"If you can afford it" also conveniently glosses over the fact that a private insurance system means that the costs for paying out of pocket tend to be insanely high, since that an insurance company pays the hospital is basically entirely unrelated to the price that you'd get charged as an individual. Even if you're making a decent software engineering salary in the US, which would put you in a much cushier financial position than most of the country, you'd better hope that you don't ever have any major accidents or develop any uncommon medical conditions or you'll be eating into your savings at an alarmingly high rate.