Nobody wants to deal with a problem like that.
When we get people who have had cheapo Mexican plastic surgery or gastric bypass the local surgeons don’t want to get involved.
I don’t doubt that what you say is true.
What we have though, is a situation of rational people trying to deal with a government sponsored irrational medical system.
People are going to go to where they can afford to be fixed, and if thing go wrong, they are probably going to show up at the ER.
To me, it looks like that’s how it’s going to be, because there isn’t any other rational solution.