We have a bunch of universities in the global top 100 and I have been to one of them which didn't cost me (or my parents) more than a few k euro.

Sure, you could always go to the emergency room at the hospital and wait hours to be seen, but I don’t think that counts.

When I lived in the Bay Area, everyone wanted to go to USCF, which is understandable being a world-class medical system. So it wasn't that easy getting an appointment.

But for routine medical check-ups? I just went to another system and could get a same day appointment no problem. Hell, I even had 5-6 different slots I could pick from the same week.

Depends on how good your insurance is. PPOs, sure - though most of the country does not have as many doctors per capita as SF. Typically an HMO will only let you have one primary care provider.

My non-emergency care in London is still excellent. It was better ten years ago.

Yes I'd like to get an appointment within a few days but even with my excellent private insurance outside of the UK it's a few weeks wait. GPs aren't sitting around waiting for customers anywhere in the world.

Here in Mexico you can schedule a private GP for the next 3 pr 4 days if you want to pay.

If it's a very minor thing, you can go to most pharmacies and a most likely recent medical graduate will be giving free consultations same day, with at most 15 min wait. (The last time I went the doctor was a Venezuelan medic with great credentials).

Or if you REALLY want to spoil, go to doctoralia.com and schedule a specialist for maybe $60 usd , with reviews and available schedule (usually within a week).

Despite that we also pay far less towards private healthcare than Americans pay, even though private insurance is far cheaper here (because they rent spare capacity from the NHS and offer their services as "topups" plugging holes where people want more.

Also in London, and never call my GP, it's all in an app, and most appointments are video calls. I've had waits sometimes, but I've also been seen within 10 minutes.

To the point that I use the private healthcare quite often.

Don't get me wrong, I'm thankful for the public service, Hospitals are superb and it will allways be there in case of an emergency, but this is mostly a site of US readers and I think we're misleading here. Our public systems are not a walk in the park either.

I won't get bankrupt, that's for sure. But I have to pay pocket/insurance if I want to get something done quickly and I'm not like, dying or something.

This is not precisely a good approach for prevention care.

I think we need a much better understanding of why costs are rising so much (not just as a result of the pandemic, even before that) and what can be done to mitigate that.

Where?

Also GP appointments within a few hours - twice in the last fortnight

At least here in Norway, if I have to wait for something and I'm sick, I get paid time off work. I'll never go bankrupt from medical bills. Taxes plus health insurance premiums was more expensive in the states than payroll taxes here.

There is an actual safety net. I'm unlikely to starve or be homeless for any length of time.

The VAT isn't nearly as bad since it is generally an upfront cost, included in price. Some exceptions apply with online shopping. ¨

Oh, and I'll mention that I can always get an appointment with my GP if I'm sick: They keep some time slots open for urgent things. I might wait a few weeks when it isn't urgent. And I won't lose my job for having appointments.

Norway has an enormous amount of wealth from oil and therefore it is not a good example to show any benefits from pooling wealth. Norway won the lottery, that is all.

https://www.reuters.com/markets/europe/norways-wealth-fund-p...

The US has oil they could pool wealth from. They have resources they could pool wealth from. Things they could invest in. But. They. Don't. They aren't even adequately taxing the folks that can withstand the tax the most: The wealthy. They used to, but it isn't like that now.

There are little things the US simply doesn't do either - just in healthcare. For example, the Norwegian system will send a home health nurse to you up to 6 times a day for short visits. This is because it is cheaper to do this than to house you in a nursing home, overall. Even if you are living on an island. The US expects you to have family take care of you: Poor people won't get home health visits, in no small part because when you don't pool your money together, things like home health care aren't affordable.

(sidenote: The home health visits aren't always adequate, but better than nothing).

Pooling money to increase everyone's wellbeing doesn't take winning a lottery.

Also, Norways oil money, as you write yourself, go into their sovereign fund and does not directly fund wellfare.

There are many theories why the Scandinavian model works on Scandinavia but does not seem to work other places, but to my best knowledge, natural resources are not any of these explanations.

That's orthogonal. Having a massive sovereign fund as your rainy day fund goes a long way in your strategic long term thinking and budget planning compared to countries without that rainy day fund.

>There are many theories why the Scandinavian model works on Scandinavia but does not seem to work other places, but to my best knowledge, natural resources are not any of these explanations.

Because lack of corruption, government transparency and regulations plus a high trust society are also needed, not just pooling all our tax money for welfare.

And those qualities don't exist in many other countries. Scandinavian countries are the global exception, not the norm.

