Q: Americans spend more on health care, isn’t that because Americans have the world’s best (highest quality) health care?

Answer:  Well, no, not really.  In fact, the best measure for health care system productivity (or quality) that I have been able to find is international comparisons on reducing death which is amenable (or preventable) to health system interventions.  Some deaths are not preventable even if the best possible health care were consistently available across an entire population.  For instance, death in the very aged population will not be amenable to health system interventions; old people will simply die at some point no matter how much health care is applied.  So, if you study deaths in a population that good quality health care could prevent, and compare those rates across all first world nations, you will find that Americans are least likely in the first world to prevent death which should be amenable to high quality health care.  We pay the most for health care by far, but our health care system is least able to do the job that medical care is supposed to handle.