I've noticed many differnces between Japanese health care and north American health care system. The merits of North American system include free health care, efficient care team, skilled paramedics and the presence of high volume centers. The disadvantages include bad accessibility, short length of hospital stay, and long waiting list. The surgeons frequently cancel cases just because there's not enough nurses or no medical devices. Having spent decades in Japanese medical system, I had never seen surgeries been cancelled.