First, we don't pay more than enough to cover everyone. About 10% of the population is uncovered today, and they need to be paid for.

We pay much more per capita, for a system that does not cover everyone, than countries pay for a system that does cover everyone. A more efficient system would cover everyone in the US at no additional cost.

when the private coverage consists only of people over the age of 40 who have to pay premiums based on that actuarial cost,

If people don't like the premiums for private coverage, they can move to the national health program. The VAT is stepped up accordingly. while the "JC" sees his cost for employee insurance fall.

If you impose a VAT, then retirees end up paying more than they do today. Because they're not currently paying a VAT.

The L&Ses have contrived to blow up Medicare, with the "trust fund" projected to run dry by 2040, so retirees are going to be paying more, somewhere, anyway. Again, the impact of the VAT will be mitigated by the fact that the providers of goods and services retirees buy, are no longer adding the cost of employee insurance into their products.

Steve