Life expectancy is a function of demographics, which averages ignore.

Income is also an assertion not supported by data. For simple procedures such as a knee or hip replacement, many people earning under $80K CAD opt for US treatment.

Likely because Canada has extremely bad waitlists which are continuing to deteriorate. That coupled with a lack of specialist medical options and lesser quality.

In Canada, a woman with breast cancer could be waiting 2 months to even start treatment. In the US, you'll be starting next week.

It's just because America is big and has a lot of hospitals and has changed dramatically many times over the past 100 years.

There's lots of places in America with spare hospital capacity. In those places, locals still cannot get affordable treatment, because our health insurance system is bad.

Meanwhile, plenty of places in the US have the absurdity of our broken healthcare system, and get to wait 4 months to see a doctor after having a stroke, like my mother had.

Or like my ex, who had to wait TWO YEARS for an MRI and neurology appointment, and that took so long that by the time her appointment was coming up, her situation had changed and needed other investigation and that appointment was not really a good fit anymore.

The situation is so mediocre in most of the US, that you have to travel hundreds of miles to see specialists anyway.

Nearly every single person in Maine who needs to see a specialist is waiting months. If you are in northern maine, you will have to wait months and travel to southern maine, or wait a year for a traveling specialist who has to fit a hundred patients into a timetable meant for 20. If you need to see a special specialist, you will be triaged on the same list as the entirety of New England for the one doctor in Boston who can actually do anything for that condition.

The same guild system that keeps US doctor compensation high is also keeping supply low! Someone is going to be waiting to see a doctor! If they weren't, US doctors wouldn't be paid as much!