This paper discusses the politics of ageing in the US within a political economy framework. Four forces are shaping US policy: austerity, federalism, deregulation, and the medical-industrial complex. Two major trends in the development of policy are the commodification of the aged and their needs and a class basis for the distribution of benefits, differentiating the deserving elderly from the undeserving elderly. Ideologies of individualism, self-help, privatisation, and procompetition are being used to delegitimate public programmes and to reduce expectations about what government can and should do to ameliorate social problems.

Recent policy is characterised not only by a reduction of federal funds for domestic social spending, but also a restructuring of the community care delivery system as it operates in the private, non-profit sector of the economy. The emergent processes of this restructuring, e.g., targeting of services based on ability to pay and individual characteristics, medicalisation, and absorption of non-profit agencies by for-profits are discussed. These policies and the consequences that flow from them are viewed in light of the search for new sources of capital investment in the domestic markets. This analysis raises important political questions concerning the transformation of relations between the state and the non-profit sector.

The division of responsibility for aged people in modern society, between the State and their adult children, has received little systematic attention although the matter remains a perennial item of public debate. This paper reports the Australian experience of debate and legislation in this field. It is argued that the State assumed responsibility for the support of the elderly when, under pressure from prevailing demographic and economic changes, nineteenth-century public welfare, charitable, penal and insane institutions were unable to respond. This claim is illustrated by reference to the legislation, which was passed in several of the States, requiring the provision of intergenerational support for close categories of kin. The reasons for the failure of the measures legislating filial piety are discussed and an assessment is offered of the utility of such schemes.

Drawing upon a variety of research data and national statistics, this paper presents a detailed analysis of the contribution made by family and informal care to the support of elderly Scandinavians. Comparative data from other countries are employed to highlight some similarities with other European, American and Far Eastern societies. Formal help is directed at the childless and those who live alone, but the conclusions draw attention to the dangers of this concentration if it excludes essential support to overburdened carers.

Through a descriptive and analytical account of recent trends in the care of elderly people in Sweden, a number of lessons are indicated for America and countries with similar health and social welfare arrangements. Clarity of objectives within a ‘normalising’ framework; sound organisational arrangements based on small local areas; effective knowledge of services by consumers and cost-effective provision are factors identified as significant.