>the city takes the right-most car lane, draws a bike sign on it, and tell cars and bicyclists to "get along"
I bike commute daily in Somerville and Cambridge MA. My routes have dedicated bike lanes for about 1/2 the distance, "sharrows" (bike sign + >>> symbol) for about 1/4 and nothing on the rest. I'll agree that the sharrows don't seem to do much, but we seem to get along pretty well with cars anyway - with occasional friction. I feel pretty safe.
I rarely see bikes impede traffic. They either ride with the flow of traffic or stay right if they can't keep up. Once in a while when the road is very narrow or torn up they might slow traffic a bit, but then get right ASAP.
In 2 years of daily commutes I've seen only 1 instance where a bike impeded a car for more than a few seconds, and that's because the road was so torn up on the right hand side that it wasn't usable, forcing bikes into the middle of the lane for about 10-20 seconds. The driver tailgated closely the whole time and started honking - in ignorance of the law that bikes have 100% right to the lane if there's not room to share it with a 3 foot margin.
Bikes often won't go super close to parked cars for fear of being "doored", but they generally seem to ride at least 10 mph, especially where they need to occasionally weave into the main traffic flow, e.g. for double-parked vehicles.
On my route the only place it gets a little crazy is where you're in 4 full lanes of traffic and have to cross from right to left in about 200 feet. All the bikes ride between lanes and generally weave their way over in the heavy but fairly slow traffic.
I've never had a reportable close call or seen an accident, but there are plenty of annoyances. Busses seem to make it a sport to brush close to you or cut you off - much worse than even large trucks do. Taxis are jerks. They blast by with inches of room. Expensive german SUVs are next worst. Always in a hurry. Oddly I've noticed prius drivers are pretty bad too, pedal to the metal. I don't get it. [edit - these are gross generalizations, and even then only apply to a small fraction of the driving population. The vast majority are careful and polite!]
My fellow bikers are not always prize material either. For too many, red lights seem not to exist at all and they blow through with barely a glance. There are the invisible bikers too, riding at night with no lights no reflectors, and wearing dark clothes. Freakin' morons. I look like a total dork/xmas tree, but I'm visible.
I get very annoyed at people who drive right over my bike lane when there's plenty of room not to. They'll go past me then get slowed by traffic and block my lane - which is painted bright green btw, with white borders. Pretty hard to miss if you're not on the GD phone. I've even yelled at them "bike lane!" a few times. (dumb, I know, and I'm trying hard to chill. Yelling doesn't help) Another pet peeve drivers who stop way right in the lane so I can't even squeeze by. It's only a few rare cars that do this, but it only takes one to screw you over. Drivers - please leave me at least a measly 2 feet!
All in all, I love my bike commute. It's honestly my favorite part of every day - at least when it's above freezing :). And I strongly wish more people felt safe to ride, because I like the company, and feel even safer in a pack than alone. It actually gets pretty congested in places during rush hour (a dozen bikes at a light isn't uncommon) but I say the more the merrier.