I have a good American friend here in Germany who has a great chance of getting a permanent status and later citizenship. She's already pretty good at German after 2 years and was offered a permanent local contract. She told me last week she's probably not taking the offer and going back to the US because she earns more and pays less taxes there. I asked about healthcare cost and all she talked about was how contraception was completely free in her american insurance and she has a copay here, how much less taxes she paid and she didn't like how the German law handles paternity issues (it's harder to get out of your obligations if your wife cheated and the kid isn't yours).
It was so weird. So many American women wish they were in her position and all she talked about was going back to the US due to paternity laws and the 10€ copay on her contraception which made her really angry for some reason.