My impression of the medical system (both here in Germany, and through reports from the US) is that it's very much like everything else: much is crap, much is mediocre, some good, and a very small, excellent sliver.
This goes for doctors, drugs, surgeries, devices.
If you want good results, you really have to take matters into your own hands, search for possible treatments yourself, evaluate several doctors until you find a competent one, research possible adverse side effects yourself etc.
Example: somebody in my family had two different surgeries by non-standard methods that gave her significant advantages over the regular methods; one of them offered (to our knowledge) in only one hospital in Germany, the other in three. In both cases her regular doctors didn't know about these methods, and were really surprised to hear about them afterwards. In both cases, she learned about these methods through some non-medical channel (a relative read about it in a newspaper, stuff like that).
If you just go to the next specialist for the field you need, chances are you don't get the optimal treatment, and the rarer the disease, the less like you get a good treatment.
One was a minimally-invasive surgery that removes old pace maker cables attached to the heart. The alternative would have been to cut up the sternum for a regular open heart surgery. Which is both more taxing on the circulatory system, and takes about half a year to fully heal again.
The other was a "tissue engineered" heart valve. They take a human donor valve, and over the course of a few weeks remove the human cells in some kind of soap bath, only the collagen matrix remains. This reduces rejection to basically zero, and allows the patient to live without immune suppressants for the rest of their lives.
Alternatives would be a regular human valve (+ immune suppressants indefinitely), animal valves (same problem) or artificial valve (typically don't last for longer than 10 years, and always has increased risk of persistent settlement with bacteria, so need to take antibiotics for every minor thing).
(sorry, medical English is really hard for me, hope this makes sense; if not, feel free to ask).
You can find the best medical care in the world in the US if you have the means to pay for it. I don't think people will agree though that it is the indicator for the best healthcare system.
I would even say that any person of any country with enough financial resources could afford and get the best treatment in whatever country of the world would happen to be offered.
Indeed, I have just realized that the main problem of the US healthcare system is that their inhabitants cannot even imagine that anything better even exists.
Healthcare is much more than being operated or receiving some treatment for a rare condition, both things that are very much researched and done outside the US both privately and with public money. Healthcare is also about allowing people with health problems to live with dignity and allow then to function in society. To care for the weak and not only to restore productivity of a broken cog. Healthcare is about a strong first line of care that prevent conditions to get worse and irreparable. Many countries with a thousand or less of US's GDP can teach a lesson or two on that. In any case, most countries are slowly copying many aspects of US healthcare, I guess it must be indeed be better, or perhaps more profitable.
IIUC the vast majority of Americans don't have that privilege either and need referrals. You have to be on more expensive health plans to be able to pick your specialist. (That's been my past experience with HMOs). I finally got on a PPO recently and it was a bizarre but pleasant experience to just ... refer myself to a specialist :)
Canada is indeed very frustrating. It's great for simple things like a broken arm. But the reality is that it's years behind in treatment of complex illnesses. There are a lot of people in Canada that travel to US to see specialists, when they can afford.
US is also able to attract the best professionals, including MDs. Here in Canada we're left with the "leftovers". Those that did not make it big in life.
I think you can shop around in Canada, if you have private insurance. the universal healthcare system is just a baseline, to keep people from dying on the street after medical bankruptcy. many jobs offer supplementary health insurance as a benefit.
the US just uses ERs as an infinitely shittier but equally costly version.
You can't book an appointment directly with a specialist.
You can't even shop around for a family doctor. You have to sell them accepting you as a patient. With that power inbalance you better follow what they suggest and avoid questioning too much or you won't have a doctor.
I've had the same experience with non-HMO coverage in the US.
With HMO's, you're guaranteed someone will be assigned to you. With traditional insurance, there's a big labor shortage, and there are often <= 1 doctors accepting patients in some towns.
You have a family doctor who you are signed up with. You can't signup with another without losing your family doctor. You can't just go see any doctor. They have to decide to take you. Then if you are lucky you get a referral for a year later. You do have places you can walk in but there ability to refer is much lower.
In the USA you literally shop around. They advertise. You can literally look for the best surgeon and ask around.
How do you find the "best" surgeon in the US? There is massive information asymmetry, and little repeat business, so it is a perfect market for lemons.
I guess I don't see why your family doctor won't be open to referring you to another specialist. My experience was probably not normal in Canada since my parents are doctors.
This goes for doctors, drugs, surgeries, devices.
If you want good results, you really have to take matters into your own hands, search for possible treatments yourself, evaluate several doctors until you find a competent one, research possible adverse side effects yourself etc.
Example: somebody in my family had two different surgeries by non-standard methods that gave her significant advantages over the regular methods; one of them offered (to our knowledge) in only one hospital in Germany, the other in three. In both cases her regular doctors didn't know about these methods, and were really surprised to hear about them afterwards. In both cases, she learned about these methods through some non-medical channel (a relative read about it in a newspaper, stuff like that).
If you just go to the next specialist for the field you need, chances are you don't get the optimal treatment, and the rarer the disease, the less like you get a good treatment.