Telemedicine is an emerging Internet application that
requires a very high level of end-to-end reliability. It includes telesurgery, which now
allows specialized surgeons in one location to operate on patients in
completely different locations. Telemedicine can offer patients in small
hospitals or remote areas access to highly-skilled specialists who otherwise
would not serve those areas. Telesurgery, as well as certain other telemedicine
applications, can only become viable if the providers have access to extremely
reliable, high-speed Internet connections.
In contrast, many other
Internet uses do not require the same level of reliability or speed. Email
traffic, most file downloading, and many other uses lose little of their value
if their transmission is delayed somewhat, although too long a delay could
diminish their value. These
types of Internet applications simply do not require the same type of highly
reliable, high-speed access that telemedicine and other applications require.
Telemedicine is an
example of an Internet application that could benefit from receiving a
prioritization arrangement. Prioritization arrangements are agreements between
broadband providers and providers of content over the Internet that allow the
content provider to receive priority access in a so-called “fast lane” to avoid
congestion on the Internet. As FCC
Commissioner Michael
O’Rielly pointed out in April 2017: “Even
ardent supporters of net neutrality recognize, as I've said before, that some
amount of traffic differentiation or ‘prioritization’ must be allowed or even encouraged.”
The 2015 Open Internet Order
contained a “bright-line” ban on paid prioritization arrangements, which was
eliminated when the FCC adopted the December 2017 Restoring
Internet Freedom Order
(RIF Order). Free State Foundation scholars have argued that the new 2017 Order will
lead to more capital investment, making better and more reliable Internet
connections available to more Americans, and will also allow for innovative
prioritizations and other arrangements that can have significant economic benefits.
Telemedicine, with its need for highly reliable, high-speed Internet access, is
likely to be one of the applications that benefits most from this increased
investment and potential for more flexibility in access arrangements.
Some, however, have suggested that the 2017 RIF Order may threaten the future
development of telemedicine. For example, Mei Wa Kwong, Interim
Executive Director and Policy Advisor for the Center for Connected Health
Policy, wrote:
At
the December 14, 2017, open commission meeting of the Federal Communications
Commission (FCC), commissioners will vote on whether to repeal current net
neutrality rules. Such action may have wide-reaching impacts on the use of
telehealth. Community health clinics, such as federally qualified health
centers (FQHCs) and rural health centers (RHCs), could see higher rates for
connectivity that may reduce, eliminate, or discourage them from using
telehealth to deliver health care services, especially in rural areas.
Additionally, telehealth in the home could be severely curtailed as consumers
may face higher prices for connectivity that would be sufficient for a
telehealth interaction. To allow practitioners and
patients to provide and access care anywhere would require reliable and
adequate connectivity that could be priced out of the users' range with removal
of net neutrality.
The concerns described above are entirely, even by their own
terms, conjectural, and are unlikely to occur in any way that is harmful to the
development of telemedicine. Paid prioritization was not prohibited before the
2015 Order, and in any event such arrangements were never implemented in any
significant way. More importantly, however, experience with paid prioritization
arrangements in other markets provides strong evidence that Internet providers
will not have the incentives to engage in conduct likely to harm the emerging
telemedicine market.
In my May 2017 Perspectives from FSF Scholars, I
described how paid prioritization arrangements are very common throughout the
economy. For example, the U.S. Post Office has long offered priority delivery,
airlines make priority boarding available to customers, grocery stores allow
for priority placement of certain products, and highways all offer priority toll
lanes to drivers. In all of these various markets where paid prioritization
arrangements have regularly been used, the result is more capital investment
and more benefits for consumers. When such arrangements are put in place, the
result is not to price the priority service out of the range of the users with
the greatest need, but rather, to price in such a way that both the priority
and non-priority customers are served, usually with both groups better off than
they otherwise would have been.
Indeed,
Virginia Governor Terry
McAuliffe last year explained how the current I-395 expansion project in
Alexandria, Virginia, is using an
optional toll system to attract private investment for highway construction
that would not have otherwise occurred. As McAuliffe correctly pointed out,
this toll system will relieve congestion and improve access for all travelers,
not just the ones who choose to pay the toll to be in the fast lane.
We can
expect the same with telemedicine following the 2017 Restoring Internet Freedom Order. FCC Chairman Ajit Pai recently explained how the RIF Order will help, not harm, the prospects for telemedicine in
rural areas by promoting more investment and allowing for more flexibility in
priority arrangements for services like telemedicine:
One
of the biggest drags on investment in faster, better, cheaper broadband has
been the FCC’s 2015 decision to scrap the tried-and-true, light-touch
regulation of the Internet and replace it with heavyhanded micromanagement. In
two weeks, we’ll vote on a plan to restore Internet freedom and bring back the
same legal framework that was governing the Internet three years ago today and
that has governed the Internet for most of its existence. This will result in
increased investment in infrastructure and more digital opportunity for
seniors, especially in rural and low-income urban areas.
One
aspect of this proposal I think is worth highlighting here is the flexibility
it would give for prioritizing services that could make meaningful differences
in the delivery of healthcare. By ending the outright ban on paid
prioritization, we hope to make it easier for consumers to benefit from
services that need prioritization—such as latency-sensitive telemedicine. Now,
we can’t predict exactly which innovations entrepreneurs will come up with. But
by replacing an outright ban with a robust transparency requirement and FTC-led
consumer protection, we will enable these services to come into being and help
seniors.
As Commissioner O’Rielly
summarized in his statement supporting
the Restoring Internet Freedom Order:
Clearly,
there are cases today and many more that will develop in time in which the
option of a paid prioritization offering would be a necessity based on either
technology needs or consumer welfare. I, for one, see great value in the
prioritization of telemedicine and autonomous car technology over cat
videos.
In sum, the real threat to the
emergence of telemedicine is not, as Mei Wa Kwong suggests, the removal of the ban on paid
prioritization. Rather, the threat to telemedicine is from prohibiting innovative
access arrangements and suppressing capital investment that would otherwise
increase capacity, allow greater access, and improve reliability of Internet
connections. Telemedicine is likely to benefit from an acceleration in capital investment
and from allowing more flexible arrangements that make priority access
available where it is needed the most. And, to be sure, there are other emerging
innovative Internet applications that will as well.
Posts
