A new report from The Commonwealth Fund found that the U.S. had the worst-performing healthcare system overall despite spending nearly double that of other countries.

Americans have the worst health care among the world’s wealthy nations, a new report says. People in the United States die the earliest and live the sickest lives out of 10 developed countries, even though the United States spends the most on health care,

The U.S. came in last in three of five categories—equity, health outcomes, and access to care—in addition to having the poorest overall ranking.