Many conservatives like to disparage social safety net programs as "nanny state" programs, but what does a nanny do? A nanny is a proxy parent for children when the parent is absent. They see to it that the children's needs are met. Absent a nanny or a parent the children suffer from neglect.
Government social safety net programs were enacted to address social problems that existed in the country because citizens didn't like the social conditions that existed at the time.
Families were, historically, the ones who took care of the elderly, but in the early 20th century, wages were low and offspring of the elderly were barely able to care for themselves. People didn't retire, they worked until they could no longer do so and then lived in poverty until they died. Old folks who were not able to work and had no family were typically housed in social charity institutions "poor houses" that also housed orphans, unwed mothers and the mentally ill. When the Social Security program was passed into law more than 50% of elderly people lived in poverty.
Social Security was designed to be an retirement insurance program paid for by the beneficiaries. Historically, Social Security has always run a surplus. That is hardly a nanny program but it seems conservatives seem to think it is.
Health care was not included with Social Security because the legislators of the time assumed it would come later. It didn't. It wasn't until 1965 that Medicare was enacted. President Harry Truman proposed a Universal health insurance plan but could not get political support for it due to its "socialist" connotations. Sound familiar?
By the time Lyndon Johnson was president, the plan for universal health insurance was abandoned, but there was political support for a health insurance plan for social security recipients and the indigent. Medicare was also designed to be paid for by its beneficiaries and would still be self sufficient were it not for the fact that payments into the program lagged behind the rapid rise in health care costs. That's not a nanny program, but conservatives seem to put it into that category.
Medicaid, health care for the indigent, could be considered a nanny program since it is not self sufficient but paid for out of the Treasury's general fund combined with contributions from the states. The alternative to Medicaid is charity. Should a government ignore the suffering of its indigent citizens relegating them to either suffer or rely on charity for survival?
Welfare existed in the country since its inception. Early colonies adopted "British poor laws." British poor laws provided assistance to those unable to work and put people able to work, but unemployed, into government workhouses to support them. Essentially, this country has never been without this sort of nanny program. Over the course of the country's history there have been many changes to the "poor laws" but they have always provided a social safety net against poverty. To abandon these programs is to neglect the poor.
Currently most economically stable governments provide social safety nets. Countries that don't, typically have large slums filled with disease, lack of sanitation and suffering. These countries are not without a class of wealth and privelege. They just neglect their poor and disabled citizens. Is this the trade off we want for lower taxes?