The Winter Issue of Democracy: A Journal of Ideas has an article about "telehealth" – video doctor visits — by two doctors, Bob Kocher and Pat Basu, who are "involved" with a company in that business. The article makes some interesting claims about the potential cost-savings and care improvements that the technology may enable.
Also interesting are the policy recommendations involved. Some of them are what you'd expect from the left-of-center Democracy journal — more government spending and price controls. The authors recommend that "The federal government must continue its efforts to build out broadband that is accessible to all Americans" and that "State and federal government regulators should also exercise antitrust enforcement to limit data monopolies that harm consumers and customers, such as the problem of electronic health-records companies charging doctors exorbitant fees to access their own data."
But others can be seen as more deregulatory. For example, they write:
the ability for a physician to treat a patient is contingent on establishing a physician-patient relationship. Some states have not clarified whether a live, face-to-face video connection establishes this relationship, which is a basic tenet of telehealth. Although most states have moved to try to clarify this, some have either obfuscated the issue or blatantly endorsed protectionist policies for underperforming incumbent providers. Policymakers can increase the adoption and benefits of telehealth by clarifying this murky issue.
Another area that needs greater attention revolves around state medical licenses. Although a urinary tract infection in Virginia would be treated identically in North Carolina, a physician in Virginia would be unable to treat a patient in North Carolina. In some states, obtaining a state medical license can take up to 12 months and cost $1,000. This creates a significant barrier to achieving some of the benefits of telehealth. Furthermore, there is no clinical rationale for these barriers. We believe that if you're licensed in one state, you should be able to practice in the other 49 states.
This raises some issues similar to those involved in allowing companies to offer health insurance across state lines. If the federal government mandates that states allow such sales, is the federal government improperly interfering with state authority? Or are the states improperly obstructing interstate commerce?
I'd rather see my doctor in person than over a video link, and I have some skepticism about some of the claims for improved quality from telehealth. But people in more remote locations or with more mobility issues may feel differently. And it's certainly worth testing to see what the results are. The article is worth a look for anyone interested in health care.
