Trailing only education, health care resembles an endless philosophical and political war, with sharp, persistent disagreements over direction and policy. The list of disputed matters includes but is not limited to: the merits of public versus private insurance coverage, the fairness of provider networks, the utility of health care subsidies, the considerable costs of technology acquisition, the irritation of surprise billings, plus newly flaring disputes over the practice responsibilities of various medical professionals.
There is even argument over who should be involved in resolving clashing views.
*The people who oppose broad health care coverage mandates consistently argue that politics should be taken out of the debate.
*The people who want to realize grandiose plans such as Medicare For All essentially wish to subtract economics from the equation.
*The people who distrust institutions and professional groups want to push out lobbyists and supposedly self-interested practitioners from decision-making.
Put these three negative checkoffs together, and we end up removing the political leaders, the financial experts, and the health professionals. Then, presumably, health care policy and decisions will be made by social media consensus, which of course is a world-class oxymoron.
Pennsylvania, along with other states, wrestles mightily with how to provide accessibility, availability, affordability, and accountability across the health care landscape. Even with all this debate, there is not enough discussion about the cost of the infrastructure for providing modern and increasingly specialized health care.
We have come a long way from the days when the allocation of NMR machines was a fierce controversy. Technology opens up amazing possibilities for care and treatment, but also poses breathtaking costs. With so many hospitals in our commonwealth struggling over bottom line woes, it is unrealistic to expect they will all be able to dig deeper. One of the sure ways to improve the capacity of hospitals and health systems would be to increase the reimbursement rates for Medicare and Medicaid. Nevertheless, state government does not appear in a land rush to up their reimbursements.
Medical providers come together in endorsing something that can considerably aid increasing access to care while limiting the cost to patients. It is not a new wonder drug, but the application of high tech – telemedicine. Health care practitioners quickly tick off the advantages: broader databases, wider information dissemination, more timely outreach, and better understanding of patient challenges and needs.
A convincing assertion comes from Judd Hollander of Thomas Jefferson University. He points out this issue is not a choice of patients staying home as opposed to going to a care facility. Rather, this provides a viable alternative for those who might otherwise ignore their condition or ailment. Right now, for too many people, the most convenient option is doing nothing, which tends to increase the severity and difficulty of finding remedies when they are later compelled to seek treatment. Multiple measures have been put in place to prevent medical errors and to boost preventive care. Why deny access to technology that can advance both causes?
How to apportion costs for the acquisition and application of telemedicine is a pitched battle between the medical community and funding entities. Once the cost questions are sorted through, concerns are expressed about how the technology can be effectively used in daily practice and how to fit this new approach into reimbursement systems. That requires legislation.
Few will be shocked to hear Pennsylvania is a laggard in suturing a solution. Why telemedicine legislation has not become law is an annoying mystery to the public. After all, there is not any Citizens Coalition Against Telemedicine waging political war. People see other states able to figure it out.
Look at the list of opposition arguments, and it can seem like a rising of medical Luddites. Safe application not proven. Insufficient board oversight. Hoopla outrunning realistic savings. Telemedicine is not some voodoo derivative or reckless treatment substitute applied by rogue practitioners. Hard to believe it would make doctors less competent or less ethical. With abundant complaints about access, this is the most promising way to bridge growing gaps in face-to-face care.
Opposition groups are skilled in defeating legislation or running out the clock on consideration. Yet, during the past two legislative sessions, direct opposition led by insurers has proved not even a speedbump in the state Senate. The House has not signaled similar urgency to act. So suspicion turns to the possibility of a poison pill amendment lurking. This can be a controversial issue no one is eager to vote on, but one politically difficult to rule out of order. Such an amendment can come from someone opposed to the bill or someone who thinks their amendment is more crucial than the base bill. In other words, someone puts their ego and issue agenda ahead of the popular will.
If that proves the case, it offers another reason accounting for dropping public confidence in the legislative process. It is one thing for folks to offer up concerns about how something might be implemented and who pays the bill. It is something else for someone to view transformational technology as a vehicle for achieving political glory on a separate issue. Putting an end to speculation is simple enough – put the measure up to a vote.
Telemedicine is not another battlefront in the poisonous and seemingly irreconcilable disputes over Obamacare. Bipartisan support in the state Senate proves that. With so much attention being absorbed by the clashes in Washington and the looming campaigns, and with so many emotional state issues competing for attention, telemedicine has trouble getting into the spotlight. But the implications for patients, and sooner or later we all are part of that class, are so large. Science and economics support telemedicine. The public awaits its benefits. Time for state government to act constructively.
David Atkinson is an Associate with The Susquehanna Valley Center’s Edward H. Arnold Institute for Policy Studies.
Nothing contained here should be considered as an attempt to aid or hinder the passage of any legislation before the General Assembly.
The views expressed here are those of the author and not necessarily those of The Susquehanna Valley Center for Public Policy.