In every national dialogue about health care, the conversation seems to focus only on what the government can do to lower costs and expand insurance coverage. And yet, while the discussion has been ongoing for decades, nothing has ever been dramatically improved by this approach. In fact, things are arguably far worse than they were to begin with. So maybe instead of continuing to think inside the box, it’s time to completely change the conversation we are having.

Rather than looking to Washington to craft policy or mandate insurance coverage, we need to fundamentally rethink the way we view health care. If we really want to foster an environment where innovation can occur, we ought to look to tech innovation rather than bureaucrats. And this is exactly where people have been looking elsewhere around the world.

In India, where health care innovation is progressing dramatically, telemedicine is a thriving market. In fact, it has been growing at a rate of 20 percent annually and is expected to be worth $32 million by 2020. Part of the reason the concept has taken off in India is due to the fact that there are so many people living in rural areas without convenient access to a doctor or hospital. And with so many people in demand, the market for accessibility was born out of need. Digital health care allows doctors to connect with their patients remotely, which in turn expands access to health care. And since digital visits also come with a lower price tag than traditional visits, this method of care is available to almost everyone.

But the concept of telemedicine has yet to really take off in America, although there is almost no logical reason for this. According to the Pew Research Center’s 2017 data, 77 percent, or three-fourths of Americans own smartphones. And with these small devices, Americans essentially hold an entire world of information in the palm of their hand. Modern technology has given us instantaneous access to almost anything and anyone. It is astounding, then, that we have not taken a digital approach to health care.

Telemedicine is not a new concept. In fact, the term was coined during the rise of the telephone, though today’s concept is drastically different. To be sure, telemedicine is not the same thing as typing your symptoms into a WebMD search. Telemedicine utilizes smartphone apps and video communications to bring medical care to those without convenient or regular access.

When an 80-year-old rancher in rural Alaska began to feel his lungs fill with fluid, he feared the worst. Years of dealing with a heart condition had taught him to pay close attention to problematic warning signs that trouble was coming, but visiting the emergency room was easier said than done. The nearest hospital was over an hour away and without fully understanding what was happening to him, he was uncomfortable getting behind the wheel. Of course, this meant he would have no other option left other than calling an ambulance.

Anyone who has ever been stuck with an ambulance bill knows all too well just how expensive they can be. In one instance, a man was shocked to learn that his two-mile ambulance ride came with a price tag of $2,700. Another patient was left with a bill for $3,600 for a four-mile ride. Understanding these costs, the rancher was reluctant to call 911 and have pay for an hour-long ambulance ride without getting a medical opinion first. Luckily, telemedicine came to the rescue.

The rancher picked up his smartphone and initiated a video call with his doctor. And after the doctor had assessed the situation and analyzed the patient’s vitals via a smartphone app, the rancher was relieved to learn that no emergency room visit was needed. Instead, the doctor prescribed new medication and the patient improved within a few days.

But country dwellers aren’t the only people who can benefit from telemedicine. Seniors with difficulties moving around would benefit from the ability to communicate with their physicians without having to leave their homes. Additionally, this form of “office” visit would reduce the costs of care for everyone. This would also benefit younger adults who are less likely to have health insurance and who are also less likely to routinely visit the doctor. And it is this younger demographic that is really driving this market.

The Obama Administration spent a great deal of time and money trying to convince millennials to sign up for Obamacare. But no matter how hip their target ads may have been, many young people were more willing to pay the fine instead of purchasing health care. While headlines touted that we couldn’t afford health care, they neglected to mention that many of us simply didn’t want it. And that matters. Many of us would rather spend our money on other things. And while catastrophic insurance is wise, for many young adults the cost was not worth the benefit. 

But while young people are less likely to have insurance coverage and do things the traditional way, they are more likely to use telemedicine. Millennial’s have come of age in an era where everything we want is available to us on demand with merely a tap of a screen. This has led us to be impatient when it comes to waiting on the government to innovate. Actually, it has caused us to be impatient about everything, including having to sacrifice time in a waiting room until the doctor is ready to see us. But telemedicine allows us to see a doctor without the wait.

Previous attempts to make telemedicine mainstream have focused on older clientele, but the fact remains that millennials are five times more likely to use new technology than their older counterparts. And when it comes to digital health care, 60 percent of millennials are already using it.

Millennials have been dubbed the most stressed and anxious generation, and this appears to be true. Not only do young people have multiple side hustles, they also are engaged in many passion projects, making it hard to go out of your way to visit a doctor. But making doctors available through smartphones has been a game changer. In fact, the area where this has grown the most is in mental health. Thanks to digital therapists, many millennials have been able to bypass pricey mental health care visits with affordable options. And since telemedicine is so much cheaper, there is actually no need to purchase a traditional insurance policy.

Without insurance, an in-person visit to the doctor can cost up to $160, whereas telemedicine runs a cost of about $40- $50 per visit. Of course, this has actually resulted in millennials using the service like Uber, scheduling visits every time there is a small concern. And while digital medicine skeptics have used this behavior to discredit it, the bottom line should be about consumer choice, not costs per visit, which is yet another reason why insurance should be left out of this.

When your choice is dictated by coverage, patients can only see doctors within their plan. And since insurance premium costs are determined by how much health care patients are consuming as a whole, frequent visits to the doctor will cause overall costs to rise. 
But since many millennials are choosing to pay out of pocket for the use of telemedicine, instead of utilizing health insurance, it is no matter how often they are choosing to use it. In fact, it further speaks to its value.

No one can get millennials to go see the doctor, but digital health care is convenient and accommodates their schedule and their wallets. The willingness of millennials to adopt this technology might be the key to broader use.

It is shocking that this concept has not caught on quicker, given its cost-cutting benefits and quality of services. But there are certain elements holding it back. For starters, regulatory burdens have caused 22 states to step in and require additional licenses before physicians can engage in telemedicine. Additionally, telemedicine laws vary so much from state to state, it is difficult to keep track. In Georgia, for example, digital eye exams—a new booming market— are prohibited whereas it is perfectly legal in neighboring states.

Additionally, since many insurance companies do not offer coverage for digital visits, many people simply don’t know it is even an option. And since many people steer clear of care that isn’t covered, telemedicine has struggled to become mainstream.

There are also concerns over the quality and safety of care, but telemedicine has been used by doctors for years and has been proven to work. In fact, Doctors Without Borders relies on telemedicine every day. The Wall Street Journal reports:

Five to 10 times a day, Doctors Without Borders relays questions about tough cases from its physicians in Niger, South Sudan and elsewhere to its network of 280 experts around the world, and back again via the internet.

At this point there is almost no reason for this technology to be more widespread throughout the country.

While many advocates of telemedicine envision a future where insurance companies provide coverage, maybe it’s time to start thinking of a time when insurance is not the end-all-be-all for health care.

Health insurance is such a mess, no one knows the cost of care anymore. I can’t ask my doctor how much it would cost to set a broken bone because it is completely reliant on my coverage not on the actual service being performed. When care is covered by insurance, it ceases to respond to actual market demand like other goods and services. Currently, the cost of telemedicine is lower than a doctor’s visit without insurance and not much more than a typical copay with insurance. Allowing it to be included in insurance premiums could very well result in increased prices.

Instead of trying to fix our broken system, it’s time to practice some creative destruction and abandon the old ways in favor of new tech-centered approaches to health care.

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