[nagrom]

You're comparing income tax with sales tax.

In the UK, on a salary of £40k (i.e. professional mid-career engineer), before you touch the money, the government takes about 25% for income tax and national insurance. Then, they take 20% of everything else that you spend unless it's non-luxurious foodstuffs, children's clothes or paper books. And, of course, if what you're buying is fuel, they actually take 85% of the price.

In addition, you'll pay approximately 2% of the purchase price of a house to the government, and you'll pay approx. one day a month in after-tax income to the local council as a property tax.

US has a 30% tax burden, UK has a 40% tax burden. France and Germany have >50% tax burdens. The last three have some form of nationalised healthcare though, which the US does not.

[fargolime]

> The last three have some form of nationalised healthcare though, which the US does not.

Plus a much better retirement plan. In the US you can wake up in a hospital after someone rear-ended you, to find you are bankrupt and going to become homeless, even when you had the best insurance. And unless the stock market returns 8% most people are going to have a rough retirement.

In the US you're lucky to get 3 weeks vacation a year. More than that, you need to quit your job. In EU countries it's generally 6 weeks by gov't mandate.

The greater taxes are probably a good deal.

[colechristensen]

Things which aren't true:

>In the US you can wake up in a hospital after someone rear-ended you, to find you are bankrupt and going to become homeless, even when you had the best insurance.

>unless the stock market returns 8% most people are going to have a rough retirement

Your health and car insurance covers exactly what it says it covers, and retirement plans aren't a mystery. In America you take personal responsibility for things which are done for you in Europe; you can make the wrong choices, but you're allowed to _make_ choices.

Vacation doesn't have much of anything to do with taxes.

[gmac]

Taking personal responsibility sounds all very well (leaving discussion of the impossibility of meaningful free will for another occasion), but private health insurance is a special kind of stupid. For example, some people are born with diseases or disabilities that we can say with certainty will cost millions in care over their lifetimes. Those people are obviously uninsurable. So health systems that don't leave people to die must involve an element of the collectivisation of risk.

[xrange]

>Those people are obviously uninsurable.

...if they were born to parents who had insurance they would have been covered.

>So health systems that don't leave people to die must involve an element of the collectivisation of risk.

...insurance is all about collectivisation of risk, is it not? You are paying in, hoping to never collect, and the money you pay in is used to cover those who did need it.

[colechristensen]

This is very explicitly incorrect.

In America as of 2014 you cannot be denied coverage, charged more, or denied treatment based on health status.

There is no longer an "uninsurable" American citizen.

[Wintamute]

Brit here. I like to take personal responsibility for choices like career path, holidays, hobbies, where to put down roots, whether to have a family, who to love, who to have sex with, how much to drink, what books to read, what religion to follow or not follow, what to have for dinner. As for how I subsist when I'm too old or sick to work, or when I wake up in hospital after an accident ... those sorts of choices I'm more than happy for the government to make, in general they do a great job all things considered.

[fargolime]

Your health insurance doesn't cover non-covered expenses.

That retirement plans aren't a mystery doesn't negate needing 8+% returns to comfortably retire.

[Spooky23]

Investment return is always a problem. Pension funds don't magically create money!

[fargolime]

The EU countries don't need 8+% returns to provide their citizens with comfortable retirements. One major reason is that in the US you need to save for living to an age much greater than the average life expectancy.

[Spooky23]

That's only as sustainable as demographic trends and economic success allows.

In New York State, the pubic employee fund is arguably fully funded, and most employees are eligible to retire at 55 with 2/3 of their salary as a pension. That fund requires a 7% annual return to avoid additional employer contributions.

[bjt]

No country mandates 6 weeks. The highest is Austria with a total of 38 days between paid vacation and holidays. Most of Europe is around 30 days. See http://www.bostonglobe.com/business/2014/08/13/one-few-count.... Scroll about halfway down for a nice infographic.

