> It is pure fantasy to assume we can get universal healthcare without European level 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.
No you don't pay less in tax. Sweden does it with 7% of total tax being cost of healthcare. Poland scrapes by with 5% PKB being 26 billion USD. US pays more than 10% from tax and much more on top privately. Your taxes are not that much smaller to account for the difference, while the country is bigger.
Yes, a single payer would have huge negotiating power to drop these silly costs you pay.
> It should come as no shock to anyone that in order to get Euro-level services, we need a higher tax burden.
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.
We also spend more to get less than Europeans on many other dimensions. There is no reason to believe that we'll be able to cut costs to European levels when we can't do anything else for European levels of spending either. (For the same price as Maryland is spending to build a suburban light rail, Denmark is building a fully automated subway line underneath downtown Copenhagen with more track miles. The notion that just making the public sector handle healthcare will bring costs down to European levels is utter fantasy.)
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 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.
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.
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.
How other countries finance their health care is incredibly wide-ranging. The point is that revenue-raising tax policies are being included in proposals to close the gap, not that they mirror how Germany and France do it exactly. Some candidates have not put forth detailed tax plans but nobody is saying we won't have to significantly raise revenues to pay for it.
> 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.
> but nobody is saying we won't have to significantly raise revenues to pay for it.
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.
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.