I have taken a few swings at American hospitals, and their often harmful lobbying stances, but Ron Winslow’s Wall Street Journal article about Minnesota’s rural hospitals airlifting heart attack patients to urban hospitals where they can get more effective care is breathtakingly impressive.

In a nutshell, here’s the innovation: if you stagger into a rural ER with a heart attack, they used to give you a clot-busting drug and keep you.  Recently, cardiologists determined that it was likely better to open up the artery and insert a balloon & stent immediately.  The problem is: many rural hospitals do not have the ability to execute the procedure, which has to be done quickly.

Since they started this practice in 2003, they’ve achieved a standard of 45% of patients getting the balloon & stent inserted in under 90 minutes and 79% in under two hours – that’s from the time you present at the rural ER until the cardiac surgeon in the urban hospital stitches you up.

Note: the expensive technology here is not actually medical: it’s the helicopter, which can cost up to $10,000 for the lift.

But guess what: insurers are paying for it. Why? Winslow notes improved outcomes: three days in the hospital versus five for the traditional treatment, and mortality of 5% of patients within 30 days of their heart attack versus 14%.

So, let’s hear no more Michael Moore Sicko nonsense about how hospitals and insurers conspire to deny care to the sick.  When the incentives are right, the treatment is excellent.  When the government messes up the incentives, the treatment worsens.

Lessons learned for public policy?

1. Innovation thrives through decentralization and local autonomy: the Minnesota Heart Institute and allied hospitals did not have to spend years navigating the FDA to get approval for this new practice – like drug and medical device makers have to.
2. Private payers are more likely to recognize and value innovation than public payers: there’s no way government bureaucrats can determine the value of such a procedure – and that’s why we must be wary of demands for the state to bless an innovation as “evidence-based” before we’re allowed to take advantage of it.
3. You never know what a “medical technology” looks like: fortunately, aviation entrepreneurs don’t have to get their products approved by the FDA, or Igor Sikorsky never would have invented the helicopter!