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North Carolina fails Telehealth Exam

4North Carolina has become a national leader in such policy areas as tax reform, school choice, and transportation funding. Unfortunately, we lag far behind in providing telehealth options to patients.
That’s the finding of a new study written by Josh Archambault for the Cicero Institute. Archambault, a longtime health-policy researcher and former legislative staffer, graded all 50 states on the policies they’ve enacted — or failed to enact — to foster telehealth innovation.
The report gave North Carolina a failing grade. There’s a regional dynamic, it seems: the four lowest-ranked states on the list are Virginia, North Carolina, South Carolina, and Tennessee.
Before exploring the findings further, let’s define our terms. Telemedicine is the practice of delivering services through telecommunication that would normally be performed in a clinical setting. Digital health is an emerging sector of software, hardware, and online platforms that keep patients informed and empower them to improve their health in a variety of ways, including diet, exercise, and treatment compliance. Telehealth is a broad term encompassing telemedicine, digital health, and related fields.
None of this is entirely new. As my former John Locke Foundation colleague Jordan Roberts explained in a recent policy guide, physicians began using the telephone soon after it was invented in the 1870s. It was a handy tool for checking on patients and offering timely advice during emergencies.
More than a century later, the introduction of personal computers, databases, and the Internet changed the behavior of both medical providers and patients. Because most payment systems assumed in-person services, however, the changes fell far short of revolutionary.
The COVID-19 pandemic was the turning point. Compelled to move interactions online, providers, patients, and, to some extent, payment systems had to adapt. Telehealth is no panacea and has some inherent limits. Barriers remain, only some responsive to policy reform. Still, there’s no rewind button to push. Telehealth is here to stay — and it should be.
In his report, Archambault identified four state policies that maximize its benefits and minimize the costs. First, state laws and procedures should reflect a broad understanding of telehealth, a trait he calls “modality neutral.” That means both synchronous (real-time) delivery of services as well as asynchronous (recorded) content and interactive systems to assist patients. It also encompasses audio, video, online text, and other formats.
Second, state laws and procedures shouldn’t compel patients to begin their consumption of telehealth in just one way. “Imagine someone experiencing a behavioral health crisis in the middle of the night,” Archambault wrote. “They might strongly prefer to start communication by text or in an asynchronous manner before being comfortable switching to a video call or in-person visit. Providers should be able to accommodate that preference so long as the standard of care can be met.”
Third, states shouldn’t impede the ability of patients to obtain telehealth services from providers who live in other states. “As Americans become increasingly mobile,” he observed, “being able to stay in touch with providers who know the patient’s history and have their trust is imperative to better health outcomes.”
Finally, the promise of telehealth will never be realized as long as nurse practitioners lack the legal right to deliver services as independent providers. Scope-of-practice reform is a longtime interest of mine, and properly included in Archambault’s grading system.
Because our laws are among the nation’s most hostile to nurse practitioners, it’s no surprise that he gave us an “F” here. Unfortunately, we fare little better on the other three criteria. Archambault recommended that North Carolina rewrite telehealth laws to define the relevant terms more clearly, expand the practice beyond mental health, and specify that the provider-patient relationship can start in any mode. He also suggested either making it easy for out-of-state professionals to register as a service provider here or adopting a reciprocity policy that treats other states’ licensures as sufficient qualification.
Which states are doing telehealth right? Arizona, Colorado, Delaware, Utah, and Florida top the list. North Carolina should join them there.

Editor’s note: John Hood is a John Locke Foundation board member. His books Mountain Folk, Forest Folk, and Water Folk combine epic fantasy with American history (FolkloreCycle.com).