[fargolime]

30 days / 5 weekdays per week = 6 weeks

[jmnicolas]

It depends : in France I have 32 days but a week is 6 days (don't ask me why) so I Have just a bit more than 5 weeks.

[bjt]

Doh. You're right. I did the math with 7 day weeks.

[b3n]

How does the tax rate influence the amount of time you may take off work?

[fargolime]

Not directly, but higher taxes tend to go hand-in-hand with the gov't ensuring a higher average standard of living.

[Retric]

The only important number is government spending as % of GDP. US ~38%, UK ~42%. However the UK has universal heathcare where US simply mandates health insurance making the effective tax burden lower in the UK.

In either case the US tax burden is close enough to EU levels not to make a significant difference.

[praptak]

> The only important number is government spending as % of GDP.

Globally. Still here might be cases where a particular group funds an unproportionally high part of the spending. And you might be the edge case where you earn the money in country A to save and retire on it in country B, so A's sales tax doesn't affect you this much.

[tartuffe78]

The US does have medicare and medicaid, which aren't universal but still are nationalized healthcare for a lot of people.

[maaku]

Nationalized health insurance, which is a little different.

[acveilleux]

I live in Quebec and technically I don't have nationalized healthcare but rather health insurance. It doesn't change the fact that I don have to pay anything out of pocket at any hospital I go to here.

An itemized and detailed claim will be made on my behalf to the insurance agency to get everything paid.

From a user pov it makes no difference how the system works.

[maaku]

Quite the contrary, the level of service can vary wildly in nationalized health care, where the state runs the hospitals. There are pluses and minuses -- you can get much better health care at a much cheaper price to the tax payer, but with all the problems you see in any government bureaucracy.

Nationalized insurance on the other hand is pretty much the system any American would be used to, except the government pays and you have long queues.

[icebraining]

Isn't that the case in Germany as well?

[biafra]

Health insurance is not payed with collected taxes in Germany. You are paying for it seperately.

[toomuchtodo]

> US has a 30% tax burden, UK has a 40% tax burden. France and Germany have >50% tax burdens. The last three have some form of nationalised healthcare though, which the US does not.

As a US citizen, I'm happy to have an increased tax burden for legislated vacation/holiday days and 20% of the population not having medical bills they can't pay for.

[fargolime]

It's more like 80% of the population, when considering expenses not covered by insurance. A hospital can charge you for anything and you're legally obligated to pay it.

[pc86]

> A hospital can charge you for anything and you're legally obligated to pay it.

Categorically, unequivocally wrong.

Hospitals cannot just make up charges. They cannot bill you for procedures/tests/services you did not receive (and if they do, you are not "legally obligated to pay it").

I know the anti-US healthcare circle jerk is pretty strong here, but we don't need to just make things up in order to prove a point.

[_delirium]

It's true that they can't just make up services, but they can do a pretty wide range of things and bill you for them, without giving you the price in advance. My dad was in the hospital once, and got something like 20 separate bills, for different services he had no idea he had received (and had no way to verify if he had even received). And my mom actually did get a half-dozen or so bills for services she definitely didn't receive. She went to the ER, checked in, but ended up leaving before getting any services whatsoever: after >1hr waiting in the ER's waiting room, she started calling around to see if she could be seen somewhere else, and left when she found a nearby urgent-care clinic that could see her. They still billed her for a "standard" ER work-up, including line items for a blood test and lab work! She had not had blood drawn, and clearly no lab work was done. Obviously she didn't pay that bill, though: if you really have good evidence that the service was not performed, you can challenge it.

[pc86]

Honestly I'd be shocked if an ER doctor knew the price of a service before doing. They probably know a general range (give or take a few hundred dollars?) for a given test, but even that I'm mostly guessing on.

Unless they're a small operation, I don't know that they'd have any direct visibility into the billing/insurance/finance side of the operation. Maybe that is the issue? I don't know how to combat that in a large hospital setting.

