The Detroit-Toronto comparison was deemed by some as "unfair." We think it interesting though in demonstrating that one group of patients could be so disadvantaged (Detroit) relative to another (Toronto) living only 200 miles away—both groups in very large metropolitan areas that are generally well endowed with health care (cancer care) resources (services are available, if not accessible/affordable).

Honolulu was chosen for study because of its most "Canada-like" health care system among the states (least prevalent uninsured population). And as hypothesized, its cancer care outcomes were more similar to those observed among Canadian patients.

It was also hypothesized that younger patients in the US (< 65, not Medicare eligible) would be more disadvantaged than their older counterparts. Such was consistently observed across contexts.