If we compare the welfare state countries with others, from the point of view of both health and health services, the crisis concerns primarily the second group of countries. Nevertheless, difficulties arise also for welfare state policies. The problem is how to respond to neoconservative attacks on social and health rights, and how to change the bureaucratic and medicalized bias of the welfare state. The "golden era" of social insurance and health services, conceived as free access to funds to cope with all the growing needs of the population, is over. Limitations, controls, and priorities have to be established. In Italy and similar countries, the tendency is toward restricting health care for those who have greater needs, cutting funds for prevention, and creating greater inequalities. It is clear that the state must intervene to reduce social inequalities, but at the same time some existing differences (sexual, cultural, ethnic) have an intrinsic value that must be recognized. A policy of free-choice welfare is useful, and has nothing to do with the selective measures that are being introduced. Moreover, a key point has become the relationship between class and gender. The working class continues to be exploited, but new phenomena arise, connected with production and social reproduction and not limited to this sphere. It is true that gender includes social classes, but no social class may represent both sexes, or different ethnic groups, or gender itself.