President Barack Obama earlier this month put the spotlight on the issue when he called on the FCC to “implement the strongest possible rules to protect net neutrality.”
But he muddied the debate when it comes to healthcare by saying the rule, “can have clear, monitored exceptions for reasonable network management and for specialized services such as dedicated, mission-critical networks serving a hospital.”
But many critics of a net neutrality rule believe that allowing internet service providers to charge for a “fast lane” or “paid prioritization” would be helpful for innovation. Such pricing would allow data from paying content providers to move more quickly to consumers. Currently, they argue, many networks slow at peak times when everyone wants to view Netflix videos or use other heavy bandwidth applications, like online gaming.
Charging those users more allows for more efficient usage of limited bandwidth, and provides an incentive to internet service providers to build more network infrastructure, which would accommodate more usage down the road. That position is partially supported by a July 2014 draft paper produced by two FCC officials, which use a model to show that overall market efficiency is improved if broadband providers are allowed to charge for fast lanes.
Billionaire internet entrepreneur Mark Cuban argued, in a post on his personal blog, that this debate has particular relevance to healthcare.
Hypothetically, he said, an emergency surgeon might want to access an internet application for a surgery—and finds that she can't get enough bandwidth for the service to work because “TV and movie services … swamp bandwidth.”
A net neutrality rule, he suggested, encourages that situation for two reasons: because it prevents the investment that would make a bigger network for everyone; and because it prevents high-priority data from jumping to the front of the line.
Cuban also doesn't believe Obama's exception for hospitals—which might put it at the front of the queue—would do much good, writing, “First in line in a traffic jam is still slow and buffering.”
Also opposing neutrality, Verizon has argued in a letter (PDF) to the FCC, that classifying internet traffic under Title II is not legally permissible, and an attempt to do so would invite legal challenges.
The push-and-pull over net neutrality has left the FCC's decision uncertain. The Washington Post reported on Nov. 11 that FCC chair Tom Wheeler had rejected Obama's call to reclassify internet traffic to Title II and he was looking to “split the baby” between internet service provider and net-neutrality advocate concerns.
Most opponents of formal net neutrality believe that classifying internet traffic under Title II would result in onerous new requirements for internet providers, as the section was designed for older types of networked communication.
Jot Carpenter, the vice president of government affairs for CTIA, said in an interview that the rules would slow new innovations for wireless providers. The exception proposed by Obama, he said, would introduce confusion for the providers.
In those instances, he said, they would have to approach the FCC and see whether their intended idea—whether a formal partnership with a content provider or an economic arrangement—fell under the hospital exception. Carpenter derided that as the “Mother, may I?” approach to governance, which he argued is bad for innovation.
It's also unclear what might fall under the exception, Kerry McDermott, the vice president of public policy and communications for the Center for Medical Interoperability and a former FCC official said. Which hospital data would apply? Would other healthcare data apply?
Because of that perspective, Carpenter and CTIA have been circulating a letter to healthcare groups arguing that proposed reclassification would increase regulatory uncertainty for mobile health, which they argue is too young to withstand the shock.
While Carpenter declined to name which stakeholder groups had been contacted, a draft copy of the letter obtained by Modern Healthcare includes comments from the Healthcare Information and Management Systems Society. It's not possible to attribute specific comments on the letter to the organization. As of press time, HIMSS had not responded to inquiries regarding the letter. And Carpenter wouldn't discuss when the letter would be officially released, or with which signatories.