Before the Interstate highways, a ride from Kansas on the old roads was a trip along the shifts in American life and living. Up through Nebraska it was first the corn, and by Iowa great fields of it heaved and rolled into the horizon. And further north the farms were well-ordered, trim and clean, nothing out of place, the stamp of Nordic influence.
The old highways ran straight or wound like vines over the plains and revealed the affection or tolerance of people to a community, a region. Roads themselves were a mark of preference and priority. Kansas enjoyed a reputation for excellent roads and highways.
Northbound US-81was two-lane and mostly curbed, a delight for the builder awarded the paving contract but a challenge for the motorist needing to pull over. Nonetheless, the smooth roads of Kansas were among the nation’s best.
In those days Kansas motorists knew when they had come into another state by the look and feel of a highway. No border signs were needed. The washer board announced Colorado, the cracks and crevasses were Missouri, and the sinkhole-dodging started just north of Ponca City, or Bartlesville. In our own state, road maintenance – good and bad – let us know when we changed counties.
The Kansas Turnpike was opened in 1956, a 236-mile, four-lane ribbon from Kansas City through Topeka and south past Emporia and Wellington to the Oklahoma line in Sumner County. Tolls were its central finance. Kansas had shown the way, and that year President Eisenhower announced his plan for a national highway system. This Interstate project would take nearly two decades to finish, kick-started with an increase in the gasoline tax from two to three cents a gallon, the taxes on tires from five to eight cents a pound, the excise tax on buses, trailers and trucks from eight percent to ten percent. The money would accumulate automatically in a federal trust fund dedicated for road construction, repair and maintenance.
The government put the nation on wheels, traveling a multi-lane highway network of 41,000 miles and, over time, adding nearly 7,000 miles to the original system. Before the Interstates and the federal highway fund, road construction and maintenance were largely left to the states. Kansas was among the best at building and keeping its highways.
The Interstate system and vast infusions of aid to cities and counties have refreshed the old roads and reinforced the new ones. The need for this was national, and essential. People welcomed federal aid that advanced their lives.
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In the way of essentials or necessities, health insurance (if not health care) is also universal. For decades Congress has shunted the matter off on the states and here we are, with the same kind of mess in health insurance that scrambled our highway system – a patchwork confederacy with smooth going for the well-connected, scraps and chip-seal for the rest.
As the Affordable Care Act is stripped of its initial benefits, states try to fill their own pot holes. Insurance companies, unsure how or whether federal subsidies would continue, plan premium increases. There are fights over workers compensation, definitions of poverty, even insurance (or not) for birth control and arguments over expansion of Medicaid. Contrast and conflict is everywhere. Health insurance now presents the kind of wild patchwork that had plagued the states in the old road years.
In Washington, paralysis. In Topeka, Republicans several years ago filed to join a wobbly coalition with nine other states in hopes that Congress will allow them to divert federal Medicare money to their own health care systems, and with no promise to use the funds to subsidize insurance.
Democrats spar with Republicans who would chip away at Affordable Care and roll back Medicaid, disrupt coverage for millions and restrict coverage for older but not Medicare-eligible persons.
The national matter of affordable health care is left to political tribes and culture warriors, and this may invite change we hadn’t bargained for. A state with no mandate that the young or the fit buy insurance – expanding the number of insured and shrinking the overall cost – could attract hordes of millenials. One with onerous Medicaid restrictions threatens rural and poor urban hospitals. States with generous plans would attract people and jobs. States with stingy and restrictive plans put older, poorer citizens at risk and tempt the offended to pack up and go elsewhere, if they can.
The pattern of our health insurance confederacy confounds the industry at large and drives the medical profession to distraction. And never mind the patient.
In America, health insurance is a universal issue, like highways. It needs a national resolution, not a patchwork.
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