> In the US, someone earning $155,000 USD...
Later you say
> $20k is a reasonable estimate for a family trying to get decent health insurance independently
So are we talking about people who have full time jobs and employee sponsored healthcare or are we talking about people getting health insurance independently?
That's on the low side. I'm currently taking a break between jobs and thus paying for health insurance out of pocket. For a family of 3 in California, I'm paying $42,000 annually.
That median number also includes people without coverage or with Medicare and Medicaid, which aren’t accounted for that way.
I'm guessing that doesn't include employer subsidies. I pay (as an individual) ~$940/month for health insurance, plus a $600 deductible and $40/visit copays for doctors, $150 copay for emergency room visits and $1000 copay for hospital admisisons.
Assuming I don't need an emergency room or a hospital admission, that's over $10,000/year just for healthcare.
Certainly not by an order of magnitude.
In the US if you are single and work for a well-funded company (e.g. FAANG types) they will probably cover 100% of the health care premiums monthly and your deductibles will be low, so a couple thousand out of pocket is realistic.
Any other scenario though, it's going to be much more. Very few companies cover all the health care costs for the family of the employee. I've paid anywhere between $1K/mo to $2K/mo for full-family coverage while employed, with the employer covering the rest (total cost is over 40K/yr).
And yes, the effective federal rate is not the total blended rate paid in the US, but it's not in the UK, either. For example, far as I know, no US region has a sales tax close to the UK's 20% VAT - sales tax is set locally but in most places is around 5-10%.