What is monumentally new about the American state today is the vast and colossal empire of entitlement payments that it protects, manages, and finances. Within living memory, the government of the United States has become an entitlements machine. As a day-to-day operation, the U.S. government devotes more attention and resources to the public transfers of money, goods, and services to individual citizens than to any other objective: and for the federal government, these amounts outpace those spent for all other ends combined.

Mark Schmitt, a regular contributor to TNR and senior fellow at the Roosevelt Institute, wrote an elegant critique of Eberstadt’s argument. So did Lane Kenworthy, a sociologist at the University of Arizona. As they note, Eberstadt is correct when he says that the entitlement state has expanded significantly in the last 50 years. But that increase reflects two factors more than anything else: Health care and old people. (Relatively speaking, the cost of low income programs outside of health care is actually declining.) In 1965, with the enactment of Medicare and Medicaid, the federal government assumed responsibility for financing medical care for the elderly, as well as the poor and disabled. It also boosted Social Security payments to provide more of the elderly with adequate incomes. The aging of the population and rising cost of medical care have made these propositions significantly more expensive over time.

Are the people who benefit from these programs today takers rather than makers? Hardly. Most of these people contributed what they could towards he cost of these programs, via payroll taxes, during their working years. If they don’t contribute now—and, remember, the majority of them still contribute something, since Medicare has both cost-sharing and premiums—it’s because they are no longer capable of doing so. They’re too old or disabled to work, and their fixed incomes leave them relatively poor. As Jared Bernstein of the Center on Budget and Policy Priorities reminded me recently, median income for Medicare and Social Security beneficiaries is about $25,000.

The growth of these programs has placed significant new demands on the federal budget. That’s why there should be, and has been, a vibrant debate about how to make the programs sustainable, whether by reducing the money they send out or increasing the money they take in. The growth of other, more narrowly tailored programs (like welfare) has also contributed to the fiscal strain, although far less significantly. That’s why there should be, and has been, an equally vibrant debate about who is eligible for these particular programs and under what conditions they should get them. More nuanced conservatives, among them Brooks, Ross Douthat, and Ramesh Ponnuru, have been part of these discussions for some time.

But the fact that the entitlement state has grown shouldn’t, by itself, alarm us. It’s actually a sign of progress, because it’s a reminder that the government has stepped in to do what the market would not. We saw, in the years before Social Security, what the world looks like when seniors don’t have adequate pensions. And we saw, in the years before Medicare and Medicaid and (now) the Affordable Care Act, what the world looks like when people can’t afford to pay their medical bills. It was not pretty. But the price for addressing those failures was the creation of some massive government programs. They cost a lot of money, yes, but we all benefit from them at some point, as Schmitt noted in his essay: “Most of us, other than the permanently disabled, are givers and takers to government, because that’s what it is to be part of a community or a nation.”