[psranga]

Is 50% your ETR if you only look at INCOME taxes (federal and state)? If so, you're probably an extreme outlier.

Or are you including payroll "taxes" (social security, medicare), sales taxes etc also?

IIUC, if you add up health insurance premiums (employer share + employee share) + all income taxes + all payroll taxes of US and compare it to the same quantity of other DEVELOPED countries, the tax burden on the US is not unreasonably high.

Keeping a developed country developed is hard/expensive. :)