The U.S. health system trails far behind health systems in 10 peer countries when it comes to affordability, administrative efficiency, equity and health care outcomes, according to the Commonwealth Fund’s latest international rankings of high-income countries. Unique in measuring and comparing patient and clinician experiences across nations, Mirror, Mirror 2021 shows that in the U.S., an individual’s chance of getting good health care depends to a large extent on income — more so than in any other wealthy country. The U.S., which spends the most per person on health care, has ranked last in every edition of the report since 2004. And the U.S. has fallen even further behind on certain measures, especially health outcomes linked to primary care access and equity in care delivery. Read the report to get the complete health system rankings and discover what the U.S. could learn from other nations to improve health care for all Americans.