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The Guild-ed Age
Texas Doctors’ Guild Fights Progress

A doctors’ guild in Texas has just thrown up a major road block to better health care. The NYT reports on the decision of the state’s Medical Board to further restrict the practice of telemedicine in the state:

On Friday, it changed its rules to state that “questions and answers exchanged through email, electronic text, or chat or telephonic evaluation of or consultation with a patient” are inadequate to establish a doctor-patient relationship. The move significantly tightens rules that already preclude video consultations except under a narrow set of circumstances. […]

Texas is among a handful of states that still require an in-person exam before a telemedicine consult can take place, according to the American Telemedicine Association, a trade group in Washington. Other states have vaguely worded policies that are not clear on whether an in-person visit is needed first.

In a country in which health care is both very expensive and hard to access, permitting if not encouraging the use of telemedicine, at least for basic primary care, should be a no-brainer. Telemedicine is cheaper than in-person visits and can connect patients in areas with few health care providers to doctors they might otherwise travel miles to see, or not see at all. That doesn’t mean we should countenance a regulatory free-for-all, nor does it mean that patients with more serious and demanding medical conditions should be pushed to use telemedicine. But we ought to welcome new technologies that, when used appropriately, can help bring down costs and reshape our often-inefficient methods of health care delivery.

Unfortunately, doctor’s guilds don’t like changes that threaten to undermine their market power. In the name of protecting patient safety, medical advocacy groups have fought against reforms that ease restrictions on telemedicine or extend more autonomy to nurse practitioners. And when these opponents succeed, America, laboring under high costs and inefficient practices, loses out.

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  • Kevin

    Expand the antitrust act to include quasi state agencies’ collusion to raise prices or otherwise limit competition – with triple damages where they do so.

  • wigwag

    Neither Democrats or Republicans are genuinely interested in confronting the dilemmas faced by middle class Americans. The two most important things that should be done to fix the problems of the middle class are to make health care and higher education dramatically less expensive while improving the quality of the services delivered. This is eminently doable with the right reforms.

    It is no accident that both health care and higher education are private systems massively subsidized by Government. It’s the Government subsidies that permit the whole sick system to thrive. Destroying the political power of physicians and professor/administrators is the single most important factor to improving the lives of middle class people.

  • Pelican

    Why should there be any standards set by those nefarious and money grubbing doctors? While we know incompetent docs can move from state to state to practice, why should those insular and self-serving medical boards decide who can manage medical care through this amazing new technology? As to bringing anti-trust charges against them, while docs are not permitted to collude on pricing, etc., we KNOW they all talk to each other, arrange deals on costs, etc., over-inflate their malpractice issues, and over-charge everyone. We demand more and more medical care to be funded by government (uh, tax-payers) with unlimited access to whomever we wish because, after all, the consequences of our personal decisions should not impact to what care we have a right (a right! according to that esteemed president, John Kennedy). Even though docs objected to Medicare, Medicaid, and the ACA, we KNOW they actually colluded with insurance companies to raise their incomes (statistics to the contrary notwithstanding). We should nationalize all medical schools, expand the ability of health care providers to include anyone with any “medical” background (as we do already through all those “supplements touting how wonderful they are for our health, but on the fine print deny any culpability in diagnosing or treating disease, hence escaping FDA oversight), and make docs government employees (uh, which they are already through those above mentioned programs) to scatter them around the country where we, the people, need them. That way we can cut costs, insure similar care everywhere, and provide the access everyone has a right to have! What will it matter if they are unionized, the way government workers are now? We will have done what every other country with our demographics has accomplished, like, uh, well… none, but who cares? Look at Germany, Sweden, Britain, Canada! Look how successful they are, well, at least until you look at the statistics and meld those with our demographics. But statistics lie anyway, especially when I want what I want, more for less!

    • fastrackn1

      “We should nationalize all medical schools”.

      Mmmm…really bad idea to ever ‘nationalize’ anything…except maybe the military.

      Healthcare is not a ‘right’ despite what Kennedy says. Our ‘rights’ are listed in the Constitution and that wonderful little document called the Bill Of Rights…both of which were not authored by Kennedy….

      • Pelican

        I’m with you! (I hope my sarcasm was not misinterpreted…)

    • ljgude

      Well I’m an American living in Australia and unless the health outcome statistics for Australia and all the other OECD countries are fictitious then the outcomes are about the same as the US – slightly better in fact which is amazing given that the US doesn’t cover everyone. The big difference is cost – healthcare in the US costs double the OECD average. To get an overview of where the US stands in overall health outcomes have a look at Hans Rosling’s ‘Best Stats you have ever seen’ lecture. It is a lot of fun too, I promise. To understand where the money is going in the US read Stephen Brill’s ‘Bitter Pill’ published by Time. US healthcare is a monster problem on the cost side. The medicine is good, often brilliant.

      • Pelican

        Excellent points. There is no question from anyone with any knowledge of the system of medical care in the U.S. that it is broken, and badly. What is lost in the discussion is the different demographics and even more so expectations on everyone’s part. Physicians “expect” compensation from “everyone”, more often limited hours, an enhanced lifestyle, while maintaining the “respect” of the general public. The profession is in need of rebalancing. The public expects superb care at every level with all sorts of amenities and ease of access, but takes no general responsibility for the general discussion necessary for real improvements. The politicians emphasize cost and their brilliance in deciding with the help of “experts” what constitutes excellent care, and push any legitimate fix onto the unborn generations to fund. I have no regrets about choosing this profession, but I do have substantial regrets at my own inadequacies, and my inability to influence the direction of the profession.

        • ljgude

          Thank you form your doctor’s take. Don’t blame yourself too much for not being able to influence the direction of the profession – it is a bit like being on a runaway train. Certainly, in my lifetime the balance between the service oriented country doctor who often never got paid to the current business first ethos has shifted, or over shifted, radically in my lifetime. In Australia we have both a public and an private system. Everyone belongs to the first and almost everyone pays a small levy at tax time, while those who so choose can buy private health insurance which gives choice of doctor and access to private hospitals. Break a leg or have a heart problem and your treatment will be the same in either system. But if you want access to non-urgent surgery or expensive procedures that can be controlled less expensively with medication and you will better off with private insurance. The public system has to aggressively control costs by say, medicating many people with AF, so the limited funds can be used to perform bypass surgery on those that desperately need it. More importantly from a cost perspective, the private system significantly reduces the demand on the public system. Because it is well structured it acts as a safety valve. If private insurance costs get too high people drop their insurance and rely on the public system and when waiting lists get too long people opt for private insurance. They keep each other reasonably honest. There is no such compensatory mechanism that I am aware of in the US system.

          • Pelican

            Hopefully we here can learn something from experiences and adjust our own decisions to our needs, recognizing pitfalls. Too many bad things have come from good intentions, and it appears, if I understand you correctly, the market still has a role to play. In purely government run systems there is a natural barrier to implementing change. With a market in play in which people can express choice, more rapid adjustments can be made, as you imply with opting out if waiting lists grow too long.

  • FriendlyGoat

    And just when we were about to believe there are no problems in red states with a red model.

    • Boritz

      I thought the same thing. These regs seem out of step with the state. Hope to find an explanation.
      Texas Medical Board
      333 Guadalupe
      Tower 3, Suite 610
      AUSTIN, TX 78701

      • FriendlyGoat

        Is there a possibility that doctors are out of step with a red model anywhere or everywhere?

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