Although most of the chatter around Paul Ryan and his radical budget proposals has focused on his attacks on Medicare, the more brutal cuts he put forward are actually to Medicaid. The key distinction is that while Medicare is a universal social program whose benefits go to all elderly Americans, Medicaid provides healthcare primarily to low-income people, and thus must be extra offensive to people like Ryan.
In his convention speech Bill Clinton stressed how these cuts to Medicaid will actually affect many middle-class families too, because it includes funds for nursing homes and disabled children of all income levels.
Why would he say this? Because it makes strategic political sense. Because large swaths of Americans at all income levels consider themselves middle-class, entitlements that benefit the middle-class like Social Security are politically difficult to cut. Meanwhile slashing benefits that go to the poor, (as Bill Clinton should know after gutting the old welfare system) is much easier for the public to accept.
Knowing that the right-wing will always regain political power at some point and want to start slashing social programs, progressives should push for universal programs that also benefit the middle-class rather than means-tested programs that only low-income people qualify for.
For example, this would mean arguing for lowering college tuition for all students rather than expanding financial aid. (It also suggests single-payer healthcare would be much harder to get rid of by future conservatives than the subsidies provided by Obamacare.)
But wait– isn’t the whole point of social programs to redistribute wealth to those most in need? Why add a large extra cost to help people who aren’t poor?
First, there’s the strategic/political reason. If we really believe things like healthcare or education or retirement security are human rights, then when we score major victories to expand access to them, we have to make our victories last. The best way to prevent future cuts is to create universal programs that people actually see as one of their basic rights as Americans, like Social Security.
There’s also an economic/policy reason. Low-income families are essentially punished when they manage to struggle their way into the middle-class because they lose government benefits they no longer qualify for. This is the precarious reality of being lower-middle-class in America, where your family faces extra burdens just as you are barely beginning to achieve the American dream. If you instead make things like college education or healthcare guaranteed at all income levels, the government is no longer essentially penalizing people for making it into the middle-class.
One potential problem is that making a program universal necessarily makes it more expensive and thus creates political challenges to passing it in the first place. However, most middle-class families already pay for things like college and health insurance, so are likely to accept paying taxes to get them for free from the government, in the same way that most people don’t mind payroll taxes to fund their Social Security benefits, because they would have had to save for retirement anyway.
On the other hand, many middle-class people might prefer privately financing education or healthcare rather than publicly financing it because of their negative views towards government. But those negative views towards government have mostly been created in the last few decades by right-wing messaging that stirred up middle-class resentment towards low-income people for being dependent on government aid (“welfare queens”, etc.) The only way to counter it is by showing middle-class voters that the universal provision of economic rights like education and healthcare is not just about helping the poor, but about stopping the rise of economic insecurity being experienced by all Americans.