Visiting Greek mythology: Heck hath no fury

6Some of you may recall the old Chiffon margarine commercial’s warning that “It is not nice to fool Mother Nature.”
Mother Nature had nothing on the Goddess Circe who was the original liberated woman. Helen Reddy might have been thinking about Circe when she warbled “I am Woman/ Hear me roar!” Today we shall ponder Circe, Greek Mythology’s Lady of the Island.
Circe was the daughter of Helios the Sun God. As an adult Goddess, she rode in Helios’ chariot of the Sun to the island of Aeaea. The island of Aeaea had no consonants in its name because consonants had not yet been invented. Being part Sun God, Circe had flashing sunbeams from her eyes with hair that shoots out fiery rays. It is likely that Circe’s eyes were the inspiration for The Association’s 1967 big hit Windy who “has stormy eyes/ That flash at the sound of lies.”
Circe was an outdoorsy gal who gave her heart too easily. She shows up in Mythology swimming in the sea surrounded by beasts who are part man and part animal. Jason and the Argonauts spot her and seek absolution for a recent murder. Circe slits the throat of a suckling pig.
She dribbles its blood onto Jason and his posse which purifies them of their murderous act. She still doesn’t much cotton to them. Shortly thereafter she orders them off her island.
Meanwhile, Glaucus, a sea God, has fallen for the beautiful mortal Scylla. Unfortunately, Glaucus loves Scylla, but she doesn’t love him. Glaucus is part fish which may account for Scylla’s body shaming of him. Glaucus goes to Circe to ask for Love Potion #9 to make Scylla fall in love with him. Unfortunately, Circe falls in love with Glaucus.
He doesn’t love her back, or even her front for that matter. This makes Circe angry at Scylla. You would not like Circe when she is angry. Circe knows about magic wands and potions. She mixes up a potion which she slips into the pool where Scylla takes her daily bath.
When Scylla gets into the water, the potion turns Scylla into a man-eating monster with a human upper torso but six dog heads on tentacles growing out of her lower body. She is an angry mess.
On another day, Circe ran into King Picus who was out hunting boars. Circe immediately fell in love with Picus who was married to Canens, a sprightly wood nymph.
Picus remained loyal to his wife, rejecting Circe’s romantic overtures. Circe did what any spurned Goddess would do, she turned Picus into a woodpecker. (Author’s note: Picus never played for the Fayetteville Woodpeckers). Canens, grief-stricken at being married to a bird, threw herself like Ophelia into a river and drowned.
Circe enjoyed her ability to transform men into animals. Rumor has it that the ability to turn men into animals remains viable in some lady persons of the female persuasion. Odysseus was on his way home from the Trojan War when he stopped on Circe’s island for supplies. He sent a scouting party onto the island which ended up at Circe’s house.
Her house was surrounded by wild beasts like wolves and lions who were just lounging around while Circe was inside singing. Circe came outside and offered the men wine which had the equivalent of ancient Roofies in it. The wine turned the men into pigs with men’s brains.
Circe put them into her pig sty to keep for an old-fashioned Eastern North Carolina BBQ pig picking. The Scout who had been watching all this occur skedaddled back to Odysseus on his ship to warn him.
Odysseus, while on his way to save his men, ran into Hermes who gave him a magic flower that makes him immune to Circe’s powers. Odysseus pulls a sword on Circe to make her swear not to hurt him and to turn her pigs back into his men. After complying, Circe naturally falls in love with Odysseus. He chills with her for about a year.
Odysseus finally tires of his fling, realizing he misses his wife Penelope. He goes back to Greece but slips back to see Circe several times who becomes the Baby Momma for three of his kids.
What have we learned today? Men are not far removed from being pigs. Pouring alcohol on a problem can always make it worse. Helen Reddy was right when she sang: “Yes, I’ve paid the price/ But look how much I’ve gained/ If I have to, I can face anything/ I am strong/ I am invincible / I am woman.”
Moral: Mess with independent women at your own risk.

(Illustration by Pitt Dickey)

