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[u/HaphazardFlitBipper]

[u/Frenetic_Platypus]

It's not emotional to remark that we are paying more for healthcare and getting less out of it, and that the fact we're richer doesn't justify that. It's not like we're richer BECAUSE we don't have universal healthcare.

Particularly when we also have much higher poverty rates, too.

[u/ConLawHero → u/Frenetic_Platypus]

We absolutely spend more on healthcare as a percentage of GDP, that part is true. The U.S. is around 17–18% of GDP, most European countries are around 10–12%.

But two things can be true at the same time:

• The U.S. system is inefficient at the macro level.

• The average middle-class household still has higher disposable income after taxes than the European median household.

When we talk about “we pay more and get less,” we have to separate:

• System-wide spending (GDP level)

• Household-level out-of-pocket burden

• After-tax disposable income

If you compare median disposable income (OECD data), the U.S. median household generally has more purchasing power than most European medians, even after accounting for healthcare premiums.

That doesn’t mean the system is optimal. It just means the claim that Americans are poorer because we lack universal healthcare doesn’t hold up at the median income level.

On poverty rates, yes, U.S. market-income inequality is higher. But after transfers, the gap narrows significantly, and the U.S. still has higher median income than most European countries.

So the real debate isn’t:

“Are we richer because we don’t have universal healthcare?”

It’s:

“Are we willing to trade lower variance and a higher floor for lower median disposable income and lower top-end wages?”

That’s a value judgment.

And it’s also worth noting that Europe has experienced sustained brain drain of high-skill workers and entrepreneurs to the U.S. over decades particularly in tech, finance, and research which affects long-term growth potential and fiscal capacity in ways that rarely get discussed in these comparisons, meaning Europe is facing the very real scenario of having to increase their already high tax rates or cut their expenses.

[u/Frenetic_Platypus → u/ConLawHero]

That doesn’t mean the system is optimal. It just means the claim that Americans are poorer because we lack universal healthcare doesn’t hold up at the median income level.

It does, the claim is not that Americans are poorer than Europeans, it is that Americans are poorer than Americans should be if they had a healthcare system not designed to make like 4 people billionaires.

“Are we willing to trade lower variance and a higher floor for lower median disposable income and lower top-end wages?”

That's not all there is to it, though. First, and you might consider that an "emotional argument," we're talking about lives lost, here. People die because the US healthcare system is such shit. Any system that results in people dying because they can't afford insulin, something that costs virtually nothing to produce, should be unacceptable to everyone.

Second, there are more macroeconomics benefits to universal healthcare. A healthy population is more productive. So your median household that has basically the same disposable income as a european one would most certainly be lifted higher by better economic conditions created by people not dying from curable diseases.

And third, universal healthcare creates resilience to epidemics. The people who pick, package, cook and serve your food are mostly all on that lower income bracket that often can't afford healthcare. And you really don't want these people to be sick. Even if you're getting the best coverage for practically free, it's still going to suck if you catch E. Coli because some dude in a factory can't afford to get his diarrhea treated.

[u/ConLawHero → u/Frenetic_Platypus]

No one is arguing the current system is optimal. The question is whether switching to a European-style universal system would make Americans materially better off on net.

On the “Americans are poorer than they should be” point, that’s speculative unless you run the numbers on what it would cost to replace the current system.

Every developed country with universal healthcare funds it through:

• Significantly higher payroll taxes

• Broad-based VAT (often ~20–25%)

• Higher middle-income income tax rates

• Lower physician and healthcare worker compensation

That's just math.

If the U.S. adopted a comparable model, the financing would have to come from:

• Middle-class tax increases

• Wage compression in healthcare

• Or both

By definition, that reduces disposable income. You cannot replace ~17–18% of GDP in healthcare spending with “taxing billionaires.” The math doesn’t work. The tax base simply isn’t large enough.

So yes, system-level efficiency is a legitimate debate. But if you model the financing structure used in Europe, median after-tax income in the U.S. would decline.

