COL is not anywhere near $50k/y ($4100/mo!) except maaaybe in some very narrow parts (basically just SV an Manhattan, assuming you want a decently large apartment). But in either of those places an engineer makes up for it by making $150k/y instead.

Also rich Americans have good insurance, I’m sure you could find an example of someone who had this happen but it’s basically a non-risk.

And if healthcare was the only problem, then Canada would be an option as well. Engineers there still make a shitload more than German engineers. Watch out for the real estate market tho.