Voters deserve information on fiscal crisis

4Every citizen who meets the basic requirements — adulthood, residency, and the completion of sentence after a felony conviction — can cast a ballot in North Carolina. There’s no test of civic knowledge required to exercise the civil right to vote, nor should there be. (Our state constitution still contains a Jim Crow-era literacy test to vote, but it’s vestigial and unenforceable.)
That having been said, effective self-government is difficult to sustain when voters lack basic information about candidates, issues, and our constitutional system. Surveys show such ignorance is especially prevalent among young people. In a recent poll of Americans aged 18 to 24, only a quarter knew the vice president breaks ties in the U.S. Senate. Most thought the Electoral College had responsibilities other than electing presidents, such as regulating campaign finance or certifying congressional elections.
Here in North Carolina, the latest High Point University poll tested the political knowledge of state residents. Some of the results, while troubling, fell short of catastrophic. Most respondents to the survey, conducted in late January, knew that Republicans currently control the U.S. House of Representatives, though 13% said the Democrats did and 22% were unsure. Two-thirds identified the GOP as the more conservative party and 55% knew that the U.S. Supreme Court was the federal branch empowered to declare a law unconstitutional.
But North Carolinians flubbed this question: “As far as you know, does the federal government spend more on Social Security or foreign aid?”
Just 21% knew the correct answer. Social Security accounts for one-fifth of total federal spending. Foreign aid is about 1%. Alas, most North Carolinians thought either that foreign aid was the bigger expenditure (41%) or that the U.S. spent about the same on foreign aid and Social Security (10%). The rest admitted they didn’t know.
I concede that civic knowledge isn’t a game of Jeopardy. Voters need not know which president prosecuted the Mexican-American War (North Carolina’s own James K. Polk) or was the first to be impeached (another native Tar Heel, Andrew Johnson) in order to exercise their franchise responsibly. Still, as America continues to stumble toward a fiscal crisis of unprecedented magnitude, far too few of us have a firm grasp on its primary causes and probable consequences.
If present trends continue, publicly held federal debt (excluding debts owed by one part of the government to another) will hit a record 106% of gross domestic product in 2027 and shoot up to 122% of GDP by 2034. Washington is now spending more on interest payments to bondholders than on national defense.
The U.S. House has just approved budget targets that, if fully implemented in subsequent legislation, would extend the tax cuts enacted during President Trump’s first term (generally good) and reduce future spending growth by trillions of dollars (also good). Unfortunately, under all reasonable scenarios, it also guarantees multi-trillion-dollar deficits as far as the eye can see.
Why aren’t voters more upset about all this? The reason isn’t a lack of concern. The vast majority say they worry “a great deal” or a “fair amount” about federal spending and deficits. The problem is that they misunderstand the causes and underestimate the necessary remedies. Far too many left-leaning people think it’s largely a revenue matter and can be addressed by hiking taxes on millionaires and billionaires. As I’ve pointed out many times, doing so might realistically nudge federal revenues up modestly as a share of GDP, by a percentage point or so. But our deficits are running closer to 7% of GDP.
Far too many right-leaning people believe combating fraud and axing a few programs like foreign aid will do the job. Nah. The sum of Social Security, Medicare, Medicaid, national defense, and debt service represents 76% of all federal spending. Eliminate every other federal expenditure and that still wouldn’t balance the budget (Washington currently finances nearly 30% of its budget by borrowing).
Voters deserve to know the truth. They deserve politicians willing to speak it.

Editor’s note: John Hood is a John Locke Foundation board member. His books Mountain Folk, Forest Folk, and Water Folk combine epic fantasy with American history (FolkloreCycle.com).

Who do you think you’re fooling?

5In one of my all-time favorite songs, Loves Me Like a Rock, Paul Simon poses the rhetorical question, “Who, who do you think you’re fooling?” Well, I would like to ask weekend news anchor turned fledgling Secretary of Defense Pete Hegseth who the heck he thinks he’s fooling by renaming Fort Liberty (nee Fort Bragg) Fort Bragg all over again. Exit the original 1918 honoree, Civil War General Braxton Bragg, and enter World War II honoree Private First Class Roland Bragg.
It is a fair bet that most Americans will never know that and will not care if they do realize what has happened.
The situation is that now President Donald Trump made changing the name of the most populous military base in the country back to Fort Bragg a campaign issue. He did so because the millions of people who have passed through the base think of it by that name and because “lost cause” and white nationalist supporters in his base were upset when Confederate Braxton Bragg was stripped of that honor.
A little history here. In 2021, Congress mandated the renaming of all military bases honoring Confederate soldiers, and 9 bases were indeed renamed in 2023. Change is hard for most people, and these changes were no exception. Layer on the political and racial tensions still swirling around the Civil War 160 years later with a hard-fought, highly divisive Presidential race and here we are.
Historians and scholars debate the question of renaming buildings, monuments, military bases, and such for people who are later disgraced in some way, in this case for supporting slavery and attempting to divide our nation. We cannot erase history, they argue, so it is better to focus on explaining it accurately and teaching it to future generations. It is a reasonable argument.
In addition, we seek to erase Braxton Bragg and the 8 other Confederates honored with military bases named for them, but we continue to honor others who also supported positions and realities we now find repugnant and unworthy. George Washington and Thomas Jefferson were both slave owners, but have you ever heard anyone advocating renaming or destroying the Washington Monument or the Jefferson Memorial? Is renaming just for those lesser than a Founding Father?
But back to the various Braggs.
Out of the millions of United States veterans, Roland Bragg was one of at least 5 soldiers named Bragg considered for the renaming. The list also included a US Ambassador and Congressman and a woman pilot who helped open flight training for black pilots at 5 locations, including the famed Tuskegee Institute. The operative word here, of course, is Bragg, because the whole idea was to go back to the future.
That said, Roland Bragg, was a hero in a way the mediocre Braxton Bragg was not. As 21-year-old paratrooper from Maine, Roland Bragg earned the Silver Star and 2 Purple Hearts for his service, which included stealing a Nazi ambulance, loading up 4 wounded US paratroopers, and driving them 20 miles through active gunfire to an allied hospital. Bragg believed that all 4 died of their wounds until he received a letter from one of them in 1993 and they reunited.
However worthy this enlisted man is, it is hard to get around the deep cynicism of this renaming. It is less to honor a hero than to wink at and perpetuate history and ways of thinking that millions of Americans find increasingly offensive and a violation of the spirit of the law passed by Congress in 2020. It is a sleight of hand that most Americans will never know happened.
So, “who,” Pete Hegseth, “who do you think you’re fooling?”

