Medicare.
  And look, dear Lord, please don't let interest rates move against us, 
but you start to actually see the Medicare outlays, the Medicare 
revenues, and then you get these arguments saying, well, if you would 
adjust defense. Well, defense is lying down here, and you start to 
realize--excuse me, the Medicare taxes and those are down here. You 
start to look at these gaps. This is where we are at.
  Sorry, I was skipping ahead a board. If you were to eliminate the 
entire defense budget--so let's just wipe out the defense budget--you 
realize it buys you a year or two, but that is about it because this is 
the projected defense line, and this is Social Security and Medicare 
where we are going.
  You would think, Members of Congress, if you actually cared about 
keeping our promises that we are going to protect Social Security, we 
are going to protect Medicare, how come every Member of Congress isn't 
walking behind this microphone holding up these boards and saying we 
are going to work on a solution to this? Instead, this is almost toxic 
around here.
  I can't tell you how many Members I run into who say, David, I want 
to talk about the debt and deficits, too, and the fact that as we grab 
all the capital stock of the country, and maybe the world, that we are 
going to slow down the economy, that we are going to be poorer. Poor 
people will be poorer; rich people will be poorer. The country's 
productivity will be crushed. Oh, but I can't actually talk about the 
drivers of the debt.
  I am going to actually say there are solutions. There is a way to 
actually start to take a step back and say, if we are willing to have 
an honest moment and say, okay, because the vast majority of Medicare 
is a general fund expenditure, what do we do? It is complicated. There 
are lots of parts of it.
  But let's first understand. There is a rule about healthcare, and 
this is not only Medicare, Medicaid, VA, and Indian Health Services, 
but everything. Five percent of the population is over 50 percent of 
the spending. So if you love and care about people, but you also care 
about spending and healthcare costs, we need to understand the 5 
percent of our brothers and sisters who drive most of our spending but 
also are the folks often living in absolute misery.
  It turns out if you are willing to spend and invest to end people's 
misery, it ends up being a way you can actually also take on that debt 
and deficit.
  Look, Republicans often come behind these microphones, and we have 
all sorts of ideas. My suggestion is we do all of them, but we need to 
be realistic.
  Just as some of my Democratic colleagues will walk behind a 
microphone and say, well, if we had Medicare for All--back to the 
comment before, it is a financing bill. It doesn't actually change the 
cost of procedures. Unless they are willing to ratchet down and go into 
rationing, which they swear they won't, it is just an alternative way 
of paying for it.
  Then we have Republicans who will come here and say, well, price 
transparency, I love price transparency. But the best peer-reviewed 
academic studies out there, it is only 0.1 to 0.7 percent improvement 
on price for healthcare costs.
  Now, you still should do it, but if you really want to start thinking 
about things that drive healthcare costs, what would happen if I came 
to you and said--you saw in that previous board--what?--it was about 
$78 trillion of borrowing, just borrowing is Medicare over the next 29, 
30 years.
  Thirty-one percent of Medicare is just diabetes. Thirty-one percent 
of Medicare cost is diabetes, and that is just Medicare. We haven't 
done the math for Medicaid, for Indian Health Services, for VA, for 
just the general populations.

                              {time}  1900

  But it helps you start to think about, okay, we know chronic 
conditions, 5 percent is over 50 percent of spending. We know in 
Medicare 31 percent is just diabetes. Maybe we are starting to 
understand the drivers of what actually consumes our healthcare costs.
  My proposal to anyone that is willing to hear is let's actually do 
something fairly radical--the concept of stepping up and legalizing 
technology in healthcare but also investing in disruption.
  Right now, the left actually has some proposals that would 
functionally do some weird, quirky things such as, as soon as a drug 
comes off exclusivity, they are going to start to tax it, and hopefully 
that taxing actually starts now to move to create generics or force the 
one over here to become less expensive now because it is all 
functionally exclusivity off-patent, and I would like radically 
different thinking.
  How about investing in absolutely curative disrupting research in 
drugs but also technology?
  Let's actually walk through something that I find fascinating--and 
this board is a little hard because there is a lot of noise on it--but 
16 percent of U.S. healthcare expenses is people not taking their drug 
appropriately. Think of that. That is like $550 billion a year. So over 
half a trillion dollars a year is when someone doesn't take their 
hypertension medicine and then they have a stroke.
  It turns out the fastest thing you can do tomorrow is the technology 
that actually helps people know that they should have taken their 
hypertension pill or their insulin at a certain time, the technology--
because this is 16 percent of all healthcare.
  If tomorrow you could remind grandma to take her medicines at the 
proper times during the day, someone with hypertension that they took 
their pills so they don't have a stroke, 16 percent of healthcare. And 
we have real simple technologies out there. We have the pill bottle cap 
that talks to you and reminds you that says, hey, you didn't open me 
today.
  For someone that may have multiple pills at certain times of the day, 
you actually now have--and there are apparently all sorts of versions 
of this now--that drop the pill in the bottle and send you a text 
message, sends your grandkids a text message also to know that the 
pills are there.
  The technology is here, and almost no one ever thinks about personal 
technology like this as a way to crash the price in healthcare. But it 
is 16 percent. It is $550 billion in a single year, not 10 years, in a 
single year. So over half a trillion dollars a year you can strip out 
of healthcare costs if you could just get our brothers and sisters to 
take their pharmaceuticals in a way that keeps them healthy.
  Now for some more radical proposals, so far this year, there are two 
papers out, one U.S.-based and actually one Taiwanese-based, but both 
from very prestigious universities. They appear to be peer-reviewed. We 
have been reading through them multiple times. We are trying to get 
other comments.

