[rsj_hn]

Yes, this is a good point. Everything is messier in real life than a few paragraphs can properly portray.

But my main point is that the difference between the national healthcare you see in Europe versus the U.S. is not the level of public spending, but the universal nature of service delivery achieved for roughly the same total public spending. The same thing for university education.

In both cases, the government spends an enormous amount and in Europe that covers a baseline of service (with private spending optional to supplement it) but in the US that covers maybe 1/2-1/3 of your bill, leaving private citizens to still face huge costs for things that are fully covered in Europe. The natural solution -- to cut employment and wages on the part of US healthcare or education workers so that they make do with the public funds they are already receiving -- is rarely advocated by those who want a more european-style system of social insurance.