The origin of the phrase "You get what you pay for" is sometimes attributed to the fashion mogul Aldo Gucci, who said, "The bitterness of low quality is remembered long after the sweetness of low price has faded." But when it comes to healthcare, Americans get neither quality nor affordability.

The United States healthcare system is the most expensive in the world, but when it comes to health outcomes, it performs worse than 11 other similar industrialized nations, according to a new report released today by the Commonwealth Fund.

The nonprofit examined the health systems of Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom, and it found that the U.S. was last or near-last in measures of health access, efficiency, and equity.

Commonwealth Fund

According to the report, the United Kingdom, which has a single-payer healthcare system, ranks first. In second place is Switzerland, which like the U.S. has a compulsory health insurance system—though Swiss health insurers are not allowed to make a profit off their basic insurance plans.

It's important to note that one reason for America's lag, as the authors explain, is our historic absence of universal health coverage. But the data for the report was collected before the full implementation of Obamacare, which dramatically expanded health insurance, so it's possible that the U.S. may rise in future rankings.