``the effective price of clothing, bicycles, small appliances, processed foods -- virtually anything produced in a factory -- has followed a downward trajectory. The result is that Americans can buy much more stuff at bargain prices. Many crucial services, though, remain out of reach for poor families. The costs of a college education and health care have soared. Ms. Hagen-Noey, for instance, does not treat her hepatitis and other medical problems, as she does not qualify for Medicaid and cannot pay for her own insurance or care.''

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