I think it has much more to do with the number of people tested and the criteria they're using for doing the test. It's not fair to compare on this basis, just as it's not fair to compare nations on the number of confirmed cases.
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Early in an epidemic, the average time since an infection was discovered is longer, which means than more of those infections have reached their conclusion. In the middle, the average "age" of an infection is much less, which means that fewer have "concluded" (often in death).
And when a healthcare system hits its limit, the mortality rate can be dramatically affected, regardless of how good it is. If you assume that public policy (not the healthcare system) is responsible for "minimizing the peak", then that shouldn't reflect on the healthcare system.
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It would be an indication, but it's not struggling *today*. It's certainly not at capacity. It has about 3000 beds per million people, which is more than enough to cope with the serious subset of the 20 infections per million... *right now*
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