There are countries in the world smaller than many US states, and they manage to handle healthcare and education just fine, so no, I don't think federalism is even remotely a problem here.

There are many books written about this.

For example, for education, it boils down to US resistance to tracking and insisting that everyone should go to college and study whatever they want. If they can't afford it and don't have a scholarship, we'll give them a loan. There are many other factors, but this is the main one.

Europe made a decision to provide 3 years of inexpensive education to the best 1/3 of its students. The US decided to make 5 years of expensive education available to 2/3 of the population (although only 1/3 or so actually graduate, the rest drop out).

Because the European schools are selective, they don't offer remedial classes and have accelerated, slimmed down degree programs that can be completed in 3 years. You don't get a lot of freedom to choose your classes. There aren't many electives outside your major. They also have much fewer non-academic staff - US universities have about as many non-academic staff as academic staff. In Europe it's closer to 1:10. No sports, few campus life programs, no community outreach centers, etc. It's really just education (Pro-Tip: go look at a German university's job listing page, and compare to an American' university's job listings). Students apply to a degree program and cannot change their major once admitted. Three years and they're done. But they graduate with the equivalent of a masters degree in the U.S., because the first two years of a four year degree they cover in gymnasium -- the prep high school system, which also has rigorous admissions and screens people out, and is provided more cheaply than U.S. college prep high schools. There are "math" gymnasiums,"history" gymnasiums, etc. My mother went to a music gymnasium. Then from the music gymnasium you can go to vocational training in music or study music theory at a university, but you can't go study, say, engineering at a university - there is tracking and specialization. That means when you are 16 your options are already limited much more than in the U.S. You are basically focusing on your major already.

The remaining 2/3 of the population are not routed into college-prep style gymnasiums but into more vocational oriented schools. They still get a good education, but there is also practical education, and then 2 years after graduating high school they will have a career - for example, a trained machinist - but not a college degree.

There are options to change -- for example, night school -- so that someone who decides later to go to college can do so. But it's not an easy road, it's a narrow road, not the wide road. Most of the population doesn't do that.

For a lot of cultural reasons, the U.S. wont adopt such a system. They will keep telling everyone college is the best option for them, that they can change majors whenever they want, and then they will make colleges offer a lot of classes that should be given in high school, and they will maintain a bloated system of administrators. Many will find themselves with useless degrees and lots of student debt. It also leads to absurd levels of overstaffing in American colleges and absurd understaffing in vocational education.

There are other reasons for the other inefficiencies. It's interesting to look for even more underlying reasons -- say trying to explain why Healthcare in the US is so much more expensive than in Europe, whether it is similar problems to Education, or just random chance that both of these are in the U.S.. I do think there are underlying reasons that tie it all together, mostly related to the U.S. being a rich, idealistic country that had a lot of surplus wealth, and now that things are changing, we find ourselves unable to afford such extravagant systems, but they are too embedded and politically powerful to change. You can find plenty of people who advocate that more money be spent -- but people willing to adopt European spending rules, lower salaries, and restrictions on personal choice -- not so many takers. Bottom line, having the government "pay for education" so no one needs to pay out of pocket requires a massive restructuring of how education is delivered. Same for healthcare. This restructuring is unpopular in the U.S.

I spent a few years in the Hungarian higher-education system (post 2006, when we switched to the Bologna system). We had a lot of freedom to choose classes, and it's possible to switch your major. (At least it was not unheard of, not many people wanted to anyway; and it is not hard to simply submit your application the next time there's admissions.) There's (very little) sports and (a lot of) campus life. (Maybe US "campus life" is paid in a large part by the institution? But even if it is a few kegs and random DJs are not expensive.)

3 years is just bachelors. But it's possible to do extra classes so the masters then only takes +1 year.

I know that Germany has vocational schools besides the gymnasiums, but I haven't known about the different types of gymnasiums. (In Hungary in almost all high-scools students can choose to prepare for the GCSE and pick specialization courses for the last 2 years, and with that it's possible to apply for any higher ed institution all around Europe. Of course if someone wants to get a scholarship then an in-country institution has the best chance for that. I have a friend who did a music high-school, probably picked math instead of music as specialization, and then right after that went to do a CS degree at a university.)

Anyway, I think the basic supply-demand argument (student loans) explains the fundamental difference between the costs, and then feedback loops explain the rest. (Sports and other non-teaching activities. Though, as far as I know, academic sports is profitable in the US.)

> They will keep telling everyone college is the best option for them,

This reminds me of the many posts/tweets where folks say "look at how much more graduates make, so go get a degree", which is of course partially the correct strategy, but also obviously it's not magic, the degree is more of a symptom.

That said it seems to me that the US labor market is more credentialist, more places blindly ask for a degree.

> and restrictions on personal choice

I don't really know what do you have in mind, but there's a big healthy private sector in Europe for healthcare too :)

> Bottom line, having the government "pay for education" so no one needs to pay out of pocket requires a massive restructuring of how education is delivered.

Definitely. I think one very important aspect is the big income/wealth inequality in the US, which somehow makes a lot more people feel like "sharing" with others will make them worse off.