The myth of American medical superiority.

Sen. Mitch McConnell of Kentucky was on a roll.

"Nothing makes me more angry ... than the suggestion that America does not already have the finest health care in the world," the Senate minority leader said Monday at a forum in Kansas City.

He got no argument from Sen. John McCain of Arizona, the former Republican presidential nominee, who appeared with Mr. McConnell. "The quality of health care in America is the best in the world," Mr. McCain said.

It has become an increasingly familiar refrain, and no wonder. It appeals to patriotic audiences and implies that reform — tinkering with what purportedly is the best system — would be dangerous and unnecessary.

So it seems almost subversive to ask this simple question: Is it true? Is U.S. health care the world's best?

The short answer: No.

It does well on some quality measures, not so well on many others. Study after study has found quality problems in U.S. health care.

Here's what experts from the Institute of Medicine, part of the National Academies of Science, wrote in a 2001 report: "The American health care delivery system is in need of fundamental change.... Health care today harms too frequently and routinely fails to deliver its promised benefits."

Individual American physicians often are outstanding. But the system in which they practice is fragmented and uncoordinated, filled with misdirected economic incentives and surprisingly lacking in basic care management tools.

The result: Even people with good insurance get recommended treatments only about half the time. Meanwhile, medical errors kill more Americans each year than breast cancer, AIDS or motor vehicle accidents.

No health system is perfect. Other countries have problems, too. But many researchers have compared U.S. health care to that in other developed countries and made similar conclusions.

A new analysis by experts from the non-partisan Urban Institute concludes: "It is safe to say that U.S. health care is not pre-eminent on quality."

Where does it stand out? "(I)n the very high costs of its health care and the share of its population that are uninsured."

In a ground-breaking report published nine years ago, the World Health Organization compared the health systems of 191 nations. It ranked the United States at number 37.

That report isn't based strictly on quality measurements. Instead, it compares actual performance against what health experts say could be accomplished with the resources spent on care.

The poor performance of our health care system is reflected in quality indicators that have become distressingly familiar in the reform debate.

— Average life expectancy is lower here than in most other developed nations.

Infant mortality is significantly higher.

— We have the highest rate of preventable deaths among 19 industrialized nations in a recent study. That rate has declined in recent years, but not as much as it has elsewhere.

— A survey of doctors in five countries found American physicians are more likely to say cost controls threaten the quality of care they provide, and to complain about limitations on medications that they can prescribe.

— American patients — especially those with chronic illnesses — are far more likely than those in other countries to report skipping medicine or missing doctor visits because of cost.

Good news: We do very well on cancer care.

The United States has a higher five-year survival rate for many cancers than most other countries.

The implication, at least in the minds of many reform opponents, is that means we have the latest, most technologically advanced treatments. But experts say the better survival rate is almost entirely because of more aggressive cancer screening here.

U.S. women are more likely to have annual mammograms than women in most other countries. Men are more likely to be screened for prostate cancer. Screening helps catch cancer earlier, when it's easier to treat. It also helps catch some cancers that never would become life threatening and require treatment. That increases the survival rate.

Those achievements must be balanced against the fact that about 50 million Americans are uninsured and have limited access to care. Millions more are underinsured and face the threat of bankruptcy should they become seriously ill.

Among other developed nations, only Mexico and Turkey have such large proportions of uninsured residents. None has a similar rate of medical bankruptcy.

Quality of care issues dramatically affect the uninsured. Remember those high rates of preventable deaths? The Institute of Medicine reports that thousands of uninsured people die every year from preventable illness. Uninsured diabetics are more likely to have uncontrolled blood sugar than those with insurance. Uninsured people with hypertension are more likely to have uncontrolled high blood pressure. Stroke, a common consequence, is the third-leading cause of death.

Lack of health insurance even skews quality measures in which the United States performs well, like cancer. People without insurance, or those who are underinsured, are less likely to get those potentially life-saving early screenings. Thus, they are likely to be diagnosed with cancer at a more advanced stage than people with coverage.

Here are some interesting statistics:

— Survival rates for U.S. cancer patients under age 45 are similar to those in Europe, but cancer patients 65 and older do much better than those in Europe.

— Average U.S. life expectancy at birth is low, but average life expectancy at age 65 is better here than in Europe.

— And while childhood vaccination rates are lower in the United States than in Europe, the rate of elderly Americans who receive annual flu shots is substantially higher.

Why do health outcomes for Americans get better when they hit 65? Because that's when they qualify for Medicare. Many get health insurance for the first time.

Congressional Republicans like to repeat scare stories about Canadian health care. Researchers have reached a very different conclusion.

Of 10 large peer-reviewed studies comparing quality of care for cancer, heart disease, chronic illness and surgical procedures, five favored Canadian care, two favored the United States, and three reported mixed results.

Mitch McConnell and John McCain may believe America has the world's finest health care, but the facts tell another story.

The biggest threat to Americans is not needless tinkering with the U.S. health system. It's sabotaging efforts to improve it.

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