To see the real possibilities of health-care reform, look beyond Washington's endless and circular debate over health insurance. Look instead at New Jersey's recent progress in telemedicine law.
Washington's health-care debate is mostly about differing visions of health insurance — Affordable Care Act vs. Republican repeal-and-replace vs. single-payer — rather than what sort of care those insurance systems buy. It's like a family bickering over whether to finance large purchases with cash, a bank loan, or a credit card while devoting little thought to what they are buying.
The insurance fight is largely about who pays how much for what, and who gets priority in claiming chunks of largely fixed quantities of medical resources. Thus, each system creates winners and losers.
But today, new technologies and new ways of organizing medical resources can create far more winners than losers — while offering many ways out of this caliginous smog of disagreement.
3D printing offers $50 prosthetic hands in place of $5,000 professional models. Internet-connected devices allow parents to remotely monitor their children's diabetes 24/7, reducing the costs of care and avoiding crises. Direct primary care (DPC) practices give patients and providers greater leeway in structuring care, often with greater emphasis on disease prevention and less on cleaning up ongoing illness.
The Mercatus Center's Healthcare Openness and Access Project (Mercatus.org/HOAP) collects data on dozens of ways the 50 states (and D.C.) encourage or allow new technologies and organizational structures to flourish. Telemedicine is one area where states have the capacity to innovate and improve care while our federal government dawdles with insurance.
In New Jersey, the state legislature and governor just took a significant step toward unshackling the possibilities of telemedicine, which combines new technologies and new institutions for delivering care. Telemed allows patients to immediately interact with physicians at any time or place.
Patients and providers can communicate via video conferencing. (Think of FaceTime or Skype.) Or they can interact via text. (Think of a patient sending thoughts, feelings, questions, or concerns to his psychologist in real time.) "Store-and-forward" technology allows patients to upload medical records, videos, audios, and so forth at any time to be reviewed at a later time by the provider.
Telemed makes it easier for patients to deal with problems early in the process, rather than waiting until a face-to-face appointment is possible. It's applicable to emergencies, possible emergencies, minor ailments, and chronic conditions. Telemed encounters can save physicians time, too, leaving them more time to see patients who truly need face-to-face encounters in the office.
Gov. Christie signed Senate Bill 291 into law last summer, making New Jersey a considerably more telemedicine-friendly state. In some cases, patients will be able to secure prescriptions without an in-person visit to the doctor. The law eliminates the need for a "telepresenter" — a nurse or other person who physically sits with the patient during electronic communications with a physician.
To satisfy providers' concerns over safety and efficacy, the law defines telemedicine to exclude simple phone calls, emails, texts, and faxes. Relationships must be more substantial, including, for example, video conferences and transfers of patient medical records to teleproviders. The law makes clear that patients need not have an in-person examination before consulting with a teleprovider.
The law also applies its permissions and principles to a variety of providers — not just MDs.
It's possible that some aspects of the New Jersey law could discourage telemedicine. It imposes significant record-keeping and reporting requirements. It requires teleproviders to review certain medical records before patient encounters. Providers must report patients' age, gender, and ethnicity to the state.
But overall, the likely effect is to open New Jersey to valuable services giving patients a broader range of choices.