By THE EDITORIAL BOARD

Even as Americans struggle with the changes required by health care reform, an international survey released last week by the Commonwealth Fund, a research organization, shows why change is so necessary.

The report found that by virtually all measures of cost, access to care and ease of dealing with insurance problems, Americans fared poorly compared with people in other advanced countries. The survey covered 20,000 adults in the United States and 10 other industrial nations — Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and Britain, all of which put in place universal or near-universal health coverage decades ago. The United States spends far more than any of these countries on a per capita basis and as a percent of the national economy.

For that, it gets meager results. Some 37 percent of American adults went without recommended care, did not see a doctor when sick or failed to fill prescriptions in the past year because of costs, compared with 4 percent in Britain and 6 percent in Sweden. Nearly a quarter of American adults could not pay medical bills or had serious problems paying them compared with less than 13 percent in France and 7 percent or less in five other countries. Even Americans who were insured for the entire year were more likely than adults abroad to forgo care because of costs, an indication of how skimpy some insurance policies are.

When Americans got sick, they had to wait longer than people in most of the other countries to get help. Fewer than half were able to get same-day or next-day appointments with a doctor or nurse; one in four had to wait six days or longer. (Only Canada fared worse on both counts.) But Americans got quicker access to specialists than adults in all but two other countries.

The complexity of the American insurance system is also an issue. Some 32 percent of consumers spent a lot of time on insurance paperwork or in disputes with their insurer over denials of payment for services they thought were covered.

The Affordable Care Act was created to address these problems by covering tens of millions of uninsured people and providing subsidies to help many of them pay for policies; by setting limits on the out-of-pocket costs that patients must bear; and by requiring that all policies cover specified benefits.

Americans are understandably frustrated with the Obama administration’s failure to produce a functioning website. President Obama’s erroneous statements that all people who like their current insurance policies can keep them — not true for many people buying insurance in the individual market — has added to anger and misunderstanding. The reform law, however imperfect, is needed to bring the dysfunctional American health care system up to levels already achieved in other advanced nations.