I've lived in the US and Canada (a couple large cities in each country), and briefly in a medium-sized city in France.
Canadian cities are the cleanest of the three countries, but homelessness and drug use are just as prevalent in Canada as in the US. I don't remember seeing many addicts in Europe but there were certainly a lot of homeless refugees when I lived there. I guess you could argue that's not the fault of the host country, unlike the homelessness in Canada/US.
Other than that, the US cities I've lived in have felt safe and livable, with vibrant street life and plenty of great restaurants and events. I prefer urban neighborhoods which are close to the downtown core, but outside of it; the visible social problems seem to be very concentrated in certain areas, which can be avoided.
If by "guarded neighborhoods" you mean gated communities with full-time live security, I think your friends are major outliers. A very small minority of people live that way in America.
I do agree with you about "less anxiety around healthcare or education". My European friends see the world and life very differently. People don't feel guilty about living a normal life in the same way that some Americans seem to: the culture here screams "strive" and "excel", and I think that drives a lot of people to be miserable when they feel they are falling short of that expectation.