The thing that Americans need to remember about that story (which didn't immediately pop into my head) is that even though the Czech Republic no longer has single-payer, there is still a clear distinction there and in the rest of the developed world between medically necessary and non-medically necessary surgery. If this were in the USA - IOW, if the hospital were offering employees free breast augmentation while at the same time turning away patients who couldn't afford cancer surgery or angioplasty - that would be a very different situation, IMO.