Good insurance is one aspect including long term disability coverage if you haven’t retired.
That’s the thing medical expenses when young are unlikely enough insurance is a viable strategy. Long term it’s worthwhile to move to a country with a less expensive medical system. You can move basically anywhere in retirement and be better off.
Again like I have been saying, good insurance is predicated on the open market and ACA being around and not being killed by Republicans. Even if they don’t outright kill it, they are trying to put in a “death spiral” where only sick people use it and insurance companies don’t want to participate.
LTC not discriminating against pre-existing conditions is also post ACA.
In a hypothetical universe with different laws people would make different decisions, like abandoning the US. But you’re asking about medical conditions which rarely apply and laws that don’t exist. That’s not a failing of FIRE for the vast majority of people.
Further FIRE doesn’t mean crap if you get something serious and die at 23, that’s just the reality of human existence.
People didn’t abandoned the US before the ACA was the law in 2011-2012. And if there were an influx of US citizens to foreign countries, I can guarantee you other countries wouldn’t be as welcoming.
There are plenty of conditions where the difference between life and death is being able to get health care
Some did. The US expat community has been quite large for decades.
Most people didn’t do FIRE style early retirement while dealing with pre existing medical conditions. There however was plenty of expats pre ACA who very much left the country for early retirement.
US healthcare is ruinously expensive but on average it’s not particularly good if you’re in the income bracket where 1/4 million over a few years is a serious issue.
There is absolutely no significant number of Americans who left without ties to other countries. I find it rich that Americans who leave the US call themselves “ex-pats” instead of “immigrants”
There’s over 1/2 million former Americans living in Canada or the UK which doesn’t require learning a foreign language. You really can’t make those kinds of sweeping statements about populations that large. Many Americans without any prior connections fled to Canada to avoid the Vietnam war for example and then made a home there.
Brit’s will also call themselves expats. https://britishexpats.com/forum/ ditto Canadians https://www.expatden.com/global/canadians-living-abroad/ Also, the US imposes taxes on Americans who leave until they renounce their citizenship on the upside they still get to vote. It’s an unusual relationship to your former country.