Alexis de Tocqueville on Free Health Care

A meme on Facebook by The Other 98% reads:

What the fuck is wrong with Americans who aren't on board with free healthcare[?]  I'm Canadian and I don't care that I pay taxes so a little boy in Alberta can have open heart surgery, or an elderly man in Nova Scotia can get the heart medication that he desperately needs. It's called taking care of your people. I'm glad I pay so that people can have a good quality of life.  It's called being a decent fucking human being.

That all sounds good and straightforward, except for some overlooked questions:

First and foremost, we appreciate the anger (What the fuck, fucking) in the message, designed to make all people who don't agree with you feel ashamed and shut up. Having said that, let us proceed:

• Should the United States and Canada (plus Australia?) offer health care or should the individual states and provinces (Texas, Massachusets, Alberta, Nova Scotia) do so — if not the individual counties or townships?

• Take Europe, which is always being dragged out for comparison: Isn't it true that there is no EU health care (or EU education department, for that matter) to speak of, that that is a matter (those are matters) to be handled by the individual member nations?

 • What is the underlying message of this meme (and of the left's raison d'être)? Isn't it that, without the presence of the state, without the presence of its politicians, and without the presence of its bureaucrats, the citizens are too dumb, too poor, too victimized, or, conversely, too evil and too greedy to take care of each other and survive?

 • What, then, is the underlying message if not that people (of whatever country) are children — poor innocent victims to be protected or spoiled brats to be punished?

So what are people (Americans, Canadians, Australians, Europeans)?

Are they children or are they grown-up citizens

who can be counted on to take care of their neighbors
— without prodding from their betters (i.e., from 
their politicians and from their bureaucrats)?

In the 1830s (merci pour the link, Maggie), Alexis de Tocqueville said that the more local a government is, the more appropriate the solutions it engenders for the (limited number of) citizens it is concerned with:

Every central government worships uniformity: uniformity relieves it from inquiry into an infinity of details. … After having thus successively taken each member of the community in its powerful grasp and fashioned him at will, the government then extends its arm over the whole community. It covers the surface of society with a network of small, complicated rules, minute and uniform, through which the most original minds and the most energetic characters cannot penetrate, to rise above the crowd. The will of man is not shattered, but softened, bent, and guided; men are seldom forced by it to act, but they are constantly restrained from acting. Such a power does not destroy, but it prevents existence: it does not tyrannize, but it compresses, enervates, extinguishes, and stupefies a people, till each nation is reduced to nothing better than a flock of timid and industrious animals, of which the government is the shepherd. …

 … In the American townships power has been distributed with admirable skill, for the purpose of interesting the greatest possible number of persons in the common weal. … The existence of the townships … is, in general, a happy one. Their government is suited to their tastes, and chosen by themselves. In the midst of the profound peace and general comfort that reign in America, the commotions of municipal life are infrequent. The conduct of local business is easy. … NOTHING is more striking to a European traveler in the United States than the absence of what we term the [central] government, or the administration.