Medicals: You can lose your medical here very easily compared to losing your medical in the US, once you lose your medical, to start collecting unemployment benefits in the US is filling out a form and sending it on an email, just ask the next time you fly with one of the guys that has been out on medical what a pain in the rear end is to do anything related to unemployment insurance here.
Then to get your medical back in the US is a matter of sending your doctor's report to the FAA and you get your medical right away.
Here losing your medical for any minor thing that wouldn't cause you to lose your medical in the US, it turns into a circus of reports and emails back and forth and visits to specialists twice because the reports of the doctors back home are worth the paper that they are written on here in Japan, and that takes easily 6 months if it is a minor issue.
And then when you get your medical back after severely cutting your income since unemployment insurance benefits are a joke!
If you are gone for 6 months, your requalification training will turn into a circus, literally! In the US you will do a couple of SIM sessions and a line check, done, back on the line! Over here you need to demonstrate that you are worthy after showing weakness for getting sick on the first place.
You put up with that nonsense when your home country's market is in the gutter, but when you can have a better QOL working for a charter outfit like Omni or an ACMI like Kallitta, Why would you?