Are Americans dying too soon? The answer is yes. When it comes to "preventable deaths" -- an array of illnesses and injuries that should not kill at an early age -- the United States trails other industrialized nations and has been falling further behind over the past decade.

Although the United States now spends $2.4 trillion a year on medical care -- vastly more per capita than comparable countries -- the nation ranks near the bottom on premature deaths caused by illnesses such as diabetes, epilepsy, stroke, influenza, ulcers and pneumonia, according to research by the nonpartisan Commonwealth Fund published in the journal Health Affairs.

During last week's marathon health-care debate in the Senate Finance Committee,  Sen. Kent Conrad (D-N.D.) bemoaned the findings.

"All of these countries have much lower costs than we do," he said, pointing to a giant blue chart showing the United States in last place. "And they have higher quality outcomes than ours."

Some lawmakers theorized that the rate could be related to trauma from guns and automobiles.

Although gun and auto fatality rates are higher here than they are in most wealthy nations, the statistics underscore more complex, fundamental challenges, say physicians, economists and other experts who track health-care systems across the world.

"Chronic illnesses are a much bigger driver of health-care costs" than trauma cases such as vehicle crashes and gunshots, said Robert Shesser, head of emergency medicine at George Washington University. "Because of our wacky system, some people are bankrupted or avoiding care and some are getting too much care -- they're hogging care."

The performance of the U.S. system is a mix, at best, said Mark Pearson, head of the health division at the Organization for Economic Cooperation and Development, which analyzes data from dozens of countries.

"Where it's good, it's very, very good, and where it's bad, it's horrid," he said. The United States, for example, is the international leader in the detection and treatment of most cancers, he said. Americans have earlier access to new medicine and technology, sometimes while the clinical trial is still under way. Europe, by waiting, often has more information on new products.

For people with insurance, "America delivers care in a timely manner," Pearson noted. That stands in contrast to the situation his own family faces in England, where relatives have waited weeks for tests or elective procedures.

But as many as 80 million Americans are uninsured or underinsured, which means they have little access to a regular physician, checkups, preventive services, affordable prescription drugs, dental care or screening tests.