The norm everywhere else is "everyone for himself, fuck you I got mine, you go get yours, if you're poor it's your fault for being lazy", despite implementing various welfare programs similar to Scandinavian ones.

There are many countries with welfare regimes similar in size to those of Scandinavia. They are qualitatively quite different. A rough categorization:

- Liberal regimes (means tested but with relatively equal benefits between participants, market oriented) are typical of the Anglosphere. Food stamps in the United States are an archetypical liberal program.

- Corporatist (aka conservative, Christian-democratic) regimes (many recipients with highly unequal benefits, often tied to family status or employment) are typical of continental Europe, especially. Unemployment insurance is an archetypical corporatist program.

- Social-democratic regimes (extensive universal benefits, direct provision of public services, full employment as an explicit policy goal) are typical of Scandinavia. The Finnish national pension system is an archetypical social-democratic program.

Of course no currently existing states are purely one of these ideal types, but they do cluster. Social-democratic welfare states (Sweden, Norway, Finland, Denmark, and to some extent the Netherlands) significantly outperform conservative ones with comparable or higher levels of public spending (e.g. France, Austria, Germany).

So don’t think calling Norway a bad example is justified at all.

So I guess at least for my country the statement above is somewhat true.

Those are marginal rates, not your effective rate which is what matter overall.

Austria has one of the higher tax rates of OECD countries, reaching 38.3% effective rate for a single person earning 167% of the average wage (source: OECD Taxing Wages)

Again the 20% when counted towards your income is marginal in that you only pay 20% on the price of covered products and services you buy. For starters you only spend of your net income, and only then after mortgages or rent and exempt products. When I last added that up for myself, VAT added up to around 4% of my gross salary.

So I stand by what I said. Most people in Europe pay nothing like 50%.

With respect to healthcare spending, Austrians do spend a lot, but your total healthcare spend, including private payments is far below what Americans pay in tax towards healthcare (source: OECD Health). PPP adjusted you spend an average of around $7.3k vs. around $12.5k in the US. About 2/3's of your $7.3k is taxes.

While I agree that some taxes are a bit too high and opportunities of building wealth without tax evasion are inexistent in Austria, but your tax percentages don't scan for me.

If I use the online calculator of the chamber of labor, on a 70k/year gross salary, you take home 45k/year NET, so you pay 25k/year in total combined taxes, meaning approx. 36% of your gross income is the tax load on 70k salary. That's not that terrible, seems in line with most developed EU countries more ore less.

The only thing missing is the taxes paid by the employer which also add up and increase the tax load, but are not listed on your payslip, which IMHO is a fault with the system due to this lack of transparency.

However, contrary to the title of this topic, it doesn't make "everyone's wealth go faster" it just supports the lower classes from falling into poverty and crime.

[1] https://bruttonetto.arbeiterkammer.at/

They quoted marginal rates, not effective rates, which is usually the case when people start talking about these high numbers.

I'm confused. What's the difference?

Let's say a country has only a single 20% tax band that kicks in at 20k.

If you earn 40k, your marginal tax is 20%, but only 20k of your earning is above 20k, so you pay 20% * 30k = 4k in tax for an effective rate of 10% (4k of 40k).

Most countries will multiple tax bands plus deductions which complicates this, and most places very few people have enough of their income taxed at their marginal rate for their effective rate to approach their marginal rate.

So if you have a marginal rate of 50% but it only kicks in when you earn over a certain amount, you will be paying less than 50% overall (your effective rate).

If you made $100k, paid $25K in income taxes, and were in a 33% bracket, your effective rate was 25% and your marginal rate was 33%.

What do you mean? I gave you the exact percentages. You can see them on the homepage of the Austrian finance ministry as well:

https://www.bmf.gv.at/themen/steuern/arbeitnehmerinnenveranl...

[1] https://worldtaxpayers.org/2019/10/austria-tax-freedom-day-w...

To be fair, 17% of the payroll and income tax are pension contributions (up to earning around thr $56k, after that it's just a tax).

Sweden reaches 50.3% for a single person earning 167% of average salary in total tax wedge (including employer payroll taxes) with no substantial deducations. An average earner has a total tax wedge of 42.4%. Sweden is one of the highest in Europe.

The average earner pays 24.3% in income tax and employee social service contributions.

The VAT adds up to less than you'd think, because for starters you won't buy anything VAT rates with the money you've already paid to tax, nor what you pay on housing, or food. Last time I added up what I actually paid in tax it was around 4%, both in Norway with similar tax levels to Sweden, and in the UK.

