A new national scorecard issued by the Commonwealth Fund’s Commission on a High Performance Health System gives failing scores to the U.S. health care system. The U.S. scores an average of 65 out of a possible 100 across 37 key indicators in the areas of health outcomes, quality of care, access, efficiency and equity.

Even though the United States spends more on health care than any other industrialized country, access and affordability have declined significantly since 2006, the report shows.

In 2007, 42 percent of all working age adults in the U.S. were either uninsured or underinsured — an increase of more than 7 percent from the previous year. The report also reveals wide disparities in health care received by African Americans and Latinos compared to their white counterparts. It also shows widespread discrimination against people with low incomes. The most vulnerable, those needing the greatest services, are less likely to receive them. Children, the elderly and the impoverished are the majority of this group.

The scorecard grades the performance of each state, with an interactive U.S. map on the Commonwealth Fund web site. Wide disparities are apparent from state to state, region to region and across hospitals and health plans even within the same geographical area. Overall, the South and parts of the West score at the bottom.

The Commonwealth Fund, which focuses on health policy reform, issued its first health scorecard in 2006. This year’s scorecard “tells us that we are losing ground in crucial areas like access to health care,” said lead researcher and Commonwealth Fund Senior Vice President Cathy Schoen. “We now have 75 million Americans who are uninsured or underinsured. Poor access pulls down quality and drives up costs of care. The U.S. leads the world in health care spending — we should expect a far better return on our investment.”

The report identifies several key sources for the current system’s failures.

Most adults cannot afford to pay health insurance premiums, which have increased faster than wages. In 2007 41 percent of adults reported that they had medical debt or trouble paying their medical bills. That was up from 34 percent in 2005.

Resources are allocated in an inefficient and wasteful manner. The report says tens of thousands die annually from errors and from causes that could have been prevented if these individuals had been provided quality health care initially.

The U.S. fell from 15th to last among 19 industrialized nations on premature deaths that could potentially have been prevented by timely access to effective health care, the report notes.

The U.S. has failed to keep up with health care improvements made in other countries, the report says. For example, we lag far behind other leading countries in the use of electronic medical records, which would help both doctors and patients.

Nonwhite patients, low-income patients and uninsured patients experience the worse outcomes, the report shows. They wait longer to see a doctor when they are ill, encounter more delays, poorly coordinated care, avoidable hospitalizations and uncontrolled chronic disease when compared with their higher-income white counterparts.

The U.S. has some of the best-equipped hospitals and best-trained physicians in the world providing extraordinary care, yet millions of its people cannot benefit from this, the report points out.

Health insurance administrative costs account for billions of dollars. These could be reduced by $51 billion to $102 billion if the U.S. changed its system, the report says. Japan, Finland and Australia, with national health care systems, spend the least on administrative costs of the countries surveyed in the report. Germany, the Netherlands and Switzerland are in the middle with a mixed private-public system.

According to the Commonwealth Fund, the “scorecard trends present a compelling case for change in the way U.S. health care is financed, organized, and delivered.”

The report calls for a national dialogue on the presidential candidates’ health care plans, with the aim of evolving a new vision for universal health care in the U.S. However it does not mention a single-payer national system as a potential solution for the U.S. Instead it offers a plan for mixed private-public group insurance and tax incentives for insurance providers.