You misunderstand what 'quality' means in this context. Quality is about the amount of compression applied to the image when the Jpeg is created. Is had very little to do with the quality of the photo. A well exposed image will print pretty much the same from a 1, 2 or 5mb image, especially from a domestic printer. You might see artefacts on a very high quality printer, but it's really not that mooch different.
Jpeg quality really comes into play if you use a lossless editor after exporting. This is in the nature of the Jpeg format. It's not an image format at all, it's a compression format attuned to images. Essentially its a special kind of zip file. When you open a Jpeg it's decompressed, so that 5mb Jpeg could contain a file that uses 50mb of RAM.
However, if you edit the image, then the file is recompressed and that means that some data is thrown away. In theory, edit a Jpeg enough times and you'll have an empty file. To overcome this, when you edit in apps like iPhoto/Photos the original file is not touched. The edit decisions are recorded in the db and only committed to the file when exported.
Exporting create a new file, containing the same photograph. But the quality of the file - which is the amount of compression applied - can be selected. If you found that the Preview in iPhoto always matched the reported size of the original then either a: that was a fluke or b: the image wasn't edited.
Medium gives about the same quality as the Preview, that's all.
The best quality to export at depends on the next use the file gets: if it's going to editing further, then high. Other than that it doesn't make a huge amount of difference.