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The Goodman Institute Health Blog

Rural Health Care: USA v. the World

Posted on April 10, 2026 by John C. Goodman

Percutaneous coronary intervention — the procedure that opens a blocked coronary artery during a heart attack — is close to an ideal proxy for healthcare access broadly. It is definitionally time-sensitive: the ACC/AHA guidelines set a 90-minute door-to-balloon target for a reason, and delays beyond that threshold carry measurable mortality/morbidity consequences.

The United States is not perfect. Eleven point seven million Americans live beyond the 90-minute window for emergency cardiac care… [That] represents 3.5% of the population of a continent-spanning nation — and … no comparable country on earth comes close to matching it. Canada, the country most frequently held up as the model America should follow, leaves 28.7% of its population outside that same window, including over a million people in densely populated … areas. Rural healthcare access is a genuinely hard problem at continental scale and the headline should be that the United States has solved more of that problem than anyone else.

Source: Anish Koka, The Health Care Blog

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For many years, our health care blog was the only free enterprise health policy blog on the internet. Then, when the NCPA closed its doors, the health blog stopped as well.

During this five-year hiatus no one else has come forward to claim the space. So, my colleagues and I have decided to restart the blog in connection with the Goodman Institute. We invite you and others to use this forum to share your views.

John C. Goodman,

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