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Their points about the role of race in the development of the U.S. welfare state and the distinction between social insurance for the deserving poor and social welfare for the underserving poor are all well taken, but this account misses a few things. Among other things, it is important to note that Medicaid, despite being a "welfare" program has held up rather well and continues to expand. Even if the ACA is struck down by the Court this spring, Medicaid will continue to play an important role. Some of this is due to the fact that this program provides nursing home benefits for formerly middle class people...but also because it enjoys support from hospitals, nursing homes and state governments. The surprising political strength of "welfare medicine" in the US notwithstanding, the trend toward redistributing wealth to the rich strikes me as a bigger concern than overspending on welfare in either country. In the spirit of the season and the exchange, I think I will go read Dickens...."are there no prisons?" Sent from my Verizon Wireless Phone -----Original message----- From: Tom Foubister <[log in to unmask]> To: "[log in to unmask]" <[log in to unmask]> Sent: Fri, Dec 23, 2011 09:15:50 GMT+00:00 Subject: UK welfare state Dear all, In today's BMJ Martin McKee and David Stuckler have a short article giving a succinct outline of how the welfare state in England is currently being eroded. The article misses the devastation underway within local government welfare services, especially in terms of care received at home, where the picture is most depressing of all. But if you're interested in a good snapshot view, which also provides a take on the US (have they got it right on the US?), here's the link. http://www.bmj.com/content/343/bmj.d7973 Happy Christmas, Tom