I cannot confirm this (I live in Vienna, Austria) but I've never had a serious health issue. I go to different doctors every year for checkups. What kind of doctors are you talking about?

Wife used to live in Vienna, Austria, and always had private doctor insurance. Her fears came true as she had a serious medical situation and was asked to wait for weeks (with pain managed by painkillers) until the surgery she needed could be done. Her private insurance stepped in, and like magic she was treated in 3 days.

Now, I believe that healthcare should never be considered optional/treated like a business, and must be equally available to all without pre-conditions on their financial well wing, but inefficiencies in the system are not to be wish washed away.

I think because Vienna is not as underfunded as other states. In Styria I had to go private for quite a few things If I didn't want to wait 3 months to see a public specialist.

For example, in Malmö, Sweden the top tax rate is 52% and starts at 45k, but even at 70k your actual tax load is something like 36%

Not counting VAT of course.

At 90k GBP you are paying 45%. I guess it depends on what “nowhere near half” means. 45% is close imo. Especially with VAT added in on purchases. Yes the average London wage is more like 50k GBP, but from that perspective it’s also only double the average wage before you hit 45%+ tax take.

The top UK tax rate (including employers NI etc) is ~59%.

1. https://listentotaxman.com/?year=2022&taxregion=uk&age=0&tim...

This is so misleading.

At £90K you get a £12,579 tax free allowance leaving £77,421 taxable. You will pay £7,540 from the 20% band, £15,888.40 from the 40% band and nothing from the 45% band for a total of £23,428.40. National Insurance will be £5,318.60 making the total deduction £28,747.

So approx 32%.

Edit: which yes takes it to 43% not the 45% I originally wrote.

Now enjoy paying another 20% VAT on any goods and services

Only the part of that that would actually be passed through to you as salary in the absence of the tax could reasonably be considered part of your tax burden. Hard to say how much that is without any information about your field or employer, but I guarantee it's less than 100%.

The average UK salary is <35k GBP. At that level total deductions are 20%, and your employer pays 10% employer NI.

> for more than small minorities of the population.

covers that situation. Simply put, only a small minority of people in the UK pay that much tax.

Not to mention the classic error you’ve made

> hit 45%+ tax take.

that tax take only applies to persons income that’s above 120k. The actual total tax burden across their income is substantially lower, given everything below £120k is taxed at a much lower rate.

Actually I didn’t error. This is the total tax paid expressed as a percentage. It is not the marginal tax rate. See the link I provided as evidence (add total deductions + employers NI together).

Why would anyone do this? Employers NI is a business tax, why would consider that a tax paid by individuals?

If you’re gonna start attributing employer taxes to individuals, then why not start including business rates and other random taxes, then you can gin up any level tax burden you want.

The fact that it was taxed above some line rather than below it doesn’t matter. (Of course that means it needs to be added to both the numerator and denominator when calculating the total tax burden, something that is often skipped.)

It further only tend to be included when complaining about high tax countries, and conveniently forgotten when people compare w/e.g. US taxation.

Nevertheless, even with them included, only a few European countries have total tax wedges above 50% for more than small portions of the population.

If you make money by your labor hours directly being billed and the buyer of those hours pays VAT on that labor, then I agree.

So long as there’s a direct and 100% link between your labor and the taxed amount, it’s value you created and was taxed away, without regard to who stroked the check to the tax authorities.

It's irrelevant to me, because it's not a tax on your contracted income.

You can make an argument that it is tax.on the value you created, sure, but not on your income because for most employees there is no direct link between value created and income.

I’m looking at it as a tax on direct labor. Which is also a consistent lens to use.

However, my initial claim that only a small portion of people in Europe approaches 50% holds for total tax wedge as well.

I’m talking about taxes that have a direct relationship to your income. If your income changes and the taxes paid change in proportion to your income change then that should be counted as taxed against your income.

Doesn’t matter if you call it labor, wage, salary.

Likewise if you have options/shares as part of remuneration it is often specified that the employee pays the employers NI for it.

Honestly it’s just a cheeky way for the govt to hide income taxes.

Why not include business rates? Because it’s not linked to the employees salary. It doesn’t change based on the employees salary.

When people outside more socialist countries say they pay far less tax, they never include any of this, so I don’t either.

That's not to say you can't. Some certainly do. And some countries are much higher. Belgium in the very significant outlier, with Germany not far behind.

Those "employer payroll taxes" are still part of your salary. It's just an accounting trick to fool you.

