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Are you better off than you were four years ago? Typical Americans today who ask themselves Ronald Reagan's famous question should have no difficulty answering when it comes to health care costs.

No. Far from it. By just about every financial measure of their medical care, Americans are worse off than they were when George W. Bush took office. And if current trends continue, they will be worse off still.

The amount workers pay for health insurance has risen by 36 percent, compared to an average 12.4 percent rise in earnings since 2000, according to an analysis by Families USA.

That's a liberal consumer group. But doubters who have not yet felt the pinch in their own paychecks can find the Families USA numbers reflected in plenty of other data indicating the nation's health care system is unsustainable.

The independent Kaiser Family Foundation reports, not surprisingly, that as insurance costs have risen, many companies are trimming benefits or dropping employee coverage altogether.

From 2001 to 2004, the foundation found, the number of U.S. workers with employer-provided health insurance fell both in absolute numbers - by 5 million - and as a percentage of the work force, from 65 percent to 61 percent.

The Washington Post reports that a survey of 900 businesses by Mercer Human Resource Consulting projects health care spending will increase by 9.6 percent per employee in 2005. So workers still with benefits should brace themselves.

As a Mercer spokesman said, the increase in health costs is four times the rate of general inflation, "And some [employers] just aren't going to sit still for it."

So more Americans will join the ranks of the uninsured, which hit a record 45 million people in 2003, or 15.6 percent of the population.

Of course, the growing squeeze on businesses and workers has many causes, some that any president can affect only indirectly and some that policies can affect not at all: a sluggish economy, aging population, new medical treatments and tests.

But in the face of changing dynamics, an effective leader would act to reform a system showing increasing signs of failure. All Americans should be assured of basic health care and catastrophic coverage. More and more are not.

President Bush's response has been an ill-conceived and dishonest prescription drug benefit for one segment of the population: senior citizens. They vote.