Driving from California to Vermont, as I did this summer, offers time to think and plenty to look at.
The vast interstate highway system that I followed for much of my journey, championed by President Dwight D. Eisenhower, was created in large part by the Federal-Aid Highway Act in 1956, which declared that building this highway system was “essential to the national interest.”
It was surprising to realize that this highway system would qualify as a baby boomer if it were a person. Freeways feel so ingrained in our American identity. Within a few decades of their construction we already think of the freedom of the open road as a fundamental American value.
These roads reflect the duality of American life today. We value individual freedom so much that in a 2013 Gallup poll, 75% of respondents ranked it as our top national virtue. Yet we consistently struggle with creating the shared infrastructure that enables this freedom.
In the latest American Society of Civil Engineers’ Infrastructure Report Card, the U.S. received a grade of D+ for our crumbling roads, bridges, dams, airports, schools, and more. When we do invest in infrastructure intended to help us all, historically that “all” has either excluded or specifically harmed communities of color.
Our current health care systems, or lack thereof, are a prime example of this failure to embrace the connection between freedom and infrastructure. The U.S. health care system supposedly runs as a free market, yet is really a broken patchwork of competing public, private, state, county, and federal health care entities. Fewer than 4 in 10 U.S. health systems have the ability to share records with another system and 3 in 10 said they weren’t effective sharing data within their own organizations.
The Covid-19 pandemic is starkly highlighting the lack of those systems. As Ben Moscovitch, the Pew Charitable Trusts’ health information policy director, tweeted: “when public health authorities have to waste time hunting down a phone number or entering faxed-in information to a database, that hamstrings their response. Unfortunately, both are happening today in spades.”
Doctors don’t know when their patients test positive for Covid-19, public health leaders don’t have patients’ contact information, hospitals don’t know if inbound patients have been tested at all. No wonder that nearly 180,000 Americans have died as I write this.
American health care today looks like America’s roads before the interstate highway system: a map of disconnected, isolated entities.
It is a broken system that Eisenhower would have recognized. In 1919, as a lieutenant colonel, he led a cross-country drive from Washington, D.C., to San Francisco. It took the military convoy 62 days to grind its way across the bone-rattling and axle-shattering patchwork of roads. When he served as Supreme Allied Commander in Europe during World War II, Eisenhower saw how Germany had enabled speed of movement via wide concrete autobahns. As he wrote in “At Ease,” his memoir, “The old convoy had started me thinking about good, two-lane highways, but Germany had made me see the wisdom of broader ribbons across the land.”
The 1956 Federal-Aid Highway Act, which Eisenhower supported, was not the first law to attempt to connect our country, but it crucially included a massive $26 billion allocation, with the federal government paying 90% and the states contributing 10%.
Campaigns to create the interstate highway system focused on the themes that it would reduce traffic, speed transportation, make it safer to leave cities in case of an atomic bomb attack, and replace what one highway advocate called “undesirable slum areas” with pristine ribbons of concrete.
Pause for a moment on that last point. While the Federal-Aid Highway Act did connect America with more than 46,000 miles of highway, it did so at a significant and brutal cost to the low-income, minority neighborhoods it was purposely routed to demolish. In 2016, then-U.S. Transportation Secretary Anthony Foxx said “we now live with a system that has, in some case, bifurcated neighborhoods; in some cases put a constraint on the ability of some areas to be as economically healthy and as strong as they possibly can be.”
Our failures in the Covid-19 pandemic, our country’s latest civil rights uprisings, our crumbling infrastructure — these are all connected in our country’s history. The choices we have made and those we have avoided in the past 100 years have led us to a place where we have become less free. The pandemic is limiting where we can travel, at home and abroad. Millions of us are restricted from offices, restaurants, shops, and schools. And Black communities, separated and diminished by concrete ribbons not so long ago, are finding the pandemic harsher in terms of economic loss and deaths as white communities.
We have the technology and the will to change this. In health care, it is possible to build a better version of the interstate highway system: an equitable information highway that connects every person in this country, perhaps in a matter of months. Health care leaders in the last decade have set a solid foundation for the technologies, connections, and standardized languages that can make this interstate information freeway happen quickly.
It doesn’t exist yet because our leaders have lacked the economic power and compassion to overrule the voices of the status quo — the many hospitals and health care organizations that say it is too hard or too disruptive to share infrastructure.
There are many ways a national health care highway system could help move us toward health justice. A 2013 study found that having access to shared patient data cut in half the rate of patients returning to the hospital in the first month after being discharged. In a 2019 study tied to diabetes cases, hospital readmissions were an area where “black patients had a higher risk of readmission compared with white patients,” leading to higher health care costs to the patient, increased chances of complications, and reduced overall health.
Black people are much less likely to be screened for colorectal cancer, cholesterol, gestational diabetes, and lung cancer, among many other diseases. Having shared health data so providers confidently know what is missing improves the delivery of preventive services.
A study published this year outlined the many ways that shared health data can be used as a critical tool in building trust with communities of color including one example where leaders “expressed directly to the collaborating research team the dire need for easily accessible and trusted health information and an infrastructure for social support.”
Eisenhower’s vision for a country better connected by an interstate highway system disconnected some Americans from their communities and their right to health. I believe that now is the time to build a technology infrastructure for health care that corrects the failings and harm created by the interstate system, helps us heal, and makes us more free. If we do that, 60 years from now the freedom of our medical information will feel as fundamentally American as our open roads.
Claudia Williams is the CEO of Manifest Medex, a nonprofit health network serving California. She was previously President Barack Obama’s senior adviser for health technology and innovation, and served as director of health information exchange at the Department of Health and Human Services.