Tinder, a dating app, has recently updated its Terms of Service. Among minor bureaucratic modifications, one major change aims to battle impersonations. From now on, Tinder will ban web developers who claim to be 'engineers'. While backend- and other types of software developers seem to be unaffected, many believe the ToS will be amended soon to include those as well.
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.