Editor's Note: This column was co-authored by Sue Peschin.

At a roundtable in Cleveland, HHS Secretary Kennedy was asked what could be done to improve rural and urban healthcare disparities. The secretary acknowledged such disparities, noting he had spent the day at the Cleveland Clinic observing a robotic-assisted heart surgery. At the Cleveland Clinic, this is just another day. In a rural setting, however, this type of procedure is unheard of.

There are many reasons for disparities in care between urban and rural hospitals–from financial resources to invest in cutting-edge equipment and attract top talent to caseloads that provide the kind of repetition that builds expertise—but for one type of cardiac surgery, a large barrier to rural access stems from financial self-interest and a pliant Medicare agency.

For the half-century before 2012, replacing a failing aortic valve meant open-chest surgery, performed by a thoracic surgeon, stopping the heart and sewing in a replacement valve while on bypass. For many patients, the risk and fear of that procedure were decisive. They declined it, and many did not survive.

An estimated 2.5 million people over the age of 75 have aortic stenosis (AS), one of the most common types of heart valve disease. Left untreated, it can progress rapidly to severe AS, and once symptoms appear, one in 10 may die within five weeks.

The FDA approval of transcatheter aortic valve replacement (TAVR)........

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