A common talking point among American exceptionalists is that the United States is blessed with one of the best health care systems in the world, and that residents of Europe, Canada, Australia, Japan and New Zealand would all trade places with us if they only could. Sadly, their claim couldn't be further from the truth. While the U.S. does have its share of first-rate physicians, nurses, clinics and hospitals, gaining access to them remains an obstacle for millions of Americans. The reality is that the U.S. still lags behind the rest of the developed world—as well as some developing countries—when it comes to providing quality, affordable health care. And thanks to the Tax Cuts and Jobs Act of 2017, approved by Republicans in both houses of Congress and signed into law by President Donald Trump, the United States' troubled health care system is likely to become that much worse.

When President Barack Obama signed the Affordable Care Act of 2010 into law, he realized that the U.S. was facing a brutal health insurance crisis. The ACA, for all its flaws, was a definite improvement over what the country had before. In 2009, a pre-Obamacare Harvard University study found that lack of health insurance was leading to roughly 45,000 preventable deaths annually in the U.S. and that uninsured Americans had a 40 percent higher chance of dying unnecessarily than Americans who had health insurance. Medical bankruptcies were rampant, even among Americans who thought they had comprehensive insurance through their jobs. Meanwhile the self-employed were uninsurable if they had a major preexisting condition, which could be anything from diabetes to asthma to high blood pressure.

According to the Centers for Disease Control and Prevention, the ACA reduced the number of Americans lacking health insurance from 48.6 million people in 2010 to 28.1 million in 2017. More than 20 million people have gained access to health care, and that number would be even higher if so many Republican-dominated states had not rejected Obamacare’s Medicaid expansion.

But by eliminating the ACA’s individual mandate, the Tax Cuts and Jobs Act will kick 13 million off their health insurance by 2027 and cause health insurance premiums to increase by 10 percent, according to the Congressional Budget Office. To make matters worse, the new law will dramatically raise the national deficit and encourage sharp cuts to Medicaid, Medicare and Social Security, all so multinationals like Comcast, Bank of America, Wells Fargo, JPMorgan Chase and Goldman Sachs can pay a much lower corporate tax rate.

If Republicans in Congress ever succeed in overturning the ACA altogether, the number of Americans who lose their health insurance could climb even higher than 41.1 million. The CBO estimated that the American Health Care Act, one of the bills Republicans proposed to replace Obamacare, would have caused 23 million Americans to lose their health insurance by 2026 had it passed, leaving the number of Americans without coverage at 51.1 million.

The fact that the ACA still left 28.1 million Americans uncovered is appalling to the rest of the developed world, where quality health care is considered a right instead of a privilege for the wealthy. Numerous countries have instituted universal health care, many in the form of single-payer (the U.K., the Republic of Ireland, Spain, Italy, among others). Meanwhile France has achieved excellent results through a dual public/private system; in fact, the World Health Organization once hailed the French health care system as the best in the world.

Switzerland, by contrast, has adopted a privatized version of universal health care, and the Swiss system has an individual mandate not unlike that of Obamacare: residents are required to purchase private health insurance, with subsidies available to help them afford it. But Switzerland, unlike the U.S., does not have employer-based insurance; company employees, like the self-employed, purchase individual plans. And rules governing Swiss insurance companies are incredibly strict—much stricter than the rules of Obamacare. Economist Paul Krugman has noted the similarities between the ACA and the Swiss health care system, although the ACA would have to be greatly expanded to achieve similar results.

Universal health care is not only the standard in Europe—from Iceland, Sweden, Denmark, Germany and Norway to Portugal, Monaco and Andorra—it is also the norm in Australia, Canada, New Zealand, Israel and Japan. Earlier this year, Donald Trump praised Australia's health care system during a meeting with Prime Minister Malcolm Turnbull, ironic considering it employs the type of government-operated single-payer health care that Sen. Bernie Sanders has called for and Republicans routinely dismiss.

