But those other places pay for those things by heavily taxing the folks that would be considered "middle class" here. In Germany, folks making $65,000 or so pay 7.3% of their income (with another 7.3% being paid by their employer) for health insurance, on top of their taxes.

What sort of lifestyle do people making $65000 have? In the US if you taxed $65,000 at 42% there would be almost no cities where you could live comfortably and securely. As a conservative estimate for a small city I would say: mortgage: $6,000 car payment: $2,400 gas: $1,560 food: $1,560 retirement: $10,000

That leaves about $11,500 for clothing, entertainment, emergency savings, vacation, education, etc.

Their tax system is progressive too, so just the money above $65,000 is taxed at 42%.

In this scenario, you're way overestimating with $10k for retirement. Put that figure at $5k or maybe even $3k. Long-term, is that ideal? Not really -- but as you say, you need to budget for clothing, entertainment, emergencies, vet bills, etc.

Regardless, people and families do it all the time and do it on less.

Most Americans making $130K (or even $65K) are not paying for health insurance -- at least not fully. Their employer is paying at least a large share of it.

You could argue that it is money that they could otherwise be paid as salary, but then they would either have to pay full cost for private insurance or be taxed more to pay for public health care.

What they are paying for that the average middle-class German may not be (at least not as much) is savings for educating their children and for their own retirement.