Converting the existing POTS network to an IP network (even for voice) is far more complicated than you make it out to be. The main reason its tougher is SIGNAL DEGREDATION OVER DISTANCE.

Every wire carrying an electrical signal over distance is subject to signal attenuation due to electromagnetic forces interfering with the signal (e.g. other cables, electrical wires, etc). This is why you can only run a cat-5e ~1500 feet before you need to insert a repeater. The way the phone company got around this for serving POTS to far points is by inserting load coils at strategic points to boost the signal enough to go where it needed to go. That said, load coils are not suitable when carrying anything other than voice. This is why DSL availability is limited to places close to the CO, or places with a heavy business presence (as there are usually satellite distribution facilities from which your DSL can originate). Additionally, telephone cables typically contain several hundred to several thousand pairs, each serving a client. The shielding for a pair towards the outside of a cable is far less than the shielding for a pair towards the core of the cable. Not all pairs in a cable are even viable for DSL.

To make this happen, the phone company needs to substantially increase the presence of fiber EVERYWHERE: This is similar to the way cable does it, in that fiber is usually run to every street, and the "last mile" is carried over RG6, which in turn is branched off of for every customer. There would of course be other implications for using the existing infrastructure for the last-mile, and last-mile really means something more like "last couple of feet".

In summary, this isn't happening any time soon since it involves substantial investment in the existing infrastructure. While FTTP is promissing, it still has a long way to go.

As somebody who spent a lot of time and energy helping acquire such a device for his father who suffered from ALS, I would like to highlight some important facts.

Many of the devices that the insurance companies cover are actually modified PC's. Before you say that people are better off buying a computer and having insurance foot the bill, look at the facts:

1. These PC's come modified with software and other interfaces which are specially designed based on years of research to meet the needs of the disabled for communication in the most intuitive way possible.

2. Often times the software is placed on an embedded windows system so that its harder to "break" with malware, and the like. Very few PC owners apart from the tech savy can say they've never gotten a computer virus or some form of malware. Even us techies slip up sometimes. Can you imagine if your lifeline were disabled by a virus? This is exactly what these devices are. Lifelines. People rely on them every day for the basic things we take for granted. Having the software embedded keeps the device functioning. Having functionality limited to...well....speaking...that makes the device far less daunting to those who might not be as computer savvy.

3. There are lots of different attachments available for these devices that let pretty much anyone with any level of disability use them. Each attachment is geared towards using the functionality a person has left. These are niche items that are pretty hard to come by at WalMart.

4. These computers are generally ruggedized (usually a toughbook, or something similar). The ruggedization is critical when the device goes everywhere with you.

The bottom line, really, is that these devices are designed to work any time anywhere for anyone. These are really custom solutions. Also, a whole lot of vendor support comes with the device, which is critical to making the most of it. This entire package, including the support, the level of customization in terms of input devices and software tools, and the level of quality and reliability seem to justify the high price in my eyes.

Your insurance company, believe it or not, has your best interest in mind as well as their own when they decide what is and isn't covered. These costly specialized devices are the best option for a whole lot of people. By only covering a solution like this, the insurance company knows you're getting what you need, which is tough to do if you're talking about building a system yourself.

I could have created a home-brew solution, but it would have been without the benefit of years of research into the progression of various diseases and the capabilities of somebody paralyzed from the neck down. Why should a patient have to deal with debugging a home-brew solution or trying to use a conventional mouse or keyboard when they can barely move their fingers? Being paralyzed is frustrating enough as it is...they don't need the extra stress.

On a side note, you can in fact work with the vendor and the insurance company to have an "add-on" placed in the computer-turned-medical device to allow you to use it as a computer as well. The expense is out of pocket, but is usually far less than the cost of a computer.