Telehealth/Health Care Flexibilities

WM Health, Charting the Path Forward for Telehealth, April 28, 2021

Finance, COVID-19 Health Care Flexibilities: Perspectives, Experiences, and Lessons Learned, May 19, 2021

Flexible healthcare delivery, especially Telehealth is part of increased automation in medicine. It began with electronic charting. (Bravo on the selection of the title of the WM hearing.) The emergence of telehealth predates the pandemic. It started as a cutting edge way for experts to consult on cases. In recent years, it has included using radiologists in South Asia to read all manner of X-Rays and scans, delivering a diagnosis to emergency rooms, urgent care and doctor’s offices.

The question of taxation must be discussed at this point. Perhaps duties should be included for such off-shore medicine. They certainly must be in the event value added taxes are established in the United States. This would bring us into the OECD norm. Senator Hatch has retired, so it is now safe to talk of such things. 

If we adopt Medicare for All, such taxes would be counter-productive. Without some kind of employer-paid subtraction value added tax, it is hard to see the creation of an affordable public option , let alone Medicare for All. Part of any transition would have to include an asset value added tax, which would include ending Pease and Affordable Care Act SMI taxes on non-wage income over $200,000. See the attachment for more information on these proposals.

The pandemic has made telemedicine the new normal. I will be glad to see it go, or at least play a smaller role. It is hard to get a good medical history and list of symptoms on a videoconference or phone call. People likely died, either of complications from the pandemic (like suicide) or SARS-Cov-2. This requires explanation.

The disease occurs in five phases. In phase one, the patient experiences symptoms of a heavy cold which goes away after a week. This phase is largely ignored by the medical community because it is impossible to get to see a doctor in person. To be fair, most patients manage these symptoms with over-the-counter medication. Symptoms last for a week. Phase two is asymptotic. 

People believe they are well, even if they assume they were suffering from COVID. In reality, most of the spread of the disease happens during phases one and two. During this period, people do not have fevers, coughing and all but one of the symptoms which are used to screen for COVID.

The intense symptoms start with phase three (SARS2) or phase four (assuming individuals have some degree of immunity from pulmonary disease, or possess inhalers - especially steroids - to manage them. 

The patients who eventually die do not know that they have COVID. They believe that symptoms will go away in a week, just as they did in phase one. Access to primary care at this stage, as well as vital information on the disease would have saved lives at this point. Add fear of dying of COVID in the Intensive Care Unit and this fear became a self-fulfilling prophesy.

The main feature of phase four is crushing fatigue, either from lung symptoms or the development of immunity. These symptoms are a two week version of the reaction to either the first shot (for people who have had the disease) or the booster (for people who have not been sick previously). 

Phase five is the long term healing, which includes coughing up mucus. Medications, such as Robitussin, are valuable for these symptoms. This phase takes a long time to clear.

Deaths are still declining, as the current available vectors are less likely to die. For a few weeks, they just wish they would. Younger patients are experiencing the third wave. Minnesota, Michigan and Ontario are likely still experiencing their first wave. This disease is spread by sneezing on people you know, usually at home or work. It has spread from Seattle and New York to the rest of the nation, meeting in the southwest and moving north. It is running out of places to go.

As more and more people get vaccinated or simply have the disease and recover, it likely will disappear, like magic. When it does, we can get back to normal medical practice. Quite a bit of care has been foregone during the pandemic. There is a lot of catching up to do.

Attachment: Tax Reform