A question about health care history

I've been wondering about a historical question lately and I would appreciate your feedback.

How did the U.S. health care system — in terms of outcomes — compare to other countries before the mid-1960s  Recall that Germany and New Zealand had some version of universal coverage well before WWII and of course many countries adopted universal or near-universal coverage after WWII.  In terms of crude "bang for the buck" comparisons — dollars spent relative to health care outcomes — how did the U.S. compare?  At that time we didn't even have Medicare or Medicaid.