> Your healthcare insurance being dependent on your employer seems like hell though. They will always have enormous bargaining power over you and I think it also leads to chilling effect, when your health is literally dependent on your job, you will think twice to go on strike, unionize, or freely express your thought, especially when combined with at-will employment.

As an American who's had to deal with the ramifications of employer-based health insurance first-hand, I can confirm that this strikes me as accurate. I'm lucky enough to be in a position where even being out of work for most of last year did not hurt my financial situation very much (my wife and I were actually able to buy our house during my unemployment), but even being in that fairly privileged position, due to her autoimmune condition, we've had to go through quite a lot of annoying bullshit from a lack of healthcare options due to basically being stuck with whatever my employer happens to offer.

With my previous health insurance (from a startup where there were around 10 employees during my time there), we were able to get the semiannual procedure she's been getting for years from her specialist doctor approved relatively quickly, but with the insurance from my current job, it took months earlier this year to get it approved because they kept denying it due to her condition (which is pretty rare in general, and even more rare for anyone to have it as long as she has; one of the first doctors she saw for it years ago told us "you're not going to find a support group for this online", and we've literally yet to find anything online about anyone else ever having it for as long as she has) not being on the list of pre-approved conditions. This was typical across several insurance companies for the initial request, but with this insurance company, they put us through an extremely convoluted process for appealing. First, they told her doctor that he couldn't email or fax them his letter of medical necessity and had to send it through snail mail, which even a month later they claimed they had never received. They told me I could email it to them, which I did, only for them to later claim I didn't have authorization to do that on behalf of my wife (something that never came up in the call where they told me to email it to them despite us both being there on speaker phone), and she had to fill out and email them a form authorizing me. She did that, but then after a while they still just sent us a blanket rejection for it not being on the initial list (as if there were any chance of it magically appearing on the list between when they initially denied it and when they finally processed the appeal?), and they could not provide us with any evidence that an actual doctor looked at the letter where her doctor stated definitively that he would expect her to likely experience permanent and potentially fatal organ damage with the treatment due to none of the other options having mitigated her symptoms in the past. After filing a grievance, they insisted that if her doctor filled out the information in a separate form that they had never mentioned to either him or us before, they would take it into account, so he did that, and then after a while they still rejected it with identical language to before. Finally after three months, they gave us the ability to have her doctor talk directly to an actual doctor on their end, and then it got approved within the next week. No one was able to provide any sort of coherent explanation as to why they kept putting us through such bullshit procedures that had no effect instead of letting us just do that in the first place.

I don't pretend to have any first-hand experience with healthcare in other countries, but no sane system would end up with such disparate outcomes for the exact same condition for the exact same patient due to literally nothing but how much bullshit the insurance company feels like putting you though. There's literally no way for us to have stayed with the insurance company that managed to actually read the information her doctor sent them and approve it within a few days the first time because they're based in a different state that the company I was employed by happened to be based in, and my current employer has no other insurance companies as options for me to pick instead. Even without all of the potential awful things that you mention people might go through with a subpar employer, the situation actually still sucks even when you do like your employer because your insurance options are tied to them. I like my job, and other than the insurance company sucking, it works well for me, but I also can't reasonably expect them to pick up an entire new insurance option for the entire company because of the bullshit I went through, so as much as I'd love to literally never have to deal with this specific insurance company again, there's no way to do that without giving up the job as well. Realistically, that would end up causing a lot more stress and uncertainty that my wife and I don't want to go through (especially when there's no guarantee that whatever insurance we'd end up with from a new job would be any better). At least in another country, we'd have some level of consistency in trying to get her treatment approved.