We do more than "refer" people to Buffalo, we actively transport them there. When working in a Toronto hospital emergency department it was a common occurrence to ask help from the excellent Criticall service for a patient in urgent need of specialist surgical care, only to be told that although there were surgeons and staffed operating rooms available elsewhere in Toronto there were no ICU beds for post-op care. The patient did not go without treatment, but it was received in Buffalo which always had necessary services available. The real problem came when there was deep snow blocking transportation.
Yes, our service has many advantages, but anyone working in it knows its defects and there is nothing to suggest these are getting addressed. The Federal Minister of Health has a personal record of genuine service to humanity, but that may not render her tough enough to fight the smugness of "Canada's wonderful system."