The United States has come dead last among developed countries since a nonprofit began ranking healthcare systems in 2004. Problems begin but don’t end with lack of access to insurance.

It’s no news to most Americans that our healthcare system has big problems. The cost of healthcare in the United States dwarfs the cost in other countries, and we don’t get better results. Roughly 7 million more Americans have obtained public or private insurance coverage through the Affordable Care Act (ACA), which rolled out at the beginning of this year. But many millions, including some who have insurance, still can’t access quality care.

When it comes to healthcare, Americans could hardly do worse, according to data from the Institute of Medicine and the Commonwealth Fund, which has been comparing the U.S. healthcare system to those of 10 other developed countries since 2004.

The U.S. population has worse health and more premature deaths at all ages and at all income levels than any of the other 10 countries. The United States has higher rates of preventable deaths and infant mortality, too.

Related News: What to Do if You Get a Surprise Bill From the ER »

When given the chance to change our system, as we have been during the prolonged battle over President Obama’s signature bill, many point to problems in other countries as a reason to leave bad enough alone. A significant number of political ads this campaign season are spreading the familiar message that European-style universal healthcare is much worse than what we have.

In a recent op-ed in the New England Journal of Medicine, Karen Davis, a health economist at the Johns Hopkins Bloomberg School of Public Health and the former president of the Commonwealth Fund, reviewed some statistics gathered just before the ACA’s biggest changes began to roll out. She painted a picture of just how widespread our problems are.

The American poor fare worst. About one-third report foregoing medical care because they can’t afford it, and healthcare bills are the largest single cause of personal bankruptcy. Americans are more likely than people in any other developed country to go to emergency rooms to get care they could get from a regular, much cheaper, doctor’s appointment. Poor Americans reported longer wait times at the emergency room than their European counterparts as well.

Still, the public seems terrified of so-called “rationed care.” They fear months-long wait times for needed care in countries with nationalized health systems. However, it turns that the panic rests on faulty facts.

Here’s what Davis wrote about rationing: “Notwithstanding Americans’ impression that other countries ration care, for lower-income adults, obtaining timely primary care is a bigger problem in the United States than in other industrialized countries.”

In the Commonwealth Fund report, lower-income Americans were more likely to report waiting six days or more for an appointment than poor Europeans. It was also significantly harder for them to get needed care in the evenings, on weekends, and on holidays. Americans who work for wages have to take time off to see doctors during business hours.

Fewer U.S. medical practices than in any other developed country — just 40 percent — have a plan in place for how to treat patients outside of standard business hours, even if that plan is directing patients to a nearby urgent care center. Urgent care centers have sprung up to fill the gap, but if they are covered by insurance, patients usually face higher co-pays.

There is a better way, Davis told Healthline. In Denmark, doctors are offered extra pay to staff a hotline at an after-hours call-in clinic. Based on their conversations with patients and access to their electronic health records, the doctors can phone in prescriptions and give callers input on whether they should go to the emergency room or if their condition can wait until morning.

An American’s first question might be, “Who pays for that?” But this setup actually saves money in the long-term.

“It actually would cost less because a phone call is a lot cheaper than an ER visit. Not having anywhere to go with a routine infection — having those people in the ER doesn’t make any sense,” Davis said.

Related News: Without More Providers, Medicaid Expansion Will Stress ERs »

American doctors are dissatisfied with the status quo, too. Fewer doctors in the United States express job satisfaction than in any developed country except Germany. They say that their offices spend too much time battling insurance company restrictions on how they can provide for patients. A third of American doctors are unhappy with their incomes, a share that puts the United States in the bottom third of developed countries.

The marketplaces established by the ACA are on track to improve healthcare access. Before the reforms, one in five Americans was uninsured; that number has now dropped below one in six. Open enrollment for 2015 begins Nov. 15.

Six in 10 people who have purchased insurance on ACA marketplaces say their policies are affordable. Seven in 10 expect the plans to put healthcare within affordable reach.

However, as Davis noted in her op-ed, 23 states have refused to expand Medicaid insurance for the poor to meet the federal government’s new income guidelines.

And as the numbers show, insurance coverage is just the first step toward improving health and healthcare.

Health Insurance Exchanges 101: What You Need to Know »