> To have a centralized state sponsored education or health care system allows it to be more efficient that smaller for profit institutions that have incentives to increase cost to the students as their profit depends on that.

There is a major flaw in this argument: mixing incentive with potential. Yes, governments have the potential to be more efficient due to scale, but there is no incentive to do it. Smaller for profit institutions don't have the economy of scale, but have the incentive to be very efficient. In the end, private institutions need to be extremely efficient to compete with the free state colleges in Europe, while free state colleges have zero motivation to improve and compete, their money is a given.