In Latin America, universal health care is the law of the land in Chile, Uruguay, Costa Rica and Argentina. Despite its radical income inequality, Brazil has also guaranteed health care to all of its citizens, regardless of income level. Brazil’s public health care system has managed to reduce infant mortality by half since it was established in 1988, while increasing life expectancy from 66 in 1990 to 74 in 2014. Even in the favelas of Rio de Janeiro, SÃ£o Paulo and other cities, Brazil’s ultra-poor have access to universal health care—unlike the 28.1 million Americans who remain uncovered, and live in constant fear of medical bankruptcy or unnecessary death.

According to a new report by the World Bank and WHO, some of the world’s worst health care outcomes among the poor can be found in parts of Sub-Saharan Africa and South Asia, but a few nations are making significant gains. Rwanda, for example, established a national health plan in 1999 and had insured 91 percent of its population by 2012. According to WHO, its life expectancy reached 66 in 2015—which is low by European standards but a vast improvement over the country's life expectancy of just 33 back in 1990. Incredibly, the average lifespan in parts of West Virginia isn't any higher—just 65.7 in 2015, per WHO.

A recent study from the University of Washington reveals how much life expectancy varies across class and region in the U.S., from 81.4 for males and 85.0 for females in upscale Marin County, California compared to just 66.7 for males and 73.3 for females in Tunica County, Mississippi. Poor men in swaths of the American south aren't expected to live much longer than poor men in Botswana, but that hasn't stopped Republicans from doing everything in their power to sabotage the ACA.

On a national level, the U.S. still lags behind a long list of developed countries when it comes to life expectancy. In 2015, the average lifespan of someone living in the U.S. was 79.3 compared to 83.7 for Japan, 83.4 for Switzerland, 82.8 for Australia and Spain, 82.7 for Italy and Iceland, 82.5 for Israel, 82.4 for Sweden and France, 82.3 for South Korea, 82.2 for Canada, 81.9 for the Netherlands, 81.6 for New Zealand, 81.4 for the Republic of Ireland, 81.2 for the U.K., 81.7 for Malta, 81.1 for Belgium and Finland, 81.0 for Germany and Greece, 80.8 for Slovenia, 80.6 for Denmark and 80.5 for Cyprus.

Several countries in Latin America have surpassed the U.S. in recent years, including Chile and Costa, whose average life expectancies were 80.5 and 79.6 respectively, according to WHO. In Cuba, a developing country with widespread poverty, the average life expectancy is 79.1. Meanwhile, Singapore's population is living to the ripe old age of 83.1.

Last summer, the Commonwealth Fund released a report rating the quality of health care in 11 developed countries, including the U.S., France, Australia, Canada, the Netherlands, New Zealand, Norway, Switzerland, Sweden, the U.K. and Germany. According to the study, America had the highest health care costs and the worst outcomes, by far.

David Squires, president of the Commonwealth Fund, observed, “It doesn’t appear that people in the U.S. use more health care in general. We go to the doctor less often than people in other countries and get hospitalized less; so, it’s not like we are making greater use. But we are paying more for the things we do use.”

The problems that the Commonwealth Fund’s study describes will surely worsen as the Tax Cuts and Jobs Act undermines the gains of the ACA and causes the number of uninsured to soar. In the past, Republicans who opposed a single-payer health care system have proposed universal health care by way of the private sector. They range from Sen. Bob Dole (a strong proponent of the individual mandate idea) to Massachusetts Gov. Mitt Romney to President Richard Nixon. In fact, one of the people Obama consulted when he was helping craft the ACA was none other than Stuart Altman, Nixon’s consultant on health care reform back in the early 1970s.

But today’s GOP has grown so contemptuous of the poor that even though elements of the ACA were taken from the Heritage Foundation, the legislation remains too generous for their liking. The GOP’s approach to health care, as Rep. Alan Grayson put it 2009, continues to be “don’t get sick, and if you do, die quickly.” And realistically, the only way to achieve universal health care in the U.S., whether it be a single-payer solution, a public/private system like France's, or a heavily regulated private-sector approach along the lines of Switzerland, will be to vote as many Republicans out of office as possible at the federal, state and local levels.

U.S. politicians and the medical community need to have a frank, candid and in-depth discussion about the ways in which other developed countries are achieving much better health care results. Otherwise, U.S. citizens can look forward to a lot more preventable deaths, unnecessary suffering and medical bankruptcies.