Healthcare in the United States is in a dismal state of affairs, not only failing to improve but actually declining in quality over the last two years, according to a new report card from The Commonwealth Fund (CWF).

On average, the U.S. scored 65 out of 100 in 37 indicators of health outcomes, two points below the CWF’s 2006 report card. Barely half of all adults received basic preventive care, including screening for cancer, and insurance premiums rose at rates that far exceeded wage increases, according to the report. Efficiency performance received one of the worst scores: 53 out of 100, due chiefly to preventable medical errors and other wasteful care practices.

The United States ranked last among 19 industrialized nations for preventable deaths, according to the report, though Americans spend more than twice as much on healthcare as any of those other countries. The CWF issued some recommendations for helping correct the problems in the U.S. healthcare field that include well-designed universal coverage, patient-centered care and incentives to promote higher quality and efficient care.