You are correct, Mr Paul had to pay for this. Medical Tourism is big business in many Countries but it important to keep in mind that even if you do have to pay for a medical procedure In Canada , it is generally cheaper than the equivalent procedure in the USA , this due in part to Canada’s Government involvement.
Just as an example. On a per capita basis the USA has about 4 times as many MRI machines than does Canada. One would think it a purely competitive marketplace the USA charge per MRI would be less. People that are not covered by Canada’s system , such as tourists can get an MRI in Canada and pay out of pocket.
The average cost for an MRI in Canada is about 1/3 the average cost of an MRI in the USA. Ie here in Vancouver if you not a citizen it around 700 dollars whereas in the US the average is 2600 dollars (Yes you can likely find it cheaper in the US )
This means a lot of Americans who do not have enough money for an MRI in the US might well go to Canada and pay out of pocket. Many US Citizens also go to Mexico for things like Dental procedures which are a fraction of the cost as in the USA.
in Japan an MRI on average is 98$ yet they still make profits off that 98$$ fee. Japan has the highest number of MRI Machines per capita in the world.
What this example seems to demonstrate to me is that the claim the US system is not a “free market” system. They are not competing on price as much as they are gouging the patient. They gouge the patient because they know these procedures are very often life and death decisions and individuals who might put off buying a car because they can not afford it, are not going to put off care for a loved one that needs it.