I was just 18 when I first heard this question, but even then, in the context of the late days of the Carter Administration, it registered with me as a first-time voter, and, I know, with my parents and older relatives during a Reagan/Carter debate in 1980:
“Are you better off now than you were four years ago?”
In the context of those years, everyone knew what Reagan’s question meant—and people—regardless of political leanings, responded to it. Inflation was high, energy prices had soared, interest rates neared 20 percent, and our 52 hostages had been held for nearly a year in Iran. President Carter’s own description of “a national malaise” seemed apt, though I've never bought the idea that he or any other President is entirely responsible for every national circumstance.
When I heard the same question asked by Mitt Romney in his recent address to the Republican National Convention, I had to think a little longer, because the economic and political equations had changed so much. Let’s see . . . just refinanced at around 5%, energy is expensive but our car gets good mileage (Carter's administration set up the first auto mileage standards), economy is rough but improving.
With the possible exception of college tuition, the one really enormous economic change from the first time that I considered the ‘are you better off?’ question 32 years ago is the incredible impact of healthcare and health insurance cost increases on the budgets of governments, businesses, and households nationwide. Compared to 1979, the ability of those under 65 who do not qualify for Medicaid to afford appropriate healthcare can only be measured in our nation's incredible rate of 45 million uninsured, including a growing number who no longer receive healthcare benefits at work.
Though some criticize President Obama for putting healthcare reform “ahead of jobs,” I can’t fault either him or Congress for getting on with the business of healthcare reform. To me, the development and passage of the Affordable Care Act represents a huge boost to the health and economic circumstances of many, many Americans. And, while its major provisions won’t be in place until 2014, it has set in place a series of positive changes:
· It puts healthcare insurance in reach for some 32 million of our 45 million uninsured, including 11 million with untreated behavioral health problems. That's a feat that no business, no entrepreneur, and no amount of private investment could accomplish. Come 2014, these folks are definitely better off, though perhaps not today.
· It puts in place a set of essential health benefits that will ensure that all plans offer an array of services that includes mental health and substance use care benefits that are at “parity” with medical benefits. While neither the EHB or parity regulations are perfect, they definitely represent progress made in the past four years. Definitely better off.