That it is part of the calculation for the employer is irrelevant - so is office costs, admin overheads, software licenses, equipment, yet we don't consider those costs deductions from an employees salary and bump the "real" salary up accordingly.

Then add on top VAT rates of >20%.

It wouldn't surprise me it hits 50% of income for an awful lot of Europeans.

Effective rate is far lower, and you can't spend money you've paid in tax on VAT, nor money you've spent on housing, or the multitude of zero rated goods which usually includes food, so the proportion of your money you pay VAT on is usually small.

Last time I actually did the math, I paid about 4% of my gross pay in VAT, and despite being in the top 1-2% or so in the UK my effective rate including VAT is still only just approaching the 50% mark.

The point is, if your effective income tax rate is 35%, you also need to add up all the taxes that aren't income tax, like the 20% VAT, gasoline taxes, alcohol taxes, property taxes, stamp duties, etc, etc.

Add all that up and I wouldn't be surprised if many people had an effective tax rate >50%

I've done the calculations in the past - the effective rate of VAT as a proportion of gross income added up to around 4% for me, because most of my money does not go towards VAT rated products.

Nor does it for anyone.

Because before you spend on VAT-rated products (or alcohol, gasoline etc.), you first pay income taxes, then you pay for housing, and food which most places is zero rated or at a discounted VAT rate, and debts. The higher you earn, the lower proportion of your income tends to go towards spending, partially because you tend to put aside a larger proportion for pensions, partly because you pay a higher rate of tax, so VAT contributes less to your overall tax burden - it's a deeply regressive tax.

Most people don't have enough money to spend on highly taxed items for it to be possible for them to get to an effective tax rate of 50%+, and most of those of us who might be able to spends our money otherwise - bigger house, bigger pensions, more investments.

I earn many times the UK national average, and so pay income tax and national insurance far closer to the 50% mark than the vast majority of the UK population. Despite that I still don't cross it when other taxes are added on. Including VAT, property taxes/council tax and similar. I'm in the top 1-2% income earners in the UK - people earning less than me are certainly getting nowhere near 50%.

Even when I lived in Norway, which has wealth taxes, some of the highest gasoline and alcohol taxes in the world, and higher income tax, and high VAT (25%), did I reach 50%.

In some of the highest tax countries in Europe, like Belgium (an extreme outlier) and Germany, higher proportions will cross the 50% line, but overall for Europe this applies to a vanishingly small proportion of people. UK is "low tax" for Europe, but closer to the average than e.g. Belgium and Germany.

Which is why the "half goes to taxes" crowd almost always ends up forced to start bringing up the total tax wedge instead of other taxes. Even then most people will never hit 50%, though more do.

Also, it doesn’t seem like Europeans are much more uneducated or unhealthy than people in the US.

I'm telling you I pay over half my salary in taxes and get little in return. Whatever happens in the US is not my problem.

Because the comment that you replied to was comparing the EU to the US: "And everyone benefits from this kind of collective solidarity - our societies are far less combative (both in the literal and the proverbial sense) than the US are."

Because in Canada, which has universal health insurance, medical bankruptcies are 25% of all bankruptcies for those over 55.

Why? Because if you're sick enough, you can't work. You can go on unemployment, but it's capped and doesn't replace 100% of your income. So if you're living paycheck to paycheck, it's not that hard to go bankrupt if you don't have the income to pay your mortgage, car loan, etc.

(Though I don't think many people need it, because most can just get a part-time job and finish in double the time, debt-free.)

edit: just to add to this: I don't think pooling / sharing is bad, there are many cases where this makes sense (investments, insurance), especially when it's voluntary, but it's easy to overdo it in a forced model. European living abroad btw, familiar with many different ways people live.

You're talking about the US, right?

I and people I know in different states have often had to wait months to get an appointment with a doctor.

The quality of education you get in the US varies drastically depending on your location, and typically the wealth of your parents.

E.g. the UK NHS costs less per capita than Medicare + Medicaid costs per capita (not per user), despite the former providing universal service. Partly explained by artificial restrictions on Medicare limiting their ability to negotiate price - the "free" market is intentionally prevented from functioning. It's pretty much corporate welfare paid for by regular tax payers. I never understand why Americans tolerate this.

The proportion who pays twice in the UK is around 10% who opt for private insurance on top. The proportion who pays twice in the US is every tax payer.

Total healthcare spend per capita (public + private) tells a pretty clear picture, where costs of healthcare in the US is totally out of control.

The US system is designed to be profitable for those running it, not offer good value for those using it.