In comments submitted to the House Energy & Commerce Subcommittee on Communications and Technology on 4/16, the American Medical Informatics Association (AMIA) urged lawmakers to view broadband access as a social determinant of health, warranting a more nuanced approach to managing Internet traffic through tiered pricing, known as paid prioritization.
The Federal Communications Commission (FCC) has finalized a rule, effective April 23, 2018, known as the Restoring Internet Freedom Order, that eliminates existing prohibitions on paid prioritization, blocking, and throttling of Internet traffic by Internet Service Providers (ISPs). Critics of the rule worry that these prohibitions have protected consumers from deceptive practices and upheld an ethos long-considered fundamental to the evolution of the Internet. Proponents see the rule as a way to engender competition and innovation, lower costs, and lead to expanded broadband coverage.
AMIA applauded Congress for delving into the contentious and uncertain issue of paid prioritization. The organization’s comments were submitted as part of a subcommittee hearing, “From Core to Edge: Perspective on Internet Prioritization,” which was held Tuesday to help lawmakers understand the tensions related to paid prioritization.
In the letter, the AMIA notednoted that (1) access to high-speed broadband greatly determines the trajectory of individuals’ health; (2) increasingly, care is delivered outside the four walls of our traditional healthcare system and more data are being exchanged across geographic and organizational boundaries to support such care; and (3) individuals are being empowered and incentivized to leverage consumer technologies to prevent and manage disease through Internet-connected devices.
Broadband as a Social Determinant of Health
While AMIA understood the basic rationale behind paid prioritization, the organization questioned why existing policy mechanisms, such as exemptions, were not viewed more favorably. Under the existing Open Internet Order, specific kinds of Internet traffic, such as data in service of telehealth, can already apply for an exemption by declaring itself non-Broadband Internet Access Services, or non-BIAS data services.
In the letter, the AMIA states, “In our view, the role of public policy should be one that encourages low-cost broadband options through increased competition with open access (i.e. no additional cost to connect to specific kinds of applications and content) and transparent terms of service (i.e. clearly stated performance expectations). Arguably, paid prioritization runs counter to the goal of open access. While we acknowledge that there could be definable instances where prioritization could be useful, such as for telehealth services, we also question the need for paid prioritization given the existence of exemption options for non-Broadband Internet Access Services, also referred to as non-BIAS data services.”
“AMIA recommends a thoughtful examination of exemptions, rather than wholesale removal of the prohibition, as a reasonable and responsible next step. Congress could review the number and nature of exemption applications, as well as consider the impact of the exemptions once granted.”
“For many Americans, Internet access is fast, responsive, consistent, and ubiquitous,” said Jeff Smith, MPP, AMIA Vice President of Public Policy. “But as care becomes more distributed and virtual, and demand for data-intensive applications increases, we must ensure that public policy – or the lack thereof – does not worsen health disparities.”
