I live in Europe. I was aware of some aspects of US healthcare: expensive overall, a tendency to bankrupt people, failing to prevent easily avoidable harm, it's just that the first item was a statistic to me. 21% of income for someone who has a median income drove it home. The trend also escaped me, I didn't follow the US social climate until recently.

I assumed cash as well, especially since the employer is shady; our cards also have chips and would easily be tied to an ID, so I was a bit thrown off. We do share the problem of catering relying on undocumented labour.