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Each country has its differences and its own customs and traditions, but people in other countries always seem to be fascinated by the United States, for both good and bad reasons. For example, a Pew Research Center survey found that foreigners are impressed by Americans’ technological innovation, but don’t think much of the standard of living.

The whole idea of “the great American experiment” seems to have led to some unique ideas that other people just can’t get behind. Some of the things that are normal to us seem downright troubling to people from other countries. Madeline Pendleton, a content creator and the author of “I Survived Capitalism and All I Got Was This Lousy T-Shirt,” shared a few of the things about the U.S. that she has found to be most confounding to foreigners in a TikTok video.

Americans have sadly gotten used to these 5 things that people in other countries usually find deeply concerning:

1. You can be fired for any reason

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Americans are used to bending over backwards to keep their bosses happy because it’s what their job depends on. As Pendleton said, “Here in the United States, your boss can just fire you for any reason with no notice.”

This is because of at-will employment, which is the law in every state except Montana. Because of this, workers can quit at any time that they wish to, but employers can also fire workers for any reason at all as long as it isn’t considered some kind of illegal discrimination.

As normal as this may seem in the U.S., this is actually not how things work in most other countries. According to Pendleton, “In a lot of other countries, the company you work for either needs to prove that they have had declining profits or sales of some kind, or they have to have a track record of you failing to do your job correctly before they can fire you.”

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2. The federal government doesn’t require PTO

The U.S. Department of Labor considers the Fair Labor Standards Act the law of the land, and it says that everything from vacation days to sick leave is something that individual workers have to arrange with their employers. That leaves different people with different amounts of PTO, or possibly even no PTO at all.

Pendleton has found this to be particularly shocking for foreigners. “So when you tell people this from other countries they’re like, ‘Well, what do you do if you get sick?’” she said. “And then you have to inform this person you just go into work sick or you lose your job and get fired. That one always really trips them out.”

3. Ambulance rides are astronomically expensive

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When you’re in the middle of a medical emergency and need to get to the hospital as soon as possible, you’re usually not thinking about money. Or at least you shouldn’t have to be. That’s not always a reality for Americans, though.

Pendleton said that people from other countries are aware that we pay for the use of an ambulance here, but they think that amounts to around $20 to $30. The financial reality “actually horrifies them.”

The actual price of an ambulance ride can vary widely depending on your location, your health insurance, and the kind of care you need. If you require advanced support, it can cost as much as $1,300 before you even set foot in a hospital.

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4. Health insurance doesn’t make any sense

I’m an American, and I don’t understand what Pendleton referred to as “health insurance in general and how it works,” so I really don’t blame people from other countries for being totally puzzled as well. Similar to the price for an ambulance ride, it sounds like most foreigners think health insurance is pretty affordable and that one monthly fee covers all of your care.

Health insurance in the U.S. is much more complicated than that. A 40-year-old who paid for their own plan through the Affordable Care Act might have to pay a monthly premium between $381 and $507. That’s just the cost of the coverage itself, though, and doesn’t include co-pays.

Many countries around the world have universal healthcare coverage for all citizens, but the United States continues to rely on a for-profit model. This pits the objectives of making as much money as possible and providing essential care against each other, which has caused quite a mess.

5. Liberals are considered progressive

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If you’ve ever heard your Aunt Susan complain about progressive politics at Thanksgiving dinner, it might be time to let her know that American liberals are pretty conservative by other countries’ standards.

“The liberal party where they live is usually a conservative party,” Pendleton shared. “They’re not wrong to be surprised that that’s as far left as our main political parties go here because the liberal party here is also conservative. But, because it’s the furthest ‘left’ option that’s considered ‘viable’ here, people in the United States just think liberals are progressive.”

David Boaz, a former distinguished senior fellow at the Cato Institute, explained that the concept of “liberalism” as it is traditionally defined actually describes the United States and a lot of other countries that value basic rights and freedoms. Still, over the years, liberal ideology has come to represent the opposite of more conservative, traditional beliefs in the U.S., even though that’s not how the word is used in the rest of the world.

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Mary-Faith Martinez is a writer with a bachelor’s degree in English and Journalism who covers news, psychology, lifestyle, and human interest topics.