It would be a wake up call to see how much we are really paying in taxes.

Agreed, but is anyone really arguing this? The US has very low overall taxation rates (as a % of GDP), well below the OECD average. It should come as no shock to anyone that in order to get Euro-level services, we need a higher tax burden. High earners have the most to lose so it's also not a huge surprise it's an especially concerning issue for them. Most Americans (including those that would benefit most from these changes) are not high earners and they will pay a more measured amount.

I'm not an expert in health care cost containment but there are many doctors, administrators, and number crunchers in the industry who think we can get there if we want it badly enough. Over one third of our total health care expenditure is on administration. By some estimates, we'd drop 15% of the cost (in the trillions) overnight with a single payer system. It's a good start.

Yes, a single payer would have huge negotiating power to drop these silly costs you pay.

This isn’t really true with healthcare. We spend 2-3x what Europeans do on healthcare per capita. We even spend about the same in taxes as they do, PLUS our immense private spending.

https://www.kff.org/health-costs/issue-brief/snapshots-healt...

At the very least, I think you have to assume we won't be more efficient than Europe in terms of getting healthcare spending down to a lower percentage of GDP. If we get healthcare spending down to 11.3% of GDP like France, we still have to find about $2 trillion per year in taxes to cover that cost.

At the same share of GDP, we’d still be vastly less efficient per capita.

> If we get healthcare spending down to 11.3% of GDP like France, we still have to find about $2 trillion per year in taxes to cover that cost.

No, you only have to find a bit under $0.8T, because public healthcare spending is already a little over $1.23T of the $2T it would be under that model. And I think people would be happy to lose ~$2.3T in private bills for ~$0.8 in additional taxes.

Are you asserting $2T in taxes is somehow worse than the current $3.5T we pay for healthcare (taxes, premiums, out-of-pocket)?

Everyone is arguing this. None of the Democratic candidates who have proposed Medicare for All have proposed corresponding European-style taxes. Nobody has proposed a VAT, which averages 20% in the OECD. Sanders has given a "menu" of options, none of which raise anything close to the required revenue. The closest thing in Sanders' plan is a 4% employee + 7% employer payroll tax. That's less than what Germany or France assess in payroll taxes to fund their healthcare systems. All of Sanders' proposals put together only raise about $13 trillion of the projected $30 trillion over the next 10 years: https://www.sanders.senate.gov/download/options-to-finance-m....

> It should come as no shock to anyone that in order to get Euro-level services, we need a higher tax burden. High earners have the most to lose so it's also not a huge surprise it's an especially concerning issue for them. Most Americans (including those that would benefit most from these changes) are not high earners and they will pay a more measured amount.

Actually, middle income earners "have the most to lose." Again, look at how Europeans actually pay for their universal healthcare. Here in Maryland, the top marginal income tax rate is 42.75%, as compared to France or Germany's 45% rate. The top marginal rate in New York or California is higher than in France or Germany. What pays for the healthcare is not higher taxes on "high earners" but higher taxes on middle income people. In France, the 41% tax bracket kicks in at $83,000. In Maryland, the marginal rate on that income is just 26.75%. (In Texas, it's just the 22% federal rate.) Capital gains is higher in France, which is unusual among even European countries in taxing capital gains like ordinary income, but there's not much capital gains income to tax. ($650 billion or so in the U.S.). Germany's and Sweden's capital gains rate is 30%, about the same as Maryland. Corporate taxes in both France and Germany are comparable to or lower than the U.S. (after Trump's tax cut).

To fund universal healthcare, we need to raise another $3 trillion per year in taxes. The total income of the top 1% is 2 trillion. Raising taxes on those people to French or German levels won't raise much more money. This is obvious from Sanders' proposal: https://www.sanders.senate.gov/download/options-to-finance-m...

Sanders proposes to raise the top bracket to 52%, above France's or Germany's. It proposes to treat capital gains as ordinary income, like France but unlike Germany, Sweden, etc. Even raising taxes on the rich to levels higher than France only raises $1.8 trillion over 10 years. The payroll tax proposal, by contrast, raises $7.7 trillion, four times as much. Going all the way and raising social insurance taxes to French levels would raise 5-6 times as much as raising taxes on the French to higher-than-France levels. So would a European style 20-25% VAT.

> projected $30 trillion over the next 10 years

This is a projection and there is much disagreement. If we spent as much per capita as Canada, the cost would go down by around 50%. Single payer is not feasible at the cost per person the US currently spends. Every other country in the world spends less (a LOT less). We have a lot of real examples to follow.

> Actually, middle income earners "have the most to lose."

You have a good point, here, but again it could vary significantly depending on revenue-raising changes that are enacted. The Sanders plan includes mostly progressive tax changes.

Actually I dislike this statement - the federal government will be collecting and disseminating a lot more money than it is today, but less money will come out of people's pockets. It is the case that taxes will go up, but "taxes + health insurance" today is more than "tax + health insurance" under medicare for all, the tax goes up, the health insurance becomes 0[1].

1. At least for primary care, it's highly probable that a lot of "extra" medical care wouldn't be captured like vision insurance, dental and pharma.

This will be influenced a lot by whether the employers give what they currently pay to provide healthcare back to the employees or if they just pocket the difference.

That’s not $3T on top of what we currently spend, though. It just moves payments that go to insurers over into taxes. We already spend that $3T (and more!) on health care.

We know from the rest of the developed world that this is cheaper, too.

Someone is paying for insurance - that’s just a part of your compensation that is deducted from your paycheck. Theoretically, that means employers should pay you more. I think it would help the cause of universal health care if employers were not allowed to subsidize health insurance invisibly. They should increase everyone’s paycheck by the amount they are subsidizing the insurance and then have it as a line item deduction.

When Obamacare came around, I saw people complaining it'd cost them $1k, and comparing it to the $40/month they had to chip in on their employer plan, as if that was the total cost of it.

You forget about the fact that universal healthcare will bring healthcare costs down as fuck. Ever looked at the price of a GP appointment before insurance in France and the US ?

> And The Times observed construction on site in Paris, which is building a project similar to the Second Avenue subway at one-sixth the cost.

This is an extreme example, but this is the persistent story of government programs in the US: they do far less while costing far more than in European countries. The US spends almost 30% more per student on K-12 education while getting worse results.

The problem of excessive cost for rail, for the most part, is specific to English-speaking countries and Japan, not just the US. Quote: "Observe from the low costs of Italian subways that corruption alone cannot explain high American and British costs. High Japanese costs can be explained by strong property rights protections and a process that favors NIMBYism…"

There was a study that I can't find offhand that led to really interesting conclusions: despite the tendency of everyone to think that their own locale's government is uniquely inefficient, wildly late and over-budget public works projects are the norm everywhere. (Look at the Amsterdam North-South line in that blog post, now 2x over budget, for example.) Public support for most infrastructure megaprojects wouldn't be nearly as high if authorities were better at estimating costs. But that means that, if authorities were better at calculating costs in advance, virtually nothing would be built, including things that everyone now considers essential such as the Interstate Highway System (estimated at $25B over 10 years, actual $114B over 35 years [2]). The tendency of public works projects to be delayed and over-budget seems to be, paradoxically, what allows us to make progress in the first place.

[1]: https://pedestrianobservations.com/2011/05/16/us-rail-constr...

[2]: https://en.wikipedia.org/wiki/Interstate_Highway_System