The doctors going to fine dining and wearing fancy clothes are in specialties that do not accept insurance or in discretionary medical services (i.e. cosmetic/plastic surgery, dermatology, cosmetic dentistry) Ones in primary care live like any other middle/upper middle income folks.

Doctors trained in foreign countries being required to go through residency/fellowship in the US is not a bad thing. It establishes an expected minimal level care, normalizes the standard of treatment as well as provides foreign trained doctors plenty of supervised training dealing with illnesses seen in the host country. This way, a doctor trained in Vanuatu, Palau or Switzerland can provide you with the same level of care as ones trained in the US.