Having similar rates of urbanization does not address the fact that the population density is still significantly different. Even if the urban rates are exactly the same there may still be many more pockets of rural areas in the U.S. that also require access to healthcare, which incurs significant costs. You're completely not addressing this point at all.

They're not "very different". And I gave numbers that show that Europe and the US are roughly equally urban. As for homogeneity, what kind of homogeneity are you thinking about? Europe is in general ridiculously far from homogeneous in most measures!