The power requirements and thus the bulky batteries of existing satellite phones could be reduced by switching to protocols which trade off bandwidth for higher error correction abilities through encoding and I don’t think existing satellite phones use the most bandwidth efficient encoding available so that could be another improvement.
There’s still the free space path loss between the surface of earth and a Globalstar or Starlink which my best guess estimate is in the order of 130db (can anyone more knowledgeable share a better estimate? I assumed bottom end of L-band, a height between Starlink and Globalstar, and used unverified dBi values for antennas at both ends).
Then there’s latency but I don’t think that’s a show stopper for many common use cases of voice and data.