“To know how to dissimulate is the knowledge of kings”, shouted the Cardinal of Richelieu11. Richelieu C. Testamento Político. São Paulo: Editora EDIPRO; 1995., echoing in the folds of history the dissimulative logic that organizes and guides the exercise of power. Very rarely are kings dedicated to the exercise of power, honoring the principle of publicity, based on the elegant ethics of transparency and impressing visibility on their purposes and actions. As a rule, when they occur, these, unfortunately, do not last.
On the other hand, public social policies - especially those that impact on the budget - never become hegemonic in a globalized world through the neoliberal way, the dogma of the regulatory force of the market and the gradual disengagement of capital from all social commitment. In other words, although they inhabit the universe of electoral promises, they tend not to be empowered within government compositions that, in contemporary democracies, far from being monolithic and homogeneous structures, are correlations of complex and dynamic forces, controlled as a rule by the economic sector and its financing planning structures.
If these two premises are correct, SUS management, as a rule, imposes on traditional political structures weak and disguised leadership: poor because of its undersized resources for its financing, besides facing countless hurdles in budget implementation, in the face of economic financial control; disguised because it is unable to assume the real challenges of its implementation openly.
If the inherent difficulties of executing social policies such as the SUS were not enough, in the specific case of the Federal District, the implementation of public health collides with hypertrophied, overly centralized and archaic administrative structure. It is an atypical federative unit, where health management accumulates municipal and state health resources and responsibilities — hypertrophied because of more than 30 thousand active servers, with a budget that revolves around 9 billion reais; archaic because it has a direct management structure with severe defects typical of its advanced age, incapable of providing swift and useful administrative tools. While reasonable, the resources were primarily appropriated by a set of union victories that compromised governability by the unreflective consolidation of wage gains well above the market, a fact exacerbated by the irresponsible and political decline of working hours. If this was not the case, the direct management model, rather than fighting, seems to stimulate high rates of absenteeism and presenteeism (noncompliance with working hours or very low service performance rates), as well as promoting an industry of labor restrictions that border the scandal, compromising the hierarchy and the functioning of the management. What is worse: this system is defended tooth and nail by sectors of the control bodies that, for an unrelenting and irresponsible labor bias, promote the necessary protection of rights but neglect the control of the duties of the labor relationship, hiding the corporate vocation of a city that grew up around the public service. All this is sustained and legitimized in its distortions frontally offensive to the public interest by systematic actions of union structures and class bodies.
Added to this set of political-administrative irrationalities, the public health of the Federal District has for decades consolidated a hospital-centered system, keeping the health care model upside down. Finally, crowning the insane scene, its management is submitted to a State Secretariat, thus exposed to the perverse logic of electoral politics.
The Rollemberg government was one that did not last because it refused to reproduce this logic of dissimulation in the exercise of power. He faced openly the challenges of putting in good order an 8-billion public debt crisis inherited from previous governments, many of which were submissive to the corporate and class interests of the public service, as well as to the structures of politics and use of the machine for personal electoral projects. It shielded health management from these traditional structures of politics – there is no way to do public health without shielding the health policy from electoral politics. He appointed a Health Secretary and was committed to the SUS. He provided support to much needed structural changes, despite the negative electoral impact of open confrontation of such interests. Secretary Humberto, a doctor and jurist, had the lucidity to confront, among others, the two most important structural issues that render local public health unfeasible: the management model and the care model. His achievements are reported in my commented paper. There is no need to reiterate, but to refer by a personal statement. However, besides the statement, I make a point of publicly praising Governor Rodrigo Rollemberg and Secretary Humberto Lucena for the courage to make transparent management, based on dialogue, and deeply committed to the Unified Health System. According to the metaphor that opens this comment, a king who did not dissimulate. In short, an elegant government. After all, as Honoré de Balzac22. Balzac H. Tratado da Vida Elegante: Ensaios Sobre a Moda e a Mesa. São Paulo: Editora Peguin-Companhia; 2016. taught us, elegance is to appear to be what one is.
- 1Richelieu C. Testamento Político São Paulo: Editora EDIPRO; 1995.
- 2Balzac H. Tratado da Vida Elegante: Ensaios Sobre a Moda e a Mesa São Paulo: Editora Peguin-Companhia; 2016.