A Tip Without An Iceberg?

Whenever I get in discussions with Americans about healthcare, health insurance, and healthcare costs, I extoll the virtues of the Canadian system. In spite of all its flaws, by any empirical measure, Canadian Medicare produces better outcomes at far lower cost than the American system. But one of the points that always comes up is the influx of Canadians crossing the border to seek medical care that is either unavailable in Canada or the waiting time is too long. I'll even get this argument from medical professionals. I always ask how many Canadians they've treated, and they'll say, "Well none personally, but I know of a clinic in Bellingham that is flooded with Canadian patients." I ask for the name of the facility, and they can't remember it, or I ask for some statistical evidence, and they can never produce it. I've always said that Canadian medical refugees streaming across the border simply don't exist; that it's an urban legend promulgated by the US medical-industrial establishment. Well, I came across a study in Health Affairs that bolsters my argument. Here's an excerpt from the conclusion of the study:

A tip without an iceberg? This study was undertaken to quantify the nature and extent of use by Canadians of medical services provided in the United States. It is frequently claimed, by critics of single-payer public health insurance on both sides of the border, that such use is large and that it reflects Canadian patients’ dissatisfaction with their inadequate health care system. All of the evidence we have, however, indicates that the anecdotal reports of Medicare refugees from Canada are not the tip of a southbound iceberg but a small number of scattered cubes. The cross-border flow of care-seeking patients appears to be very small.