The health system in the U.S. is failing, a startling new report finds.

The U.S. ranks as the worst performer among 10 developed nations in critical areas of health care, including preventing deaths, access (mainly because of high cost) and guaranteeing quality treatment for everyone, regardless of gender, income or geographic location, according to the report, published Thursday by The Commonwealth Fund, an independent research group.

Based on the new findings, people in the U.S. die the youngest and experience the most avoidable deaths, even though the country spends nearly twice as much — about 18% of gross domestic product — on health care than any other nation ranked.

Surveys indicate that health care is among the top priorities for voters in the November presidential election. Vice President Kamala Harris has pitched building on the Affordable Care Act, commonly known as Obamacare. Former President Donald Trump has given little detail about his health care vision; his running mate, JD Vance, has suggested deregulation.

Thursday’s findings show, the researchers say, that the U.S. spends the most but gets the least from its investment.

“No other country in the world expects patients and families to pay as much out of pocket for essential health care as they do in the U.S.,” Dr. Joseph Betancourt, the president of The Commonwealth Fund, said on a call Wednesday discussing the new findings.

Ironically, the steep price people pay doesn’t guarantee superior care.

“We are undersupplied with the things that people need most,” including doctors and hospital beds, Dr. David Blumenthal, the former president of The Commonwealth Fund, said on the call. “That’s one of the reasons why you have to wait so long in the United States for specialty care and one of the reasons why no one can find a primary care physician.”