Having done this myself, I don't really see it. Yes, health insurance is expensive, but I can also bill substantially more than my non-US counterparts can in their respective countries. Even with paying for health insurance myself, I don't see how I'd come out ahead in any other country right now unless I relocated and kept my working hours / client base in the US.
Sure once you have solid revenue and a repeatable business model, but it certainly costs enough to have an impact on people just starting out. When I quit my job to work for myself in 2019 I was choosing between $600/mo COBRA or nominally cheaper marketplace plans with absolutely terrible coverage, just for myself. I had plenty of runway and software development is in demand so it wasn’t a huge burden, but with a family it could easily have cost $2k+/mo. I’m sure that’s enough to dissuade people from trying new things, especially in niches where it takes longer to get to profitability.
