By NextBestFitPhase 1: Enactment & build · Step 1.12
Set up the new taxes
Months 0–18 · Treasury, IRS, SSADiscuss this step
How other countries handled this same piece of implementation, what happened, and what it means for this plan.
Side by side
| Country | Approach | Result | Lesson for this plan |
|---|---|---|---|
| This plan (U.S.) | IRS and Treasury implement the employer health payroll tax (7.5%), the household income-based premium (4.0% above an exemption), and the top-end surtaxes, each phased in with the enrollment waves. | ||
| Germany | Payroll contribution of 14.6% plus an average supplementary rate (about 2.9% in 2026), split employer/employee, up to an income ceiling. | Transparent, dedicated financing; contribution ceiling makes it regressive at the top. | Payroll financing works but needs a broad base; the plan has no ceiling. |
| France | Shifted from payroll toward the CSG, an earmarked tax on almost all income including capital. | Broader base, less reliance on wages. | Taxing all income, not just wages, spreads the burden; the plan's household premium follows this. |
| Taiwan | Payroll premium split employer/employee/government plus a supplementary 2.11% premium on bonuses, dividends, interest, and rent (2013). | Broadened the base to non-wage income. | Supplementary premiums on capital income improve fairness. |
| Canada / UK | General taxation (income, sales, VAT), not earmarked premiums. | Health competes with other spending each budget. | General-tax financing is efficient but exposes health budgets to annual politics. |
Germany
- What they did
- Payroll contribution of 14.6% plus an average supplementary rate (about 2.9% in 2026), split employer/employee, up to an income ceiling.
- What happened
- Transparent, dedicated financing; contribution ceiling makes it regressive at the top.
- Lesson for this plan
- Payroll financing works but needs a broad base; the plan has no ceiling.
France
- What they did
- Shifted from payroll toward the CSG, an earmarked tax on almost all income including capital.
- What happened
- Broader base, less reliance on wages.
- Lesson for this plan
- Taxing all income, not just wages, spreads the burden; the plan's household premium follows this.
Taiwan
- What they did
- Payroll premium split employer/employee/government plus a supplementary 2.11% premium on bonuses, dividends, interest, and rent (2013).
- What happened
- Broadened the base to non-wage income.
- Lesson for this plan
- Supplementary premiums on capital income improve fairness.
Canada / UK
- What they did
- General taxation (income, sales, VAT), not earmarked premiums.
- What happened
- Health competes with other spending each budget.
- Lesson for this plan
- General-tax financing is efficient but exposes health budgets to annual politics.
More precedent
- Germany's statutory health insurance contribution: 14.6% of wages + an average 2.9% supplementary rate (2026), split employer/employee.
- France's CSG: a broad income tax earmarked for social security.