The Commonwealth Fund on Tuesday said that the U.S. healthcare system has declined since 2008 with a current “score” on 42 indicators of healthcare quality, access, efficiency, equity, and healthy lives of 64 out of 100.

So our top dollar (double the cost in other countries) health care system had more preventable deaths that could have been prevented by timely and effective medical care than any of the other 15 industrialized countries included in the report, while our average infant mortality rate is 35% higher than rates in the top-performing states, and other high-income countries have infant mortality rates that are significantly lower than our best-performing states. Indeed if we matched the French results, 91,000 fewer infants would die prematurely each year.

Perhaps our fear of medical bills when uninsurred is the problem, since in 2010, 81 million adults were uninsured, up from 61 million in 2003. And its not like spending 1 dollar in 5 on health care holds back our ability to compete in this world, or to create jobs in America. Indeed its not like our mental health is affected by 40% of working-age adults in 2010 having medical debt or problems paying medical bills, up from 34% in 2005.

Then there is our efficiency when we do not force everyone to use a single effective administrative system, with the U.S. scoring only 53 out of 100 in that category, which looked at whether patients were receiving duplicative services and whether hospitals had high readmission rates, among other indicators. Seems 44% of adults reported that they didn’t have a primary care provider in 2008, and only half said they received all recommended preventive care. If the U.S. did as well as top performers, 38 million more adults would have a primary care doctor and 66 million more would receive all recommended preventive care. Also one-in-four elderly Medicare beneficiaries were prescribed a “potentially inappropriate drug.” But the kids are the future, as one-third of ages 10 to 17 are overweight or obese. Perhaps Insurance companies as claim managers for Medicare, pushing shorter hospital stays as cost savers, may not be working given 20% of Medicare patients hospitalized for certain conditions or procedures were readmitted within 30 days in both 2003 and 2009.

But its best to look at the bright side – there was more public reporting of quality data than in previous years; more hospitals adhered to recommended protocols to prevent surgical complications; the percentage of adults who smoke declined from 21% in 2004 to 17% in 2010; and a greater number of people were controlling their high blood pressure than in previous years. And we have the excuse that most of the data in the report came from 2007-2009, which was before the passage of the Obama Affordable Care Act (ACA).

So if you believe that the current 25% of the population in 15 states that lacked health insurance will have meaningful health coverage post the ACA mandate required in 2014, as the states come up with the money to follow ACA’s requirement that the threshold for Medicaid be changed so more low-income people will be eligible, so perhaps we need only wait. And perhaps our weak “primary care foundation and from inadequate care coordination and teamwork” will be fixed by the ACA trying to encourage team-based care, including accountable care organizations and giving primary care doctors bonus payments for coordinating care of their Medicare patients.

Anyone for single payer basic care for everyone paid for by a payroll tax and cost controlled by a national budget that sets the reimbursement rate for that basic care that must be accepted or lose your license?

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