Faced with the prospect of the first major national health reform initiative in 15 years, America’s airwaves are filled with increasingly raucous debates about the pros and cons of ideas being proposed in Washington and on editorial pages across the country.

A common theme is how the U.S. health care system stacks up when compared to the rest of the world and the impact that reform could have on it. Recent surveys show that the majority of Americans believe that despite spotty coverage, high costs and other problems, the U.S. health care system—and the quality of health care delivered—is the best in the world. But is it really?

An analysis from the Urban Institute looks at the evidence on how quality of care in the United States compares to that in other countries and provides implications for health reform. Authors Elizabeth Docteur and Robert Berenson find that international studies of health care quality do not in and of themselves provide a definitive answer to this question.

What they do show is that the evidence for American superiority in quality of care (or lack thereof) is a mixed bag, with the nation doing relatively well in some areas—such as cancer care—and less well in others—such as mortality from treatable and preventable conditions.

And while evidence base is incomplete and suffers from other limitations, it does not provide support for the oft-repeated claim that the “U.S. health care is the best in the world.” In fact, there is no hard evidence that identifies particular areas in which U.S. health care quality is truly exceptional.

Addressing the American public’s widespread concern about the potential negative impact of health reform on the quality of care they currently receive, the authors conclude that reform should in fact be seen as an opportunity to systematically improve quality of care, rather than a threat to the existing system. It provides an opportunity to build on strengths and correct weaknesses in U.S. health care, working towards aims for improvement that the care provided is safe, effective, patient centered, timely, efficient and equitable.