International comparisons between the United States and other nations’ healthcare quality, continue to generate significant debate. Sources such as the World Health Organization’s or Commonwealth Fund’ are somewhat unclear in their focus when discussion system quality and tend to devolve into subjective and questionable metrics with questionable validity and reliability to examine the complex nature of healthcare. This analysis discusses some of the challenges associated with comparisons and discusses metrics that may serve international comparisons better by questioning the premises of continued discourse in the matter. The purpose of international comparison is to evaluate the world laboratory of health care policy and processes; the discussion needs redirected in both focus and content.