The Commonwealth Fund is at it again with another headline-grabbing survey showing how absolutely abysmally dreadful the U.S. health care system is.

It says we rank last among six nations it surveyed, including Australia, Canada, Germany, New Zealand, and the United Kingdom, in a long list of access, efficiency, equity and other measures . You might note that these other countries have very different health structures than we do, with much more government domination.

There is more wrong with this survey than we have time or space to describe here, but a core problem is the kinds of questions they ask.

No where that I could find do they talk about relative survival rates after someone is diagnosed with cancer or how quickly you can start chemotherapy or get heart surgery if you are in crisis -- questions that get to the true quality of medical care in a country.

This study is based on a public opinion survey of primary care physicians in these countries, asking how easy it is for their patients to get care evenings and weekends, waiting time to see a doctor, how easy it is to print out a full list of the medications their patients are taking, etc. We have a very different system with a lot of problems. But we also have strengths, which this survey largely ignores.

This is an opinion survey that is very light on hard data, and yet it is being used to club the U.S. health sector once again. Is the strategy to wear down the morale of our health care workers and tear down the U.S. system so voters will demand that it be replaced it with a government-run version? You have to wonder.