Not to go too deep into the weeds, but there are comparable trade-offs, such as premiums being a percentage of pay instead of a flat fee. The German system is w

Not to go too deep into the weeds, but there are comparable trade-offs, such as premiums being a percentage of pay instead of a flat fee. The German system is without a doubt better, but I think (and hope) that the US is closing this gap with the ACA and a general awareness of the problem. But we don't need to compare ledgers to show that 80k USD in Berlin, Munich or Frankfurt won't go nearly as far as 200k in SV or SF. That's what exchange rates and the big mac index are for, and that's why I converted the currency to USD in my original comment. You can argue the rate is maybe 10 or 15% off, and I can argue for 10-15% the other way, but no way is a dollar (0.82 EUR) 2-3 times as powerful in Germany.