Well, that's the thing: there's surgery that's very obviously "needed" in order for the patient to regain some semblance of a normal life, and there's surgery that's "needed" for the patient to remain living. If "elective" means not "needed", then what definition of need is being used? Every time I've been cut open insurance has called it necessary; not one of them was life-threatening.

Then there's stuff that's "even more optional" (if that phrase makes any sense): sterilization for an otherwise healthy person, cosmetic changes...