Oh, it is difficult to overstate just how broken the system is until you've experienced it and a more sane alternative (my daughter was born here in the US and I'm Canadian).

However, from a lifestyle perspective of a great programmer it's a non-issue. Once a person has an H1-B it is trivial to change companies. So even though technically you're tied to an employer (visa + healthcare), in a city like SF where a great programmer can get a job in a day (literally), it's a total non-factor.

But seriously after experiencing the american healthcare system a couple of times the only phrase I can use to describe it is "pure evil". I can pay my way out of that pure evilness, but it is evil that 99% of people can't. So I can totally understand if you don't want to be a party to that system for moral reasons, but that's a lot harder to be consistent about.

You already have that dependency in terms of your visa. If you don't work for your employer anymore, you don't have a visa any more, and you need to leave the country fairly quickly or get a new visa elsewhere. In the light of that the healthcare part doesn't matter as much.

You're right, the healthcare issue bites citizens much more than work visa holders (who are already screwed).

It's still broken (like so many other things in the US) and therefore one more deterrent to even considering going the work visa -> green card -> citizenship route.