This essay sketches the class structure that a large-scale deployment of artificial intelligence might produce in advanced economies. Because AI is a general-purpose technology, its aggregate effects cannot be predicted, but three consequences can be reasoned through: output per unit of live labor will rise; a surplus population of the durably unemployable, potentially 15 to 20 percent of the labor force, may emerge; and the mass of profit will grow even if the rate of profit does not. The result is a tetra society of four classes: a surplus population kept quiescent by transfers and cheap entertainment, a precarious service-sector working class, a homoploutic elite combining high labor and capital incomes, and a small stratum of techno-lords. Such a society would lack a middle class in the twentieth-century sense, and richer, more AI-intensive societies could therefore prove more politically unstable than poorer ones.

Background
Deriving measures of policy effects from policy documents requires accurate information on what policies were in force, when they took effect, and what provisions they contained. Government publication and preservation practices can make this history difficult to reconstruct. This study presents and evaluates a workflow for constructing longitudinal policy measures in one national policy series.
Methods
A workflow combining document recovery, automated extraction with human validation, and construction of longitudinal measures was applied to NHS England’s Additional Roles Reimbursement Scheme (ARRS) from 2019/20 to 2026/27. Fourteen policy versions were split chronologically into eight development versions and six later versions used to evaluate keyword, deterministic, and large language model (LLM) extraction against an author-verified reference. Three simplified measurement strategies were compared with the validated longitudinal record.
Results
Historical reconstruction recovered 14 substantive policy versions across eight years, while the NHS England landing page exposed documents from only one policy year. Reimbursable workforce categories increased from 5 to 27 between 2019 and 2026. On the evaluation versions, the LLM matched all scored targets for eligibility status, effective dates, and reimbursement amounts, while eligibility conditions were less accurately extracted. Simplified measurement strategies altered the reconstructed exposure history. Using one policy document per year credited 96 category-months before eligibility began, equivalent to 7.3% of the 1,320 eligible category-months, while keyword coding produced 138 category-month errors, equivalent to 10.5%.
Conclusion
In this policy series, the workflow recovered a broader historical record than current web access alone and extracted predefined variables accurately, yet accurate extraction of eligibility conditions and new policy content presented challenges. Valid longitudinal measurement required historical source recovery, explicit coding and dating rules, evaluation on later versions, and human verification. The workflow can offer a structured approach to measuring changes in governmental decisions about eligibility, financing, and conditions over time.

Background
Far-right populist parties have gained significant electoral success across the world, yet little attention has been paid to whether and how they shape health and contribute to health inequalities.
Methods
We conducted a scoping review to synthesize the available evidence on the link between far-right populism and health. We searched PubMed and Scopus between May and June 2026 to identify studies investigating this link.
Results
The review suggests that the health consequences of far-right populism can be understood across at least three levels: (1) the individual level, at which support for far-right populist ideologies may decrease individual health and foster adverse health behaviors; (2) the interpersonal level, at which exclusionary rhetoric may foster discrimination, stigma, and social exclusion and hostile social climates, with implications particularly for marginalized groups; and (3) the societal level, at which far-right populist governance may influence population health via welfare chauvinism and exclusionary policies that affect the social determinants of health.
Conclusion
Based on the emerging patterns identified in our review, we propose a preliminary three-level framework for understanding how far-right populism may be linked to health. This framework helps to integrate existing findings across the individual, interpersonal, and societal level. The evidence base is still developing, and more systematic, longitudinal, and comparative research is needed to better understand potential causal relationships.

Background
The Swedish healthcare system is tax-funded and universal with low copayments, governed by politicians at national, regional and local levels. Since the early 1990s, the healthcare system has gradually been transformed from a mainly public system to an increasingly private for-profit driven, but still tax-financed system. This article describes the main driving forces and their effects.
Methods
The marketization of healthcare is contrasted to the legal and ethical framework established by the Swedish parliament for the healthcare system. The Swedish Health and Medical Services Act states that care should be provided solely according to need and on equal terms for the whole population, prioritizing those with greater need.
Results
Since the 1990s private enterprises and lobbyists have argued for market-oriented reforms where for-profit private providers can freely locate and operate outpatient services on public funding. A so-called choice reform (LOV) was implemented in 2010, mandatory in primary healthcare but optional in specialist care. This led to an expansion of for-profit private providers. In 2024, 52% of primary care visits and 22% of specialist care visits were to private providers. LOV has greatly reduced the power of regions to govern healthcare. It favours patients with limited rather than those with greater and more complex needs; it increases inequities in access between rural and urban areas, and between urban high- and low-income areas. The increase in private specialists has also enabled an increase in private healthcare insurance coverage, allowing the insured faster access to specialist care within the tax-financed healthcare system. This is inconsistent with the Health and Medical Services Act.
Conclusion
Marketization has increased inequalities in access to care in Sweden. Studies are needed on how to strengthen the primary healthcare system and to address inequalities in healthcare services related to increased privatization and marketization.

Comparative scholarship on health systems has largely relied on institutional approaches, based mainly on the public–private divide. This article argues that political dynamics are central to understanding the shaping and evolution of health systems. France offers a particularly instructive case due to the complexity of its system: intertwined public-private mix, changing modes of governance, persistence of historically rooted arrangements and institutional disjunctures. Drawing on policy tracing, with attention to critical realism, and conducting a contextual and historical analysis, the article shows how actor configurations, power resources, ideological conflicts and political crises have structured the French health system over time. The introduction presents the characteristics and paradoxes of the French system, which this article contributes to explain. The following two sections trace the separate institutionalisation of the two key policy actors: first, the nineteenth-century formation of the medical profession, structured as a national scientific elite, local political notability, and a corporatist organisation ; second, the belated and contingent construction of a national health insurance system, confronted with the resistance of organised medical liberalism. The third section analyses how the power relationship between the medical profession and the government have evolved after a major change of the political regime (Vth Republic) and pressure from economic and social challenges, such as modernizing hospital infrastructure, universalising access and containing expenditure. It shows growing government leadership, and yet limited statecraft over parts of health sector. The conclusion points to the interest of long-term policy tracing, as a method that allows to uncover underlying power structures and identify the causal factors of change, an approach applicable to other national cases.

South Africa’s National Health Insurance (NHI) reform was enacted in May 2024. It is the country’s most ambitious effort to achieve universal health coverage (UHC). South Africa has one of the most unequal healthcare systems globally. NHI debates are often framed in technical terms, focusing on cost and feasibility. This analysis shows that power relations and stakeholder interests fundamentally shape the reform’s design. This study draws on policy documents, parliamentary records, and stakeholder submissions from 2011 to 2024, with the political background from 2007 and legal documents to 2026. It applies Walt and Gilson’s policy triangle framework to examine how context, actors, and policy content interact. Key design provisions were embedded in the policy from its inception. These include the continuing voluntary role of medical schemes and accreditation frameworks for private healthcare providers. They reflect the private sector’s structural influence and fiscal constraints rooted in South Africa’s political economy. These are not concessions made during legislative passage. Public-interest civil society organizations were substantively engaged in the NHI process. These include health rights groups, trade unions, and rural health networks. Their influence was limited by restricted access to decision-making forums. The analysis draws lessons for policymakers pursuing UHC reform in contexts where the private health sector is powerful and governance is fragmented. Effective implementation requires governance capacity before or alongside financing. Sustained civil society engagement is an essential mechanism of accountability.