> Different climates, industries, demographics and educational achievement change what diseases/health issues are present and how they are dealt with in the community.
I'm sorry, I'm not buying this without some source that shows that Americans need more healthcare than Swedes due to those factors.
> A sparse rural population has different healthcare needs than an urban one, for example.
Sure, but the US is 82% urban, Sweden is 88%, Germany 77%, France 81%, Norway 83%, Denmark 88%, Finland 85%, Switzerland 74% – I can go on [1]. All very much in a comparable range.
[1] https://www.cia.gov/library/publications/the-world-factbook/...
> State level administration makes more sense than trying to coordinate a policy across a continent.
Fine. Many public hospitals in Germany and Switzerland – two countries with federal systems – are run at the equivalent of the state level.
> What is cross-continent coordination supposed to win anyone anyway? It just makes the politics harder to manage.
I'm not claiming that the US would have some gain in these areas for being huge! I'm merely questioning your claim that "it won't scale".
> I'm happy to say that; there will be things Sweden is doing that are completely different to what Germany does because of scaling.
This is incredibly vague. Of course there are "things done differently". That's not an argument for why the US can't do a version of the same.
> Plus the fact that they have different laws and legal systems.
Why is this relevant? That's like saying "the flags are very different".
> Although I suspect neither of us speaks Swedish or German, so it would be hard to settle that one decisively.
I can understand Swedish just fine, and rudimentary German. Even if I couldn't, the legal, healthcare and educational systems in both countries are well-described in English language sources.
> Australia faces similar issues where West Australia has a decidedly different culture to the east coast states and it doesn't make sense to try and coordinate housing policy between them.
I'll perhaps grant that the housing situation may be extremely different from place to place, and coordination can be hard, but I still don't understand an iota of what you mean when it comes to healthcare and education.