I don't think that's the issue. SF has tons of tax revenue, but it can barely build anything, and it can't keep the streets clean or safe.

Total (federal) receipts are also relatively unchanged as a percentage of GDP since 1955. On top of that there is A LOT more GDP to go around. The real differences are source of revenue (Payroll taxes massively up, corporate income tax down) and the spending of the income (basically, anything that isn't Social Security, Medicare or Medicaid).

We could potentially spend like the 1950s, but it'll be a tough sell to cut Social Security and Medicare in half or more. You might get some right wingers behind doubling the military budget though.

The amazing thing about all that $ for medical care is we're barely any better off than people in the victorian era:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672390/

And actually, if weight by quality of years lived, almost certainly worse off.

(That's a British paper, but let's say US and UK are roughly equal.)

This is, I think, because we're basically poisoning ourselves w/ poor diet, then trying to mitigate w/ medical care.

Probably most people would more or less agree with the above statement, but then you'd find very little agreement about what exactly about our diet makes it so unhealthy. (I think the #1 culprit is excessive linoleic acid.)

Well, also because of the societal trap of health insurance. If you have health insurance, you're (hopefully) not paying for your medical costs. So the medical costs get jacked up- after all, you, the buyer, don't front the bill.

If nobody had health insurance, medicine would be cheaper. Of course, for every individual who can afford it, health insurance is a good choice (individually).

No doubt the efficiency of the care that is being provided could be dramatically improved, but that's not the root problem, IMO.

I basically agree with you.

I think here's exactly your problem. All the freedom (to discretionaly spend) is now at the top, compared to the 1955. Today, people formally do get the money, but immediately they have to spend them again up on the medical care, rent, education and other required social services. (And debt service - I think debt servitude also plays a role in this.)

On the other hand, you tax corporations less. So the corporations (which are controlled by a small group at the top) have all the freedom to spend. But what would they buy? Will their spending increase their profit?

That's why you are not "building society" anymore - concentration of wealth. And as a result, people do have less freedom to spend (less money), and they will not engage in interesting endeavors.

Millennium Tower, Salesforce Tower, Mission Bay? SF builds.

Tax revenue per capita is higher today. 1955 had a high tax rate, which lowers revenues.