It is no better, and often worse when adopting internationally. We did an orphanage adoption to ensure the finality of the adoption at placement. WE have no regrets about our adoption and our daughter, but certainly she had many issues that were either unknown or undisclosed. LIke arriving at age 2 half deaf and having no language development at all. WE had met her and started the process at 15 months, and were aware she was delayed at that time and also had a severe cross-eye condition. But she was far worse 10 months later when the adoption was approved and she could leave the orphanage.
The US agencies use in-country facilitators, and those facilitators may or may not provide full-disclosure, to whatever extent it is available. We were in the heartbreaking position of refusing to go forward with our first referral - a little Roma girl who was SOOOO severely affected by either fetal alchohol or fetal drug exposure, or some other form of brain damage that she was absolutely non-responsive to any stimuli. Because I had spent time with brain damaged adults after my father's brain surgery, I recognized many things that the average person may not. The facilitator tried to use guilt ("You just want a perfect child" "You don't like the way looks (not true, we already had pictures and knew what she looked like)" and so on to try to coerce us into proceeding with an adoption of a child that I knew would need lifetime care. We, as older parents, knew we would not live long enough to be there for her the way she'd need.
Our wonderful daughter has overcome many delays and difficulties, these have not fazed us. But certainly none were addressed in the minimal med report that the agency provided.
I do wish to comment that one cannot presume that a person working as a waitress is NOT a nursing student. MY sis, who now has two masters, including one from Yale, has waited plenty of tables working her way through school. And my father, who had a juris doctorate, prefered to work selling real estate and trading. So a person working in a field they like can STILL have the degree the agency stated they did. They MAY not have lied.
Also, as an adoptive parent, what is really important is that the adoptive parents have a stable, happy, loving, supportive and safe environment for their child. And time to spend with them. My husband does not have a masters, nor do I, but we have a nice home in a very good neighborhood, a good school for her, and a great marriage. She is a very happy, kind, loving and accomplished child. I'd hate to think we would have been considered not good enough to adopt because he lacked a masters degree.