[toomuchtodo]

It will not change on your time horizon. If you want better healthcare, move to a developed country today. It will take a half decade or more for US healthcare to improve in any meaningful capacity, assuming the necessary events take place to enable improvement in the system.

(to improve US healthcare, laws will need to change; when those laws change is a function of election outcomes and cadence; those election outcomes are a function of the electorate, who they vote for, and the rate of cohort turnover; think in systems)

[maxerickson]

Did you mean half a century? Meaningful change in 5 years would be pretty amazing.

[nozzlegear]

> It will take a half decade or more for US healthcare to improve in any meaningful capacity,

This timeline seems wildly optimistic

[toomuchtodo]

Mamdani has moved fast in NYC [1], faster change is possible when the motivated are in positions of leverage. I admit a five year time horizon is aspirational and dependent on “everything going right” with regards to election outcomes and the policy pipeline, from introduction to bill signing. I’m open to more realistic suggestions so I’m more accurate when I speak publicly on this topic (I help a non profit help US residents get out of the US, explaining the risk model of remaining in the US is a component of that work).

[1] https://www.mamdanibulletin.com/

[bpt3]

> I help a non profit help US residents get out of the US, explaining the risk model of remaining in the US is a component of that work

Congratulations, I think you just described the most ridiculous non-profit in existence.

[toomuchtodo]

Not to (potentially vulnerable) humans who want or need out. If you can self serve the information and logistics to accomplish this, fantastic, but many cannot and therefore need some help. If you are happy on US soil, you're outside of the "charity expat migration consultant" TAM.

It's actually been a fun exercise in building a gen AI solution to pour context into queries and get custom migration plans [eligible visas, employment connections at the destination, potential non traditional paths outside of work visas] out like an expat/migration plan vending machine. Output is verified by a human familiar with the problem space and away we go getting someone to where they want to go.

"Make something people want. Don't worry too much about making money." The demand, I argue, is proven. You should try to be more curious.

Record Numbers of Younger Women Want to Leave the U.S. - https://news.gallup.com/poll/697382/record-numbers-younger-w... - November 13th, 2025 ["In 2025, 40% of women aged 15 to 44 say they would move abroad permanently if they had the opportunity. The current figure is four times higher than the 10% who shared this desire in 2014, when it was generally in line with other age and gender groups."]

Americans are leaving the US at rates not seen since the Great Depression — and 5,000 even gave up citizenship last year - https://finance.yahoo.com/economy/articles/americans-leaving... - May 24th, 2026

Americans Are Leaving the U.S. in Record Numbers - https://news.ycombinator.com/item?id=47161219 - February 2026 (93 comments)

[bpt3]

Sure, lots of people have no idea what it's like to live abroad and have doomers telling them to get out because it's not their fault they aren't successful in the country where the middle class has the highest disposable income in the world. I'm well aware they exist as a person who spends some amount of time online, so you can spare me the lecture about being curious.

Those people would be better off under a more generous welfare state, but immigration policies in those nations are much less dysfunctional than our own. If you are able to offload some of these people onto another nation, I thank you, but it's a very odd focus for a charity.

If you want an example of how uninformed the people inside your TAM are, see the younger women polled in your citation. Based on other data, I strongly suspect they are motivated to leave due to actual and potential changes in abortion law and policy in the US (which I do not support for the record), and have absolutely no clue whatsoever what rights they would have in most of the rest of the world (spoiler alert, it's less than most Americans have).

[toomuchtodo]

> Sure, lots of people have no idea what it's like to live abroad and have doomers telling them to get out because it's not their fault they aren't successful in the country where the middle class has the highest disposable income in the world. I'm well aware they exist as a person who spends some amount of time online, so you can spare me the lecture about being curious.

What disposable income? There is very little, if any, middle class left ("K-shaped economy"). You say misinformed, but the economic ground truth is clear as day imho.

Americans Are Falling Behind on Their $1.25 Trillion Credit-Card Bill - https://news.ycombinator.com/item?id=48327518 - May 2026

‘It’s never enough’: young Americans struggle to build financial independence as cost of living spikes - https://www.theguardian.com/us-news/2026/may/31/young-adults... - May 31st, 2026

Brookings: States of Affordability: A series on where and why US households struggle to make ends meet - https://www.brookings.edu/articles/states-of-affordability-a... - May 27th, 2026

This is how close American households are to the financial edge - https://www.npr.org/2026/05/28/nx-s1-5836525/affordability-r... - May 26th, 2026

Urban Institute: The American Affordability Tracker - https://www.urban.org/data-tools/american-affordability-trac... - Last updated April 2nd, 2026

> Nearly half of people in American families cannot afford the true cost of living. Urban research finds 49 percent of people in American families don’t have the resources to cover essential expenses to live securely in their community.

> The cost of essential goods and services is rising faster than earnings. Since 2017, average earnings have grown about 43 percent nationwide. Over the same period, home sale prices have increased 81 percent and rents 54 percent. The lowest-cost Silver health plan on the Affordable Care Act Marketplace has risen 77 percent, and child care costs have grown dramatically.

> Rising everyday expenses, including energy and transportation, are adding new pressures on households. Residential electricity costs have increased faster than earnings across much of the country, leaving customers paying about $40 more in December 2025 on average than they did in December 2017. Gas prices have also risen sharply, with the national average growing by $1.00 per gallon since late February 2026.

> Affordability pressures are spreading beyond traditionally high-cost areas.

> Many previously low-cost regions, including parts of Atlanta, Chicago, Louisville, Winston-Salem, Columbus, Nashville, western New York, south-central Wisconsin, and central Florida, are seeing costs for housing, health care, and groceries rise faster than in other areas.

Brookings: In every corner of the country, the middle class struggles with affordability - https://www.brookings.edu/articles/in-every-corner-of-the-co... - December 2nd, 2025

Americans are losing spending power, say researchers: Most can no longer afford a ‘minimal quality of life’ - https://www.cnbc.com/2025/06/13/most-americans-cant-afford-a... - June 13th, 2025

US Dept of Labor: Childcare costs remain an almost prohibitive expense - https://blog.dol.gov/2024/11/19/new-data-childcare-costs-rem... - November 19th, 2024