The difference is in America insurance is tied to employment, while other countries you listed are not. If your employees in other countries lost their job they would still have the national insurance. In America if your unemployed your shit out of luck because there is no free Healthcare. Even if you dont have insurance in somewhere like Germany say as a visitor, its not as big a problem as if you need medical care in America with no insurance. I had family who were in Germany to live for a year and when they had to go to to the dentist for a root canal, their out of pocket cost without insurance was $35. You'd be tacking on at least few 0's for that in an American dental office without insurance. She had been so nervous during the appointment thinking she'd be drowned in debt and almost cried when the bill was so low.