WASHINGTON

A 2007 health-care survey by the Commonwealth Fund found that the United States, with the most expensive health system in the world, is outperformed by other developed countries on measures of quality of care, access to care and health outcomes.

And, although the other countries reviewed had varying types of health-care systems, most provided a publicly financed system, with universal coverage for their citizens. It is that kind of a national health-care system that the Americans should use as a role model for reform of the U.S. health-care system.

America’s health-care crisis grows more serious year by year. Forty-seven million Americans — nearly 20 percent of the U.S. population, are without any health insurance, and that number grows as more and more workers and retirees with job-related health-care coverage watch it disappear in a shrinking economy. Further, it is estimated that there could be as many as 25 million Americans who are underinsured — only a serious illness or medical emergency away from financial ruin.

In “Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care,” the Commonwealth Fund focused on interviews with physicians and patients in Australia, Britain, Canada, Germany, New Zealand and the United States who were asked to speak about their experiences and views on their health systems. The U.S. ranked last in most areas, including access to health care, patient safety, timeliness of care, efficiency and equity. Americans also were last in terms of whether they had a regular physician. In another study of why health costs in the United States are so much higher than in eight other countries of the Organization for Economic Cooperation and Development — Australia, Britain, Canada, France, Germany, Japan, the Netherlands and New Zealand — it was found that, even though the U.S. spends the most on publicly and privately financed health insurance, its citizens had the most potential years of life lost due to circulatory and respiratory diseases as well as diabetes.

The number of uninsured Americans is rising while the number of U.S. companies offering a health-care benefit to employees is falling. Health-care premiums have risen 78 percent in the last six years but wages have risen only 19 percent. The financial health of the American middle class deteriorates every month because of health-care costs.

The public-private programs that have been established in the U.S. — Medicare, Medicaid and the SCHIP program — have proven to be successes, making vast improvements in health outcomes for seniors, low-income families and children. That doesn’t mean they are without flaws, but they have proven to be efficient deliverers of health-care service to the populations they cover.

A guaranteed American health-care plan would cover every American citizen with services financed publicly and implemented privately. An American program would create a national risk pool including every American, driving the risk down to the lowest possible.

Under an American health plan, there would be no interference with the delivery of health-care services by the private sector, while public financing would provide financial support to drive the system to achieve maximum efficiencies and lower costs.

Such a system works in many of the industrialized nations; it would work for the United States as well.

Amy F. Isaacs is the national director of Americans for Democratic Action ( www.adaaction.org).