The one time I had surgery I ended up getting 3 separate bills for varying amounts, but any time I asked for documentation about a given procedure or test it was provided in writing well before the due date of the bill.

[fargolime]

I once asked the financial adviser for a hospital, how much the CAT scan will be. He said $1700. On the bill it was $4500. Here's how it really works, according to a relative of mine who works in the billing dept. of a major hospital: each month they decide how much to charge patients for services already rendered, so they can meet their monetary goals for that month.

[fargolime]

> Categorically, unequivocally wrong

Hyperbole much?

They can charge you for services / products rendered and which aren't covered by insurance, and they can charge any price they want and you're legally obligated to pay it. Of 3 times I helped my parents with processing their hospital bills, it was over $10K in non-covered expenses each time.

[pc86]

Is your complaint that a hospital can charge you for a service that was rendered, that they perform services you might have to pay for, or that they assume you're not interested in rate-shopping your surgeon?

Yes, you are legally obligated to pay for services rendered. I think you'll be hard pressed to find someone to argue the opposite, though.

[baconner]

The problem isn't that you have to pay for services rendered. The problem is the pricing and service system is extremely opaque. You can receive services without ever having an opportunity to know what those services are or how much they will cost. And that's not restricted to high emergency care its everything. It's not comparable to paying for services in other industries where pricing is presented up front or at least before services are rendered. The opaqueness leads to price inflation as well so service prices aren't regulated by the consumer market.

For example once my wife had to go to the er and we'd taken great pains to know ahead of time what hospital was covered best under our insurance. Yet the bill contained test services performed in he hospital that were not covered because a room in the hospital was operated by a separate lab company that didn't accept our insurance. There was literally no way for us as consumers to know that one type of blood test regularly covered by our insurance in a covered facility would go through the magic door into an uncovered facility. Price inflation and surprise bills are emergent properties of the system and that needs to change.

I am all for consumers having choice and taking personal responsibility for their care but our healthcare system makes that effectively impossible.

[fargolime]

The observation is, in EU countries with nationalized healthcare you don't get a hospital bill. In the US you can have good health insurance and still get a bill that bankrupts you and leaves you homeless. You can't rate shop in advance of getting rear-ended.

[mikeash]

You previously said "charge you for anything" which is substantially broader than "charge you for services/products rendered."

Reading your previous statement literally (and I saw no reason to read it in any other way), it meant that a hospital could charge you for buying an elephant and you'd be legally obligated to pay.

And you're complaining about other people using hyperbole?

[fargolime]

They can charge you for some pretty ridiculous things, though. My mom got charged $175 every time an assistant nurse checked on her, 4 times a day. It wasn't reduced by insurance; instead they didn't cover it at all, so she was obligated to pay the $5000 charge.

[rhino369]

The working poor get shafted in America, but the middle class gets a better deal. They hardly pay taxes, get employer paid health insurance and vacation.

[legulere]

Germany doesn't have nationalised healthcare. It's just mandatory for most of the population and the health maintenance organizations are extremely regulated (how much money they should take, in what cases they have to pay how much, ...)

[humanrebar]

> You're comparing income tax with sales tax.

For the purposes of personal budgeting, I don't see why the comparison is unfair. I'm trying to discuss taxation levels, not tax schemes as such.

> US has a 30% tax burden

That's more on point. That's also low. It doesn't include state and local income taxes. It also ignores other kinds of taxes like property and sales taxes. The U.S. has state-level taxes, which complicate things but they definitely affect the individual taxpayer.

[nagrom]

Your original comment was questioning why a 24% VAT is considered to be outstandingly high. It's the highest rate of VAT in the EU, and broadly speaking taxes in the EU are already higher than in nations of equivalent technological and economic development. So, it's not an unreasonable feeling that a 24% VAT rate is high.

That 30% tax burden for the US is from the same wikipedia page as the European tax burdens. I am assuming that the methodologies used to arrive at the figures are broadly comparable.