I’m a Canadian and I’ve worked in health care.

This is only done for very specialized treatments where the province (they run the health care delivery) doesn’t have the treatment and/or the American resource is closer than a Canadian treatment location.

For example Nova Scotia will send some complex paediatric cases to Boston. They could send them to Toronto, but Boston is closer. Same with Manitoba but they use Minneapolis.

Canada is only 40m people and almost half that is in one province. The smaller provinces simply don’t have the population to justify having every possibly medical bell and whistle.

Point is when province sends Canadians for US treatment is isn’t actually about better quality as not all provinces have the same in house capacity and often the next largest city with such capacity is an American city.

Also, outside of the supremely wealthy Canadians, very few go to the US for private care. There is a medical tourism market to Mexico and other parts of Latin America for elective surgeries and uncovered treatments for some chronic conditions, though.

Canada should just join the US. (Joke <- have to be explicit these days. )