The decision by Canadian provincial premier Danny Williams to travel to the United States for heart surgery has provided conservative critics of Obamacare with a concrete illustration of a long-held talking point: as socialized medicine stagnates, America's dynamic free-market health-care system is the envy of the world.

And some critics north of the border agree.

"Think about the absurdity about Canadians spending their income on medical treatment outside the country because it's not provided here at home," Brett Skinner, president of the free-market Fraser Institute, told the Vancouver Sun.

Skinner said that Williams, who opted for surgery in the U.S. on the recommendation of his Canadian doctors, was among an estimated 41,000 Canadians who sought health care in the states in 2009 due to long waiting lists and poor access at home.

The Toronto Star wonders, did Williams — a wealthy lawyer and businessman known by some as "Danny Millions" — "have, and spurn, the option of having the heart surgery in Canada? If the procedure could be done in Canada, would he have had to wait long for it? Did he fear a public perception of jumping a queue, or simply chose a ritzier health-care setting that he could afford and would grant him swift care and privacy?"

Government officials have avoided questions about the specifics of the procedure, but have told reporters that doctors never offered Williams the option of having it done inside his home province of Newfoundland & Labrador. That has left many speculating on whether the operation was available elsewhere in Canada.

Dr. Eric Stone, a Newfoundland cardiologist, told the National Post patients there are regularly sent to Montreal, Toronto and Ottawa for procedures like transplants and treatment of congenital heart defects, said.

Dr. Christopher Feindel, a cardiac surgeon at Peter Munk Cardiac Centre at the University Health Network in Toronto, told the Sun that "The vast majority of heart procedures are available all across Canada, in most centres," with the exception of a few rare and extensive operations that are specifically referred to the states. In fact, he said, Americans often travel to Toronto for surgeries involving valve repair techniques developed by Canadian surgeons.

But patients in Canada must also wait for operations according to priority: "emergent — you're done right away," "urgent — you're done in a few days" or "elective — you may have to wait for a while, because you're not at any significant risk." Patients can wait as long as 26 weeks for bypass surgery, and even the highest-priority cases can wait as long as two weeks for treatment.

According to the Canadian Institute for Health Information (CIHI), Newfoundland has the highest heart attack rates in Canada, and does comparably poorly in treating them. The risk of dying in a hospital in Newfoundland within 30 days of adittance for a heart attack is 10.9 percent, while the Canadian national average is 9.4 percent.

While extrinsic factors make the incidence of heart disease and coronary heart disease higher in the United States than Canada, Americans are more likely to receive treatment for their problems, according to a working paper by the National Bureau of Economic Research. More than half of those Canadians with "unmet" health-care needs cited wait times as the main reason for not receiving care. Canadians also report much longer waits for specialist consultations and non-emergency procedures.

Americans, by contrast, cited costs first among reasons for not receiving care. But research finds that personal income is actually more closely tied to health-care outcomes in the Canadian single-payer system than the American multi-payer system.