Nowhere is the failure of the health care system, as currently managed, more evident than in the surgical care of obesity. A marked contrast has emerged between surgery in the United States and Canada for these patients. It is not clear whether the reluctance to supply surgical services in Canada is due to a bias in favour of “more deserving” patients or whether the considerably higher rate of obesity surgery in the US is due to the excesses of private enterprise. Governments have acknowledged that an element of the former proposition is true by referring obese patients to centres in the US. This practice, which appears to be a measure to keep the peace with failing managements of the superhospitals, undermines the whole foundation of surgical practice in Canada. For the first time, surgeons have not acknowledged a responsibility for the care of a whole sector of society. Not only do considerable resources follow these patients over the border, but an opportunity to refine laparoscopic surgical skills is being wasted.