I have been an advocate of telemedicine for decades.  Way back when my friend Nancy was a nurse and working with other health professionals to make this concept a reality.

Except for regulatory issues, the concept still makes perfect sense.  Instead of traipsing this way and that to find the doctor needed- or more importantly, when sick folks lack adequate transportation- one can get the care that is needed to become well.   With all the equipment advances over the past three decades, we can have bedside monitors directly linked to physicians halfway around the globe to discern diagnosis, improvements, and treatments.

If you live in the middle of nowhere, telemedicine would provide timely healthcare access. Little need for helicopters to swoop in and take the patient to a facility.  Moreover, those with chronic conditions could still live at home- no need to be cooped up in an assisted living facility- or a hospital.

Way back in the very early 70s, we were developing devices that could monitor brain activity and neuropressure; respiratory vitals; blood chemistry to discern how nocturnal home dialysis was progressing.  All of these devices worked.  But, all of them required remote linking to a health professional to complete the loop.

Some 20+ years ago, we thought this technology would be widely used.  There was a small network, High Plains Health, with a small federal grant that provided healthcare to ten small rural communities in Eastern Colorado and Kansas.  These communities were at least 200 miles from the nearest city and had populations of 2500 or less.  Now, it’s called the High Plains Research Network (note that key word research) and is limited to Colorado residents.  Oh, and it’s part of the University of Colorado’s School of Family Medicine.

The Bureau of Indian Affairs uses telemedicine.  Because the agency lacks the resources to visit all those folks on the reservations.  And, since the reservations are permanent tribal territory and, therefore, not subject to state laws, this practice of telemedicine is perfectly legal.

You see, that’s the problem.  States regulate the practice of medicine (or not).  They determine which individual can or cannot practice.  That means one must obtain- and maintain- a state approved health professional license.  Whether you are a nurse, a physician, an osteopath, or a dentist- every one of these professions is regulated by the state.  And, if  you are out of that state, you are out of luck.

It’s how some of the states have been making abortion nearly impossible.  They intimidate all the physicians in the area, they scare them s….s so they won’t provide desperate women the medical services they need.  And, don’t allow physicians from other jurisdictions to satisfy that need.

Telemedicine can only be practiced within a given state- if the practice is licensed.  And, if the telemedicine service crosses the state line, multiple licenses (including the payment of fees to multiple states) and compliance with individual state laws (that often conflict with one another) must occur.  Which is why patients end up using their state-licensed practitioners, a means of controlling supply and prices available to the patient.

But, there may be a way around these insane regulations.  What would happen if the Federal government simply licensed telemedicine? Under the Commerce Clause (of the US Constitution), a law could be passed requiring the health practitioner to be licensed exactly where the practitioner is located.  They would be licensed in one state, their home state, and follow the rules, regulations, and procedures of their home state.   But, these practitioners could treat any patient with whom they have internet connectivity (or, perhaps, telephonic contact).

Of course, there would have to be some changes at the insurance company level, too. Because the insurers would have to include these federally authorized folks in their state pool of approved health providers.

But, it would greatly solve our physician shortage- and drive healthcare pricing downward.

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