If efforts at better cost containment fail once again, and health care costs rise to $36,000 on average for a typical American family of four under age 65 — as almost surely it would — that $36,000 will be borne entirely by the family. That family’s disposable income would be much higher if the growth of future health spending was better controlled. And, as noted, many smaller firms will stop altogether providing job-based health insurance.

It would be a major problem for families with an income of less than $100,000 a year. In 2007, only about 25 percent of American families had a money income of $100,000 or more. Close to 60 percent had family incomes of less than $75,000.

Here it must be remembered that the wages and salaries of the solid American middle class have been relatively stagnant in recent years and are likely to remain so for the next decade. Unemployment is not likely to fall significantly soon, regardless of what stock prices do on Wall Street. Indeed, often stock prices rise as firms lay off workers to drive up profits through leaner payrolls.

This prospect — relatively stagnant family incomes combined with family health-care costs that double every decade — is what America’s middle class should contemplate as it thinks about the imperative of health reform.