Dr. Jones argues that telemedicine will provide "sustained improvement" at least to rural patient care, because it will allow rural physicians to televise medical examinations to specialists who are far away and otherwise inaccessible to rural patients. Dr. Carabella responds that, though this benefit might occur initially, smaller hospitals will eventually try to save money by replacing physicians with technicians who can televise most medical examinations to larger centers. Thus, fewer patients will be able to receive personal attention, and so both rural and urban patient care will see a decline in quality.

Dr. Carabella counters Dr. Jones's position by arguing that the long-term effects of telemedicine will counteract the benefits Dr. Jones foresees. While there might be initial improvements to rural patient care, as Dr. Jones suggests, Dr. Caraballa suggests that the incentive to reduce expenses will ultimately cause smaller hospitals to outsource most of their medical examinations to telemedicine technicians. This cause-and-effect chain will result in a net decline in quality of patient care in both rural and urban settings.