It was the same growing up in San Jose, CR. My friends would always meet up on Saturday nights at the Burger King next to the San Pedro mall. It was so fancy! American fast food wasn't cheap either, probably 2-3x more expensive than most other places you could eat in town.

Was it the same food as we get in the US, just with better service/setting?

In my experience, yes. A Big Mac is a Big Mac pretty much everywhere. The non-US stores do often have some menu items that are targeted to local tastes, that you would not see in a mainland US store.

The McDonalds in Rome near Termini had an amazing desert bar!

I wonder if the international franchises have more freedom to vary the menu? I'd guess the standard signature items like the Big Mac and fries are pretty much mandatory though.