[acdha]

I'd want to start by looking for data about what is happening in those countries – there's probably more than it might seem, especially if you look outside of the English-language media. I regularly see mention about work happening in those countries – and don't forget Canada – but it's definitely less VC-driven as well.

The two factors I suspect explain most of this are the existing concentrations of industry – i.e. SF has such a massive footprint that it'd take years to wind down even if the situation was pretty dramatically skewed – and the lag between U.S. healthcare costs rising far greater than the rest of the world and that reaching the point where people are actually making significant decisions around them. In the 90s and early 2000s you didn't hear it mentioned as much as a decade later, after the double-digit annual percentage increases continued to eat away at profit margins.