Paul Johnson began his relationship with the series with his analysis of Conservative economic policy in The Coalition Effect and will return, with his team, to his conclusions then, analysing not just the first period of austerity but also how Conservative economic policy has evolved through the post-referendum premierships of Theresa May, Boris Johnson, Liz Truss and Rishi Sunak.

Recent years have witnessed other significant changes. For example, cash is used less and less while good manners seem to have increasingly characterized past behavior. Spending of individuals and families seem to come more and more in fixed amounts. The law of demand seems to play less of a role, while the overall budget has become more important. This means that tightening the belt can play less of a role when economic conditions worsen during recessions and inflations. The value of economic exchange now depends much more on the information contained in the exchange than on the value of the labor and material of what is exchanged. This may have implications for the welfare as distinguished from the economic value of the exchange. More recently the scarcity of rare materials and of difficult to produce inputs (such as micro transistors) may have become more important.

The fiscal system of the United States exacerbated the COVID-19 pandemic. The United States makes decisions about how to allocate resources using a fiscal system that assumes a baseline of private ownership from which Congress may depart by generating “revenue” and appropriating funds to the executive branch to spend for a specific purpose. This chapter describes three aspects of this allocative framework that contributed to the country’s tragic failure to meet the coronavirus challenge. First, scorekeeping, the process for predicting what legislation will “cost” and what it will “save” to meet the political desire to minimize the need to borrow. A decade before the coronavirus pandemic the Affordable Care Act created a significant “Prevention and Public Health Fund,” but as Professor Westmoreland first documented, Congressional scorekeeping rules that treat preventive investment as worthless encouraged Congress to “raid” the fund to spend on purposes other than public health, which it did. Second, Congress’ reliance on short-term appropriations to retain influence over the executive branch. Although essential to the separation of powers, the parasitic power of the purse and its insistence on short-term spending packages repeatedly stymied and hobbled federal relief with short-, medium-, and long-term impacts on the nation’s health and economic wellbeing. Third, the executive’s asymmetric discretion over spending. The president’s discretion to refuse to spend made it possible for President Trump to frustrate the efforts of Congress to continue the country’s support for the World Health Organization by declining to allocate appropriated funds for the organization in the midst of the pandemic.

This chapter presents the first annual estimates of Liberia’s economic performance based on archival data since its declaration of independence in 1847 until 2000. A lack of easily accessible data has been one of the main reasons why Liberia has appeared so infrequently in comparative work in African economic history. The collection of data was a central component of imperial governance, and historians have relied on the legacy of those efforts; independent states had both different incentives and, often, lower capacity. However, this chapter shows that it is possible to reconstruct through qualitative records annual estimates of trade and government finances dating back to Liberia’s foundation. These estimates then form the foundation for the first series of historical national accounts which can be used to compare Liberia to other countries. They show the Liberian economy during the late nineteenth and early twentieth centuries, when many other African economies were growing. A period of rapid economic growth began during the 1930s, which continued for much of the next half century before a catastrophic reversal from 1980. This chapter sets the stage for the more thematic chapters to follow.

One striking feature of the US health system, for people like us who are interested in evidence on how improvements in the way medical care is provided and financed affect its outcomes and costs, is that we have a pluralistic, not to say fragmented, medical care payment system. What is wrong with fragmentation? Think of a restaurant dinner for a large party of people. Usually they would order salads, main dishes, and desserts from a menu, and might be expected to ask the waiter to calculate the part of the check that represents their dishes – they would pay fee for service – and one could describe the pattern as fragmented. However, what if the group wants to divide the check equally? What if wine is cheaper by the large bottle but diners ordering different entrees want different wines, raising the bar tab? What if it is a restaurant where at least some dishes are better shared than on individual plates? Then a more integrated approach to dining and payment may lower cost may be better – at least for many. Many experts judge an arrangement in which health care is divided individually into different courses and ordered and paid a la carte as a system that is fragmented and ultimately costly to administer and inefficient. That is the challenge for payment reform – to move away from itemized “fee for service” (FFS) pricing to combined payment for a set menu or meal plan, and to do so in a way that will do more good than harm.

A trite, if apt, metaphor for the American health care and insurance system is a battleship that has been sailing in a particular direction for many years, with many of us as free riders in a direction we do not prefer. That direction is characterized by spending growth that outpaces virtually any other sectoral trend in the economy, and by quality and outcome measures that, at best, improve little and, at worst, deteriorate. The battleship takes up 18 percent of gross domestic product (GDP), furnishes employment to nearly 15 percent of the workforce, and consumes a large share of federal and state governmental budgets (Figure 2.1). Even if we could figure out how to cut the power, this dreadnought would continue to coast in the same direction for the foreseeable future. The obvious conclusion is that it has been and will continue to be hard to turn the vessel to go in a different direction. As of this writing, the novel coronavirus pandemic has affected the use of care as well, putting many “normal” services on hold to accommodate sick patients. And while it is too early to conclusively confirm the effect of the pandemic on spending trends, there is likely to be an effect (although even the direction is not known). Once the pandemic stabilizes, consumption of health care services will probably not return exactly to past behaviors, but there will be a strong tendency to slide back. What might help to avoid doing so, and most importantly, what evidence can be currently offered or generated to support efforts to change course?

Most people want to live long and they want to live well. Quantity of life is experienced through the lens of quality – surviving is not enough without thriving. And the whole idea of quality only exists within the broader reality of the scarcity and uncertainty that is inherent in life. We can acknowledge this truth without allowing it to paralyze us. We can live with the knowledge that life is finite and that its end – in both timing and circumstances – is uncertain. Still, living in constant fear of illness and death can wreck an otherwise good span of years.

This chapter studies the role of public opinion in the politics of education reforms in Spain between 2011 and early 2018. The influence of public opinion in education reforms varied, depending on how salient and coherent public opinion was. Public opinion sent a loud and clear signal in opposition to the government´s cuts in public education spending. Although heavily constrained by the major financial and economic crisis, the government corrected some of its budget cuts in the run-up to the 2015 elections and especially once it had lost its parliamentary majority in the same elections. On aspects related to the structure and governance of the education system, salience was high, but public opinion was much more divided (loud but noisy politics). In this case, the conservative government was clearly appealing to its core constituencies and relied on its parliamentary majority to enact its major education reform in 2013. In this political environment, the public gave little attention to policy reforms in early childhood education and care and vocational education and training. Quiet politics lent greater influence to the government’s budgetary concerns and to organized interests in the development and implementation of reforms in these sectors.

This chapter studies the role of public opinion in the politics of education reforms in England from 2010 until early 2018. We find the influence of public opinion to vary depending on the salience and coherence of public opinion. When issues were highly salient and public opinion was coherent (loud politics), the government appealed to public opinion. It expanded free access to childcare and partly corrected its original attempts to cut public spending on schools and increase tuition fees for higher education. With high salience on the issue but conflicting preferences across partisan constituencies (loud but noisy politics), the government pushed through its reform agenda, which targeted the preferences of its core constituencies. It was able to continue to do this provided it possessed sufficient strength in parliament (in the case of its attempt to expand selective grammar schools) and as long as public opinion remained sufficiently split between supporters and opponents of the government (in the case of tuition fees). When salience was low, quiet politics predominated. Several reform issues related to the governance of the education system failed to capture much public attention, which gave interest groups an opportunity to insert their preferences into the decision-making process.