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London is exorbitantly expensive. You have to either be very well off or very poor to live there without penny pinching, paradoxically. That's because the latter is often given free council housing in areas where free-market prices would be several thousands of pounds for a house in rent a month.
Most other cities are much better off in comparison, Edinburgh is expensive, but not the point it scares people away.
My main gripe is that I'm not being paid free-market wages. The NHS is a monopsony employer, and has a stranglehold on medical residencies and higher training. Doctors have faced sub-inflation pay raises for over a decade now, and even the meek and conflict-avoidant British doctors took to the streets in protest not that long ago. This lead to a recent pay uplift, but nowhere near enough to account for cumulative inflation. More or less every year, you face a gradual real-terms pay cut.
I am not strapped for cash, but only because I live well below my means and have no dependents. When I consider what I'd end up paying for things like childcare (I expect I'll marry another working professional, if not necessarily a doctor), it's rather eye watering. I don't think things like groceries or rents are significantly lower than the States, and housing prices have to account for the fact that UK housing is tiny compared to the former.
And regardless of the precise COL, which can vary substantially like you think, there's no way that the double or triple pay raise the US represents is beaten by it. Proportionally, I'd pay much less for private insurance than I would for the NHS, through taxes.
That's the beauty of the States, you can choose to live anywhere from subtropical marshland to arctic conditions or a baking desert. I'd head to somewhere where the winters didn't last over 4 months.
It's by far the most subjective claim I make. Some people, like @2rafa would claim that London is unmatched for its vibes and culture. I wasn't particularly impressed myself. I would absolutely take the Bay Area every time over anything that the UK offers, but others have different preferences.
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