Three wishes for the telehealth genie

According to folklore, extraordinary beings resent being confined within ordinary spaces. In “The Fisherman and the Jinni,” one of the stories Sheherazade tells her misguided husband in “One Thousand and One Nights,” the being in question is so angry at being imprisoned for centuries in a bottle that he has to be tricked into granting wishes rather than killing his lowly liberator outright. In Disney’s “Aladdin,” the genie isn’t so vengeful but still describes his confinement as “phenomenal cosmic powers” uncomfortably crammed into an “itty bitty living space.”

The real world isn’t teeming with mystic flasks or misty sorcerers. But to the people who first told fairy tales around campfires, our modern abilities to tame the elements, construct labor-saving devices, cure diseases, and fly through air and space would look an awful lot like sorcery. And, truth be told, our real world is teeming with would-be heroes trying desperately to bottle up disruptive discoveries and technologies.

Take artificial intelligence. Might it displace workers, deform journalism, debase literature, and place destructive new weapons in the hands of diabolical foes? Yes. Caution is warranted. It cannot, however, be un-invented, permanently stunted, or monopolized by a few self-appointed guardians. To believe otherwise is, indeed, to remain in a fantasy world. As a practical matter, we have no choice but to develop and use AI, as prudently and productively as we can, so as to maximize its benefits and minimize its risks.

I feel the same way about a less “gee-whiz” innovation that nevertheless presents promise as well as some peril: telehealth.

Although the digital technologies and practice models behind telehealth services predate the COVID-19 pandemic, it catalyzed a dramatic expansion. Patients needed help. Hospitals were, by necessity, limiting exposure. Physicians, therapists, and other providers were, too. So, barriers to telehealth fell. Only some were reinstated after the crisis.

Over the past five years, this innovation has proven itself to be cost-beneficial. “Telehealth is not a silver bullet,” wrote Josh Archambault and Joshua Reynolds, coauthors of a new report on the subject, “but it remains one of the most efficient and cost-effective ways to expand access to care, particularly in underserved rural communities.”

Published by the Massachusetts-based Pioneer Institute and Texas-based Cicero Institute, the report grades the 50 states according to how much they’ve adjusted their administrative and regulatory policies to facilitate provider and patient use of telehealth.

North Carolina, I’m sad to say, fares poorly in the Pioneer-Cicero study. We earn, and I do mean earn, one of the 10 failing grades Archambault and Reynolds assign. We make it too difficult for North Carolinians to obtain services from medical providers in other states. We don’t explicitly define telehealth in a neutral manner, allowing for a range of time sequences and modes (live vs. prerecorded, audio-only vs. full video, live check-ins vs. remote monitoring of conditions, etc.) based on patient and provider preferences. And we don’t allow nurse practitioners to deliver the full range of services for which they are licensed — whether remotely or in-person — without the costly and largely superfluous oversight of physicians.

Before reading the report, I was generally familiar with the case for telehealth reform and expansion. I’ve written about it before. What I didn’t yet know, however, is that the federal government has created new financial incentives for the practice under its Rural Health Transformation Program. About half of the $50 billion in grants will be awarded according to policy mix, not just baseline need, with access to telehealth represented in the grant formula both directly and indirectly.

The A-plus states of Arizona, Colorado, Delaware and Utah know what North Carolina has yet to accept: telehealth is here to stay. It’s never going back in the bottle. So let’s grant it three wishes: 1) define telehealth properly, 2) permit patients to use it freely, and 3) empower nurse practitioners to deliver it efficiently. The results won’t be miraculous. But telehealth can expand access while moderating costs. That’s good enough.

John Hood is a John Locke Foundation board member. His books Mountain Folk, Forest Folk, and Water Folk combine epic fantasy and American history.