Spokane metro is 579k. Geneva metro population is 633k. So Geneva metro has slightly more people than Spokane metro. Of course, the metro areas are wall to wall (so Geneva metro is adjacent to Lausanne metro) but they both have their own healthcare systems and aren’t gaining much more from scale than American metros.

And Spokane is a small case. There is nothing comparable to the Seattle metro in Switzerland. The closest you get is Paris in France or Milan in Italy.