Cheer up, things will get worse

5Tired of reading about Elon Musk’s adventures in rearranging American government? Bothered by the prospect that his Musketeers obtaining your IRS records may turn out poorly for you? Unsure if buying pre-construction time shares in Gaza Riveria Villages on the Mediterranean is the best use of your Bit coins?
Worried that Ukraine will not exist after Trump and Putin carve it up? Remember what happened after Hitler and Stalin divided up Poland? Ignore the news. It’s time to put on a happy face. Take advice from the MC in Cabaret: “Leave your troubles outside. Inside this column, the world is beautiful. The girls are beautiful. Even the orchestra is beautiful.”
We are going to pour several spoonfuls of sugar on all those unpleasant thoughts. Take off your thinking cap, we are going to cross the Event Horizon from grim reality into the land of blissful willful ignorance.
Today’s lesson will lessen the chaos surrounding us by digging up smiley face aphorisms suitable for printing on inspirational plaques sold at the Cracker Barrel. That’s right, boys and girls; walk down Quotation Lane to lighten up current reality. Our old pal Samuel Coleridge advised forcing a willing suspension of disbelief to enjoy life. John Bucher once said: “Ignore the fact that the arc of the moral universe is long but bends toward chaos.” Chaos is just a negative name for reality. Back in the 60’s there was a popular poster that cheered us up proclaiming “Reality is a crutch.” You don’t need no stinkin’ reality when you have a willing suspension of disbelief. Like Voltaire had Candide say: “We live in the best of all possible worlds.” Attitude makes reality swell.
Alice and the White Queen discussed reality during Alice’s visit to Wonderland. Alice laughed: “There’s no use trying,’ she said; ‘one can’t believe impossible things.”
“I daresay you haven’t had much practice,” said the Queen. “When I was younger. I always did it for half an hour a day. Why, sometimes I’ve believed as many as six impossible things before breakfast.”
Gentle Reader, get up a half-hour earlier each morning and practice believing impossible things. If you need coaching on this skill, watch more Fox News. It will take you there.
Be like the ax in the proverb: “The ax forgets. The tree remembers.” Who wants to be like a Weeping Willow tree? Trees are morose with bark worse than their bite. Cut through the inconvenient reality of 2025 to be an ax. Despite what Joyce Kilmer said, trees are stupid anyway. They just stand around waiting for DOGE to turn them into toothpicks. National Parks are so 20th century. It’s time for the National Parks to pay their own way. Drill baby, drill! Tea Pot Dome be darned. Oil derricks produce more revenue than Red Wood Trees any day of the month.
Reality just makes people unhappy. Our old buddy Thomas Hobbes opined that “life is solitary, poor, nasty, brutish and short.” Who needs that sort of reality? Ignorance makes one happier. Daniel Patrick Moynihan said: “It’s not ignorance that hurts so much, as knowing all the things that ain’t so.” The more stuff you know that ain’t so, the happier you will be.
Maya Angelou was dead wrong when she wrote: “Every storm runs out of rain.” The news has more rain than you can shake a stick at. Look at the hurricane damage in western NC, floods in California and Kentucky. Wouldn’t you be happier if you didn’t have to think about reality?
An Arab proverb summed up how best to deal with reality: “It is good to know the truth, but it is better to speak of palm trees.” You can know the truth if you choose, but speaking it can get you into trouble.
America’s favorite lawyer, Jackie Chiles, Esquire of Seinfeld described the problems of reality well: “It’s egregious, preposterous, lewd, lascivious, salacious, outrageous, and flaunts the conventions of society.“ Pro tip: If you are flaunting the conventions of society by following reality instead of happy talk about the current Administration, stop it. Get over your fixation of reality. Stop complaining about reality.
Another Arab proverb says: “The dogs bark, but the caravan moves on.”
If you persist in focusing on reality, not only will you be unhappy, but you might end up in GITMO stuck between the Devil and the deep Blue cheese. There is a reason the Swiss put holes in their cheese. They have figured out how to sell you holes. Reality is nothing but a Black Hole of unhappiness. Look for the holes in reality. There you will find true happiness.

(Illustration by Pitt Dickey)

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