Federal programs that include Medicare and Medicaid, along with technology developments in the private sector such as Alexa are two sets of forces that represent enormous influences on the health care domain. Apart from furnishing health services and paying for them, parallel activities by other government entities play essential roles in generating innovations (e.g., National Institutes of Health) and ensuring safety of new health products (e.g., Food and Drug Administration).
The Medicare Board of Trustees reported on June 5, 2018 that in 2017, Medicare covered 58.4 million individuals, 49.5 million aged 65 and older, and 8.9 million who are disabled. Total expenditures in 2017 were $710.2 billion and total income was $705.1 billion. Medicaid is the nation’s public health insurance program for individuals with low income. It covers more than 70 million Americans, including many with complex and costly needs for care. The program accounts for one in six dollars spent on health care in the United States and more than half of all spending for long-term services and supports. Plus, it drives state budgets and is the largest source of federal revenues to states.
Amazon Echo and Dot devices are improving patients’ lives by enabling those who are bedridden and unable to reach a wall thermostat to regulate room temperature. When issuing commands to a device, the software can be rearranged to accommodate whatever words a patient is capable of using to perform various household tasks and set medication reminders. An Alexa app called Marvee can translate voice snippets into text messages and deliver them to pre-specified contacts. Meanwhile, Amazon has filed a patent for the Alexa voice assistant to recognize coughs or colds. That firm also has been exploring options that would allow it to mine medical records to diagnose patients and it has been exploring the possibilities of testing patients for disease at home.
Technology developments impinge on the government both directly and indirectly. For example, the Apple Watch can generate data as a consumer health tracker. The company touts the ability of this device to detect atrial fibrillation, although evidence is gathering that it does so less accurately for users below the age of 55. Efforts currently are underway to determine if private Medicare plans are interested in subsidizing the watch for beneficiaries.
As devices of this nature collect consumer and patient health information, concerns are raised about how adequately current policies protect privacy. Congress could play a useful role by clarifying the amount of authority and ownership patients have over their own records, and the extent to which patient information can be held by a health system. Steady advances in germline gene editing and artificial intelligence also call into question whether existing policies suffice to ensure that patients are protected from possible harm. A congressional in-house think tank, the Office of Technology Assessment (OTA), was disbanded in 1995. As legislators increasingly are called upon to deal with technology issues, restoring the OTA may be warranted as a means of assisting them to perform satisfactorily.
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