I honestly think that is one of the primary factors.

That and how health care is tied to employment.

When Europeans change jobs they tend to go on vacation for a while, Americans immediately scramble for a new job out of fear of getting sick.

> Americans immediately scramble for a new job out of fear of getting sick.

Or in fear of paying a tax penalty unless they buy some substandard marketplace plan (yes, I know the marketplace plans were sabotaged for political reasons in some cases, but that doesn't change the result)

> Starting with the 2019 plan year (for which you’ll file taxes in April 2020), the Shared Responsibility Payment no longer applies.

https://www.healthcare.gov/fees/fee-for-not-being-covered/

Of course this is new, so fears in recent history were definitely real.

Also add in that household income is (fairly) stagnant[0] but costs are increasing.

Anecdotally the only people I know that visit other countries either are: not from the US; come from a wealthy family; or have little money and that's just what they spend their money on. I know very few middle class people that visit other countries (outside of work related tasks). The excuse is always "I can't afford it." For me, that's my excuse. But that's not only money but time (which is correlated). I mean a round trip from my location to London is about $2.5k (similar cost for anywhere in Europe, Japan, or New Zealand). If I had a couple grand to drop on a vacation I'd do it. Though I'll say that I can get a round trip to Malaysia for under $2k, which is more reasonable (especially considering expenditures while there are less).

[0] https://www.advisorperspectives.com/images/content_image/dat...

I believe that that graph is adjusted for Urban CPI so so increased costs would be taken into account. It's also a bit difficult to see the change in median household income due to the scale so here's the federal reserve's version where it is easier to see[1]. The increase in real median household income has been significant since the mid 80s. There are plenty of factors in play but I don't really think stagnant wages relative to other countries are to blame for fewer American tourists. Honestly, I just don't know many people in the U.S. who would think to vacation to Malaysia. The Caribbean is a lot closer and less expensive to travel to.

[1]https://fred.stlouisfed.org/series/MEHOINUSA672N

"I can't afford it" is and empty excuse.

My flight from NY to KL a few months ago was cheaper than my flight from Orlando to NY.

The cost of living here is significantly less than the US. I would conservatively say 50%.