Earlier quoted context omitted.
Comparing USA states to countries is a very common practice of uneducated Americans.
In the case of health care, it’s apt because the federal government cannot force states to take actions. They can only issue guidelines.
In comparison to USA states, the European countries are a real mess: lots of small autonomous areas, language barriers everywhere (with some places only speaking particular dialects), hospital networks and management with wild variations (with a crude mix of private / public / semi-private-public / church / volunteer), population distribution with radical variations between country (hey Spain, how are things?), train network that still doesn't quite commute between countries because someone 2 centuries ago said that there might be a war coming anytime soon, etc...
To top all that, countries are much faster in claiming their autonomy than states (they are countries after all). This single fact has big implications in coordinated efforts.