We generally don't have the social care facilities of other first world nations as a matter of choice. A capitalist environment and small federal republic aren

We generally don't have the social care facilities of other first world nations as a matter of choice. A capitalist environment and small federal republic aren't the best equipped to provide them, and our adversarial government system is particularly ill-suited to being efficient at providing such services. Lack of taxes isn't the problem, but Crony Capitalism, powerful lobbying, and government protectionism are almost certainly the more likely culprits. The health care system is already broken in this nation because Congress broke it through wage regulation in the 40s. That same government has now professed that they want to fix it by adding more of what broke it in the first place. I think that the Affordable Care Act has some good parts to it, and hopefully it will at least work at an economy of scale to mitigate the additional layer of pay abstraction that broke it in the first place, but by no means do I think that it will fix the more recent problems it has created.