By far the most important reason why government expenditure can be expected to increase greatly over coming decades is growing health expenditure. There are strong grounds to expect that government health expenditure will grow by at least 4 percent of GDP in all advanced nations in the period up to 2050.

Government spending has dramatically increased everywhere in response to the coronavirus pandemic and the savage recession which it has triggered. In the wake of this, the debate about the size of the state has gained new urgency. However, nearly all of the spending is – and should be – purely temporary. The much more important question concerns long-term trends in government spending.