Since it’s supposed to cut costs, expect to be talking to a computer instead of a medical professional in the near future if nationalized healthcare passes.  Government Is Funding Technology to Monitor People’s Health-Care Behavior by Having Them ‘Visit’ with Computers

“Health-care professional time is very, very expensive,” says Robert Friedman of Boston Medical Center. “We’re not going to constrain health-care costs by giving patients absolutely unlimited time with doctors or nurses–they’re too expensive.”

So healthcare is no longer about the patient’s needs, it’s about costs.  A point to keep in mind when you’re making up your own mind about univeral healthcare.

In an effort to increase efficiency in the treatment of certain health-care problems, the federal government has provided Friedman with about $22 million in grants since 1995 to develop technology that can save people actual visits to a doctor’s office by allowing them to make “virtual” visits in which a computer speaks to them via a digitalized voice over the telephone.

…“Telephone-Linked Care (TLC) technology has been developed and applied as an alternative to and a supplement for office visits as a means to deliver ambulatory care,” Friedman wrote in an article titled “The Virtual Visit,” in the November-December 1997 issue of The Journal of the American Medical Informatics Association.

TLC?  Give me a break.

It’s for the patient’s benefit because he won’t have to hustle to the doctor’s office and wait for hours, sure.  But in-person visits are about more than monitoring numbers.  They build rapport and trust.  You will not get that from a machine no matter how calm and caring the vocals sound.

You talk to the machine and the machine gives you a pat on the head for the right answer:

The TLC computer system works with patients to address common medical conditions such as alcoholism, asthma, depression, diabetes, heart disease, hypertension and spinal-cord disease through a telephone interface with the patient.

TLC can also be used to monitor personal behavior patterns by using computer-generated telephone calls and question-and-answer sessions to ask patients about such things as their fruit and vegetable consumption and their physical activity.  The computer can even praise patients for exhibiting positive behavior in the answers they give.

“The goal is to monitor patients who need monitoring daily rather than just when they are seen in the office,” Friedman told

They want to export these systems to China:

“This project will result in the establishment of research capacity in China to develop, evaluate and disseminate an automated, low cost, culturally sensitive, easily accessible and effective program to promote healthy behavior in the population (e.g., active lifestyle, healthy eating, and smoking cessation),” says the NIH abstract.

“Should these programs be deployed in China, they would have the capacity to decrease the prevalence of many common chronic diseases and improve their control in the population,” says the abstract.

Sounds like a good fit for communist China.  They’re all about “promoting” the proper attitudes.

The information will go into the electronic database, the one that will be completely private and will never, ever, be used for political or social coercion:

“The system monitors patients through ‘virtual visits’ and detects and notifies clinicians about important clinical problems to attend to,” Friedman wrote in his NIH grant abstract. “It also promotes patient self-care (e.g., medication adherence and appointment preparation). Data collected through TLC-C are integrated into the patient’s electronic health record (EHR).”

So instead of communicating with the computer robot, the patient becomes the robot.

Patient reviews:

“Positive reactions included that TLC was ‘fun’, made them more aware of what they ate or how much exercise they did, gave them helpful information, served as a ‘friend’ or ‘mentor’, and helped them change towards a healthier life style,” Friedman and other researchers wrote.

Other participants reported more negative reactions, including that “TLC talked down to them, treated them like a child, made them feel guilty, had an unpleasant or ‘disembodied’ voice, was inflexible and did not allow them to get or input information they thought important, was boring and repetitive and did not help them.”

What happens if patients are serially non-compliant, a common human behavior? Do they get “disappeared” out of the database and out of treatment?  That’s happening in Great Britain, where treatment is refused to obese people and smokers and others who don’t fit the bureaucratic profile, like being old enough for a Pap smear to be considered cost-effective.

Way to take the person out of personal responsibility, and the care out of healthcare.  Wonder if the computer’s bedside manner will be adjustable.