Regular readers know that I’m more than a little cranky about the ancient habit of Democrats of raising heaven and hell to defend the Medicare program while ignoring threats to Medicaid, based on the cynical belief that the former is popular among people who actually vote, while the latter is a “welfare” program of interest only to po’ folks who don’t vote or vote so reliably Democratic that they can be ignored. It’s a particularly offensive habit at the moment, since the GOP’s evil designs on Medicaid are much clearer and more immediate than their convoluted schemes to slowly strangle Medicare benefits.

So I share Jonathan Cohn’s surprise and happiness that the Obama campaign is now actually running a 30-second ad about Medicaid and only Medicaid. To be sure, it’s only about the long-term care function of Medicaid, which affects those prone-to-vote old folks, not to mention their children, who face the possibility of much greater “sandwich generation” woes if states implement a Medicaid block grant with reduced funding by cutting back on the “middle-class entitlement” of long-term care assistance.

Jon’s piece does a good job of explaining how a Medicaid block grant would work and why it will almost certainly lead to big changes in benefits or eligibility. But he leaves out one very important factor: the eagerness of many Republican governors and state legislators, especially in the South, to cut Medicaid eligibility on purely ideological grounds.

But this, of course, is part of the reason block grants are so perennially popular among Republicans in Congress and in national politics: they remove proponents from direct responsibility for controversial actions they absolutely know their policies will produce. After all, they will piously say, you don’t want some “one-size-fits-all” approach from Washington, do you?

At some point block-grant-the-safety-net proponents need to be very bluntly asked: “Is allowing old folks to die in dignity a ‘one-size-fits-all’ prescription? Exactly where would it not fit? How about basic health services for the disabled? Where will that not fit?”

I have no idea if Joe Biden tonight or Barack Obama in the future will be able to pull off this sort of two-step attack on the GOP’s evasive but destructive proposals for programs like Medicaid. Surely no one more deserves it than Paul Ryan, whose budget represents the most direct assault on the New Deal/Great Society legacy that we’ve seen since the Great Society itself, and who likes to obscure his nasty proposals with a blizzard of numbers and crocodile tears for the more vulnerable Americans, who in more honest moments he describes as “takers.” (As Cohn puts it, Romney and Ryan would “expose the elderly and disabled, as well their loved ones, to the kind of suffering this country spent decades trying to eradicate.”)

But whether or not it’s a sign of things to come, it’s good to see a campaign ad about Medicaid. Who knows, someday it may become politically fashionable to talk about the needs of poor people, whether or not they are old or disabled or have middle-class kids.

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Ed Kilgore

Ed Kilgore is a political columnist for New York and managing editor at the Democratic Strategist website. He was a contributing writer at the Washington Monthly from January 2012 until November 2015, and was the principal contributor to the Political Animal blog.