This was posted by Elizabeth on the DS Board with the permission of Dr. Gagner:

"Yes after 15 years in the US, the health care climate is no longer
amicable to weight loss surgery. I am looking forward to 15 years of
practice in Canada before retirement. I can still operate US patients
in Montreal, as it is only 1 hour by plane for 1/4 of the US
population, and driving distance from Northeast major cities. The
surgical level of expertise in Canada is very high (surgeons can only
practice in Canada if they are Board certified, not a fact in US),
hospital standards (sterilization, etc...) are at the same level as in
the US (not so in Mexico and other Latin American Countries), and
costs tremendously lower than in the US (in general hospital costs are
half of what they are in the US."