[[Page H6176]]

They talk about, hey, there may be a cure for type 1 diabetes. There 
may be a cure, still has a long way to go, but there actually appears 
to be some in-lab breakthroughs on type 2 diabetes.
  Wouldn't you and I, the left, the right, stop some of the monkey 
business around here and say if we know 31 percent of Medicare cost--
and we know Medicare is the primary driver of U.S. sovereign debt. It 
is time for an Operation Warp Speed for diabetes. You don't have to 
call it ``Operation Warp Speed'' because I know that triggers some 
folks on the left, but the fact of the matter is a concentration of 
bringing disruption to cure people to end misery because we have to 
stop this thought process here of saying the way we are going to end 
people's misery is we are going to build more clinics so you have more 
access to a doctor.
  My argument is to have the revolution because the revolution is here. 
Just think, a couple of years ago, we were dealing with the cost of 
liver transplants for hepatitis C, and then we came up with a cure. We 
can do this.
  Now you start to understand there are clinical trials out there for 
some new types of stem cell therapy. I read this paper multiple times 
because it was complicated and fascinating. Stem cell therapy, they 
worked through the rejection problem, and it appears--at least the 
early paper--to be a cure for type 1. There is a derivative paper that 
is out there actually from a Taiwanese university talking about their 
success in type 2.
  It is a different thought process. One of the greatest things we can 
do for U.S. sovereign debt and not collapsing this society and 
destroying my 6-year-old daughter's economic future, as well as anyone 
that is heading toward retirement, is actually how we invest our money 
today in things that end people's misery, and by ending that misery, 
all of society as well as those individuals' benefit.
  The amusing part is I have been on this floor for several years 
talking about messenger RNA. Back when we used to call it CAR-T and you 
heard the stories about taking someone who functionally their immune 
system, the cancer they had, doing functionally what we now know as 
mRNA. Well, it looks like the breakthroughs and the fact that we have 
now turned much of what are diseases into software problems, and this 
is hard for a lot of folks to think through, particularly in the time 
where we have those who are very virus and vaccine conscious, but there 
is incredible hope here.
  As you all know, right now going into the field is functionally a 
vaccine for malaria. Now, it is only about 30 percent, is the data, 
effective, but when teamed up with some other pharmaceutical, it is 
like 70 percent. It will change misery around the world.
  Well, it turns out, that same messenger RNA goes far beyond COVID. We 
actually now are starting to understand malaria, a whole bunch of 
cancers. Do you know one of the published papers from early this summer 
looks like they think they actually have a cure for HIV? Influenza, 
heart disease, it is fascinating. But helping the body, actually its 
immune system, work and rehab the heart. There are some amazing things. 
You saw the papers earlier this year about cystic fibrosis and thinking 
we are almost there for a cure.

  Remember, 5 percent is 50 percent of our healthcare spending. Maybe 
it is time to rethink about the world and the fact that we are going to 
invest in the disruption that is cures that end the misery instead of 
financing a country where we might actually lower drug costs, but the 
disruptions, the cures that could come in the future don't show up.
  We can show you, in lots of studies, there are multiples out there 
when we are looking at the Democrats' H.R. 3 that by the end of the 
decade you actually saw the curve actually go up in healthcare costs 
because the cures didn't show up.
  The other thing, and this is not a particularly great slide, and it 
is getting a little old, but we have a whole binder in the office of 
articles talking about algorithms and, in this case, AI being able now 
to detect cancers very early, and the fact of doing that with this type 
of technology and technology that you can have at home. You can 
actually almost have it wearable. You can have it in your own medicine 
cabinet. Using those types of technologies is also part of our path to 
crash the price of healthcare.
  Remember, we are not going to change the United States getting older 
fast, the graying of America. But where we can bend the curve, bend 
misery and also bend the threat of the incredible amount of debt we are 
building up every single day, it is saying we are all in. We are going 
to do wearables. We are going to legalize technology. We are going to 
actually invest.
  The fact of the matter is it is happening right now where we are 
actually seeing countries around the world realizing how big of a 
problem diabetes is. Now there are awards going out saying, wow, we 
actually now have lines of research that look like we can finally 
disrupt the disease.
  So, this was sort of the follow-up on last week where we did the 
whole slide chart of what is actually happening in U.S. sovereign debt 
and how much trouble we are really in and how fast it is building.
  You have to do a whole series of things. You have to grow the economy 
consistently. You have to manage tax policy. You have to manage 
regulatory policy in a way that is for maximizing economic expansion. 
You actually have to deal with immigration in a way that maximizes 
economic growth. Opening up your border, importing massive amounts of--
let's be brutal about this--poverty where that poverty and inflation 
are crushing the working poor in this country. The working poor will be 
substantially poorer at the end of this decade because of these 
policies. That is cruel.
  How about if we had growth? Because growth is moral. So you do these 
things of tax policy, regulatory policy, immigration policy, and then 
the financing and tax incentives and the encouragement to do things 
that disrupt because you could actually do it in both healthcare; you 
can do it in energy; you can do it in transportation where we can make 
the future actually pretty darn amazing and actually end a lot of 
suffering and turns out it is the path that actually bends that debt 
curve that wipes us out as a society if we don't actually start to tell 
the truth and deal with it.
  There is a path. There is optimism. Every day this place squanders 
working on the real problems and instead of the insanity of some of the 
policies that are being proposed today that the economists on both 
sides say will make the country poorer by the end of the decade, we are 
going the wrong direction.
  Madam Speaker, I hope at least someone out there hears the message 
that there is a path. It is just getting harder and harder to get there 
because every day we fall further in debt.
  Madam Speaker, I yield back the balance of my time.

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