So why is size and complexity an issue? Why is it that in a country of 1.3 million people I pay a reasonable amount of taxes, get free healthcare and even if I

So why is size and complexity an issue? Why is it that in a country of 1.3 million people I pay a reasonable amount of taxes, get free healthcare and even if I do prefer a private provider pay EUR 50.- per visit. But a similarly sized US town can’t do that. So maybe the role of the feds is to make it so that the size and complexity would matter less?