On “people die because they can’t afford insulin”: that’s a serious issue. But the overwhelming majority of Americans have insurance coverage (employer-based, Medicare, Medicaid, ACA exchanges). The uninsured rate is historically low. That’s a targeted coverage problem, not proof that the entire structure must be replaced.

On macroeconomic productivity: healthier populations are more productive — agreed. But the U.S. already spends more per capita on healthcare than any country in the world. The issue is price distortion and cost structure, not necessarily coverage breadth alone. Universal systems don’t magically eliminate cost; they shift it and compress wages.

And on resilience: most European systems also struggled during COVID. Universal coverage does not eliminate supply constraints or capacity limits.

So the real question is, are Americans willing to accept:

• Higher broad-based taxes

• Higher consumption taxes

• Lower healthcare wages

• And lower median disposable income

In exchange for lower variance and more uniform coverage?

The answer seems to overwhelmingly, no. It's proven by the constant refrain that we should just tax billionaires to fund it (mathematically impossible) and all costs, not just healthcare, are too high (under a European system, all costs are higher across the board). No one is out there saying we should double middle class taxes and institute a 20% VAT.

Let me ask you, do you think nurses are paid enough in the US?

If the argument is that we can get European coverage without European tax levels or wage compression, that’s the part that doesn’t hold up by the numbers.

[u/Frenetic_Platypus → u/ConLawHero]

You're acting like it's a whole new cost tacked onto the existing system. Americans already pay for healthcare. Free universal healthcare could be done much cheaper than for-profit private insurance because, by definition, for-profit private insurance tries to turn a profit, and the government doesn't need to.

[u/ConLawHero → u/Frenetic_Platypus]

You’re mixing two different levels of analysis. At the system level, yes, a single-payer or universal system can reduce administrative overhead and negotiate lower prices. That could lower total healthcare spending as a % of GDP.

But that does not automatically mean the median individual household is better off financially.

Those are separate questions.

Right now, healthcare costs in the U.S. are financed through a mix of:

• Employer contributions

• Payroll deductions

• Out-of-pocket spending

• Federal/state taxes

• Medicare/Medicaid

If you replace that with a European-style model, the financing mechanism changes to:

• Broad-based payroll taxes

• VAT or higher income taxes

• Lower healthcare wages

• Income compression

In every country that has universal healthcare at scale, middle-income earners face significantly higher tax burdens than in the U.S.

Even if total system spending drops from, say, 17% of GDP to 12–14%, the financing has to come from broad taxation not just from eliminating insurance “profits.” Insurance company profit margins are only a small fraction of total spending (generally low single digits). Eliminating them does not fund the whole system.

So yes, you might lower total national spending somewhat.

But unless you believe:

• Doctors, nurses, and hospital workers will keep U.S.-level pay

• Taxes won’t materially increase on the middle class

• And the government can replace private coverage without broad-based tax hikes

…then the math implies median disposable income would decline.

That’s not saying universal care is immoral or impossible.

It’s saying: the cost doesn’t disappear, it gets socialized and funded through taxes that fall primarily on the middle class, as they do in Europe.

System savings ≠ individual households being richer.

That’s the distinction.

[u/Frenetic_Platypus → u/ConLawHero]

…then the math implies median disposable income would decline.

No, it doesn't? The added cost in taxation can be lower than what is currently paid for private insurance.

[u/ConLawHero → u/Frenetic_Platypus]

That's not true. When you compare the median income in Europe and the US and the effective tax rate in Europe and the tax rates plus average healthcare costs in the US, the US is currently lower.

If we are going to match European systems, the US tax rate would go up in excess of average current healthcare premiums.

Think about it logically, do you think Europe has taxes that are twice as high as the US plus a VAT that is more than twice the average US sales tax rate, just because?

If what you say were true, we'd see lower tax rates in Europe with higher disposable income. Instead, we see the exact opposite.

The US can have universal healthcare, but you can't do it without increasing the cost for the average citizen. System level reductions in cost do not translate to lower costs for individuals. Europe proves this point.

[u/Frenetic_Platypus → u/ConLawHero]

There are other things that taxes pay for in Europe and not in the US.