Short Abstract:

This paper explores the theoretical and empirical relationship between universal healthcare, social trust and redistributive preferences by conceptualizing universal social policies as a ‘spaces of equality’. It suggests trust mediates the connection between universalism and support for redistributive policies, emphasizing their joint role as collective capabilities.

Long Abstract:

This paper explores the relationship between universal healthcare and individual perceptions of social and public trust by conceptualizing universal policies as 'spaces of equality' that shape citizens’ relationship both vertically with the state and horizontally with society. Drawing on the capabilities approach, particularly the notion of social trust as a collective capability, the paper situates trust as a foundational element in the functioning of welfare systems. Within the capabilities approach, social trust is conceptualized not only as an individual attribute but also as a societal resource that enables cooperation, collective action, and the realization of human capabilities (Sen, 1999).

Building upon this theoretical foundation, the paper examines healthcare as a case study of broader universal welfare programs, exploring how universalism in healthcare provision shapes citizens’ trust in governmental institutions and societal structures. The capabilities approach underscores the importance of considering not just the material outcomes of policies, but also the extent to which they promote individuals' freedoms and capabilities to lead the lives they value (Nussbaum, 2011). In this context, universal healthcare can be seen as a crucial aspect of enhancing people's capabilities by providing access to essential healthcare services regardless of socio-economic status, thereby contributing to the expansion of human capabilities and the promotion of social justice.

The paper posits that trust serves as a mediator in the relationship between universalism and the political support for redistributive policies, with higher levels of trust facilitating greater public acceptance and endorsement of redistributive measures aimed at reducing social inequalities. Trust is essential for the effective functioning of welfare states, as it influences citizens' willingness to contribute to collective welfare through taxation and their confidence in the state's ability to deliver on its promises of social protection and support (Rothstein & Uslaner, 2005).

To operationalize the analysis, the paper utilizes a novel Healthcare Universalism Index developed by Schillings and Sánchez-Ancochea (2023), which measures the extent and quality of universal healthcare provision across different countries. Additionally, data from the World Values Survey (WVS) and the European Values Study (EVS) are employed to capture individuals’ perceptions of social trust and their attitudes towards redistribution.

Employing multilevel regression models across a sample of 108 countries, the analysis reveals a robust association between universal healthcare and social trust. Furthermore, the study demonstrates that the combination of improvements in universal healthcare and trust is essential for strengthening support for redistributive policies. Specifically, the presence of trust acts as a precondition for the positive relationship between universalism and individuals’ preferences for taxation and social security.

The findings of the study lend support to the hypothesis of 'virtuous cycles of universalism,' suggesting that universal policies can cultivate social trust by creating 'spaces of equality.' These spaces, characterized by universal access independent of socioeconomic background or status, have the potential to foster cross-class coalitions and solidarity, thereby bolstering support for redistributive measures aimed at enhancing social justice and equity.

In conclusion, the paper underscores the critical role of trust in shaping the effectiveness and legitimacy of universal welfare policies, highlighting the importance of fostering social trust as a collective capability within societies. By exploring the mechanisms through which universalism and trust interact to influence attitudes towards redistribution, the study contributes to our understanding of the complex dynamics underpinning the relationship between welfare state expansion and social cohesion.