In these discussions I think people often overlook one significant factor in delivering services to people in the US; population density. The EU and also France

In these discussions I think people often overlook one significant factor in delivering services to people in the US; population density. The EU and also France, have a higher population density than the US. The US is 33 per km, whereas France is 100, based on Wikipedia. This translates to higher costs because maintaining hospitals in low density areas raises the cost of care per capita. This is also a reason that inter-regional train service has never been a good option in the US. There are regions where it works, but coming up with a one-size fits all solution is hard. The metropolitan regions of the US have always subsidized the rural parts. We people of the cities have always paid a fee on our phone bills that helps reduce the cost of phone service in rural areas, as an example. I actually dislike this, because I think it subsidizes sprawl. I believe the ACA is a good step (personally I'd like to see Medicare offered as on option alongside all state insurance plans), but it does need fixes. Whatever the solution, it's going to look different from Europe and France in particular.