I don't understand what any of that has to do with healthcare.

Ok, thanks for your question.

Ok, I'm not American, I'm Australian (getting that out of the way up front).

But... But, we are saturated with US culture, American social norms and politics. I could say with a large degree of confidence that an average Australian (or European) could pass a pop quiz on the United States probably better than an average American. This isn't a boast, it's a fact of life due to the relative size of our comparative social footprints.

So when I say that the US isn't one country, but many, I'm not being facetious. Your federal system consists of a bunch of little fifedoms comparable with Germany in the 18th century. On the face of it, yes, you are, of course, 'United'. In reality you guys seem fundamentally Balkanised.

Culturally, socially, religiously, and very much politically, you might as well have hard borders.

That's what my casual one-liner meant to convey.