Net Neutrality and TeleHealth

A battle is raging over net neutrality that threatens to reach the magnitude of the SOPA/PIPA debacle of 2011. Net neutrality is the concept that all data from content providers (companies like Netflix and Google) are treated equally by internet service providers (ISPs) like Comcast and Verizon. This means that content is delivered on ISPs network at the same speed, regardless of origin or destination. Netflix now accounts for a staggering 31.6% of downstream (provider to consumer) internet traffic, and in February, Comcast and Netflix reached an agreement for higher speed service for its content, with Netflix paying an undisclosed sum.

For the vast majority of the internet's existence, neutrality has been the default, but in the last decade this has become increasingly precarious. The FCC has introduced regulations over the past few years that ensured certain aspects of net neutrality, preventing service providers from restricting transmission of any legal content through discrimination against certain content providers. In January of this year, these regulations were struck down by the DC Circuit Court in a case brought by Verizon against the FCC on the basis that ISPs could only be regulated in this fashion if they were considered common carriers (as are telecommunications and utilities), which is currently not the case.

The FCC announced on May 15th that it will explore two options for resolving the issue, open for public comment for a period of four months. One option is strong net neutrality, reclassifying all ISPs as common carriers. The second would require a basic, unrestricted level of service, but allow for price discrimination for superior service—formally ending net neutrality but preventing the problem of ISPs intentionally slowing connections to force content providers to pay for premium service.

The outcome of this debate will impact all users of the internet, including the eHealth and teleHealth communities. Some see a tiered-service model as beneficial for health care, as it would allow for faster, more reliable service for critical data. If health outcomes are at stake, this may be an enormous benefit or even a necessary prerequisite for high-level reliance on internet service.

Net neutrality advocates believe that a preferential internet would be devastating to innovation, competition, and progress. For the quickly growing teleHealth industry, such rules could provide a high barrier to entry that stifles startups, they claim, requiring small companies to pay for premium service in order to compete.

While a non-neutral internet might give larger companies a competitive advantage, many of the content providers that could afford and would likely receive preferential content distribution are among the strongest proponents of neutrality, with nearly 150 companies like Google (which owns YouTube), Netflix, Amazon, and other major players coming together to issue a protest letter to the FCC.

In addition, the FCC’s caveat requiring a high level of basic service means that this is unlikely to be a significant problem for small companies. Simple information like text actually requires extremely low bandwidth relative to multimedia like the movies on Netflix or YouTube, resulting in these companies’ disproportionate share of information flow (YouTube accounts for an additional 18.6%, making their combined total over 50%).

The telehealth industry’s growth is likely to continue unhindered regardless of the outcome of the FCC’s evaluation period.