There are two things that give me serious pause about living and working in the USA, and that have made me not pursue or accept opportunities that I've been offered in Seattle and San Francisco.
1) Visas & immigration
2) Health
1) Visas & immigration
2) Health
I found this deeply disturbing, as my wife is a skilled professional in another field and if I were to accept an H1B offer, she would had to become a house wife more or less.
1) The visa stuff is a PITA, but if you are in a situation where you can tell some company to deal with it, it shouldn't be too bad.
2) You get pretty good health care working for most companies in the US as a programmer. If you lose your job, you can presumably relocate to where you were before that has a different health care system.
http://www.welcomeoffice.fvg.it/common/are-you-a-non-eueea-c...
If you're in Italy and a citizen of Italy, you are covered. There are likely gray areas for non-Italian citizens. They generally see you first, and ask questions later though, especially if you have the health service card, which any Italian would. I (US citizen) went to the emergency room once before getting mine, and the bill was €0.00, although I did have to buy some stuff at the pharmacy and was charged full price for it, for which the pharmacist was quite apologetic.
The best thing: the health insurance headache that US citizens have been conditioned to accept as a natural feature of life is totally missing. If you are ill you just go to the physician.
I see a contradiction in what you wrote: for all resident; but you have to work, or be the spouse of someone who does? These are different things.
I have personally been in that position, and I was refused coverage when I moved to UK for a new job, and was made redundant after three months. I then went back to Spain where I had work prior, and was refused coverage there, because my previous dues were only good as long as I stayed in Spain.
1) My wife has a chronic health problem. What guarantee do I have that if she needed treatment, for that or something else, that insurance wouldn't find a way to weasel out of covering it? Also, eventually I would lose coverage under OHIP, the Ontario Health Insurance Plan, after an extended absence (1-2 years? not sure exactly), so going back to Canada for treatment would not be an option forever.
2) My health insurance would be covered and sponsored by my employer. I'm already dependent on my employer for my income. In my mind, also depending on them for health care coverage is putting too many eggs in one basket.
Point being, if it's a good enough offer, you might be able to make it work if you're not bent on rejecting it because of your general disdain for the US healthcare system (which I can certainly comprehend).
As to your second issue, I agree with this. I think tying these things together has had a large and unfortunate impact both on people and on the US economy. The ACA is far from perfect, but it does at least move some of this in the right direction.
[1] If it isn't obvious, I am speaking in generalities. As with all insurance, some conditions and medications are covered more prevalently and conveniently than some others.
To be fair, this can make it difficult to move anywhere. Countries like Canada and Australia can refuse you an immigrant visa if you have pre-existing health conditions (much like insurance companies will refuse to take you on):
https://www.immi.gov.au/allforms/health-requirements/overvie... http://www.canadavisa.com/immigration-medical-inadmissibilit...
Anyway, I agree that it sucks to live in a country where you have to think about this shit. Even with the best network (blue cross or blue shield) it's still not as good as France with a decent mutuelle for example.
Dont believe the hype if you work for a company that is going to sponsor your visa, chances are they will provide health insurance. I pay $25 a month for myself and $175 if I had a family of 4.
My girlfriend uses Obama Care and pays $21 for basic insurance. Unless you are self employed then chances are you wont be paying much and now with the new health plans even these plans are affordable.
I'm from the UK, and if something is wrong, your biggest challenge is making appointments with the right people.
Some of my colleagues from the UK who have had to go and see someone in the US report that it's a minefield of: a) Checking which doctors take your kind of coverage b) Co-pays c) Ensuring you know what you are/aren't covered for d) Random bills that may appear after you visit someone, depending on whether their interaction with the insurance company
Nothing like the states, where, in a similar part of the country (city/rural wise) I needed to make non-emergency appointments 4 months in advance.
Can you choose you GP in the UK or are they assigned?
It does depend on whether they have space on their books of course. But by and large, people choose a GP close to where they live, and pick the first one they like the name of on the list at one of the closest surgeries.
The way the system works here is if anything is life threatening, you just go to Accident & Emergency at the nearest hospital.
Otherwise you go to your GP for pretty much everything. You'll have an appointment within a couple of days if it's non-urgent, or told to go in immediately. They perform a basic diagnosis, and either take care of you then and there (minor first aid, basic procedures, prescriptions), or you get referred to a specialist. If you are getting referred, you can say which one you want to be referred to.
And from all of that, you never ever get a bill or see anything relating to accounts. You just get your treatment and care.
1. You'll get a number of bills. We don't know how many you'll get.
2. Each bill will be for some amount of money. We don't know how much, not even an order of magnitude.
3. Your insurance may pay anywhere from 0 to 100% of your bill. We don't know what they will do.
4. Whatever your insurance doesn't pay, you are responsible for. We don't know how much that will end up being, but you need to agree now to pay it later.
It's total insanity.
I used Obamacare for the month of January. My plan cost $507, I received the card on the 30th of the month (so the plan was unusable before then), and they (Blue Shield) were impossible to reach. They have a very understaffed phone line for Obamacare users, separate from their "regular" service for group plans.
All the Chinese public hospitals are about long waits, giving red envelopes to your doctors, overprescribing antibiotics and IV drips, and scammy Chinese medicine.
I have private insurance; the hospitals are way better but the prices make the USA look cheap.
Put it this way: USA has first world health care problems, china has developing world health care problems. If you want cheap quality medical tourism, try Thailand.
As one might expect of countries that are first world and developing world, respectively. When people complain about the US healthcare system, the implicit comparison is probably other first world countries.