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On thing you cannot count on in the US is healthcare expenses .
Insurance from the ACA, if it survives, is anything but cheap if you earn a decent wage. And healthcare costs is one of those things that is incredibly expensive.
I have a medical condition that requires me to get a colonoscopy every year and a MRI every year or 2. With a negotiated rate, the colonscopy is about $25,000 and the MRI is about $15,000. So right out of the bat, if I had to pay out of pocket, that's $40k/year. People say, well you can get it cheaper in mexico, thailand, taiwan etc etc. Well, if this s routine checkup, yes. But if this is a routine checkup, I wouldn't be doing this every year. Basically, I have a genetic condition that is guaranteed 100$ colon cancer, and doxtors found out about this when I was early 30ies. Before that I don't drink, dont' smoke, no drugs, and for the most part eat healthy no soda, no excessive sugary snacks, lots veggies, lots of white meat and fish, and red meat sparingly. Sorry, something caused your DNA to mutate because nobody else in familial ancestory or your sibling has it and you're considered a "spontatneous mutation". So basically while most people get their colonscopy in their 50ies and find many 1 or 2 polyps... Doctors found over 1000 polyps in my colon, which basically meant taking the entire thing out. Well I was lucky, because if you take the entire thing out, normally they create a little butthole for you in front and you get to wear a bag the rest of your life that catches your shit. And you can't eat most everything, so your quality of life goes way down....For me, I had an option they take most of it out and leave the last 5 inches so I can more of less function the same way. But in doing so, that last 5 inches will continue to grow shit, but instead of 1000, it;'s more like 20-30/year. So every year I need to go see Mr. Assman, so he can go remove the 20-30 things that grow in there so they don't develop into cancer, which is guaranteed if i just leave it there and do nothing. Cost aside, it's just annoying as fuck to prep for a colonscopy, drinking that awful fluid, shitting the entire day, and then not being eat for 48 hours before and then after because they also need me to swallow a pill camera to check the rest of my GI track. You're not going to be able to do this at 1/4 the cost in mexico. And if you go to a country where there is universal coverage, you'll be waiting forever to find a specialist that does this, again it needs to be done every year. Here in the states, don't bother if you have a preexisting condition with getting on an HMO plan or with a high deductible HSA plan. And the you are left with a PPO plan which frankly doesn't matter if you pick the bronze, silver, gold, or platinum plan... The diffence between all 4 is the lower tier plan is you pay lower monthly premiums but have higher deductible and out of pocket costs...The platinum plan you pay higher monthly premium but lower out of pocket expenses...But if you do these special procedures, you're going to hit the maximum out of pocket expense anyway, so you end up paying about the same regardless of which plan you pick.. The monthly premimum and out of pocket expenses total about $15k/year or a $10/year saves versus without insurance and goes up with age. Yes, there is such a thing such as mediCal which is free medical coverage, but that only is a free option if you have close to nothing in your savings account, and then you are fully dependent on the social benefits of the US. MRIs, are not better. Simple procedure, but again around $15k out of pocket without insurance.
Then let's talk about dental. Fortunately for me, my teeth are pretty decent. But some people dealt a shitty hand, like my GF, just has bad teeth. She brushes all the time, doesn't eat sugary shit, and yet still manages to get severe tooth decay. Dental is one of those things that royally suck in the US, even if you have insurance. Insurance while cheap, maybe $50/month covers very little, usually about $1000-2000 maximum coverage a year. Getting a filling these days cost a few hundred, getting a crown a thousand, and implants, let's not even talk about that. You can try to go to mexico and get it done, like she did , to save money, only for the dentist down their to royally botch things up and caused more damage that good, which is why she ended up needing to get about $20k worth of implants back here.
I estimate that both me and my GF's healthcare burn rate is about $25k-40k/year (insurance premiums + copays + out of pocket expenses). There's insurance costs associated with my kid and her kids, but the assumption is when they grow up, they will have their own insurance. There was a period of time when I early retired from tech 4 years ago and that was pretty much my out of pocket healthcare costs for everyone. But as of last year, not that I really needed to work, I went back to work by invite of a CTO to work on AI, as a personal interest, and one of the side benefits (besides a pretty good paycheck that I really don't need, stock grants that are worthless right now) was pretty darn good PPO medical insurance where my total expense for myself and my kid is close less than $1000/year, leaving only my GF's dental costs of a few thousand. Huge huge savings by being on a company sponsored healthcare plan.
It's expensive to get sick here in the US. It's even more expensive if you are born with a pre-existing condition.
In fact, given everything that happened concerning my medical condition, the followup divorce from it, the detour I was forced to take when some asshole coworker stole my project while on medical leave....I seriously thought about doing the 180 degree reverse and driink heavily, smoke heavily, do drugs heavily, and eat high sugary snacks and food and totally fuck up my health since it couldn't be really fucked up any more and my health care costs to deal with it all would still be the same, lol.

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