On the first of January, 2015 a new presidential term and a new legislation on the National Congress began, which elections were marked by the strong presence, concerning campaign financing, of companies linked to the health market. The costs of such have already been felt and may be too high for the Unified Health System (Sistema Único de Saúde - SUS).

The scenery is complex and reflects the strategies for strengthening the health market, which throughout the years has been built and implemented under a weak regulation, tax subsidies, public funding and mechanisms that facilitate the presence and expansion of the private sector in the health sector in the country.

Once again, the electoral process rekindled the expectations of the Sanitary Reformation Movement (Movimento da Reforma Sanitária - MRS) towards the consolidation of the SUS. However, the optimism did not last too long, and the SUS started to pile up defeats within the Congress and the federal government itself.

The expectation of the MRS started being frustrated with the sanction, by the Presidency of the Republic, of the Conversion Act (Lei de Conversão) No. 18, from 2014, originated from the Provisional Measure (Medida Provisória) No. 656, from 2014, which changed the Law 8080/90, allowing "the direct or indirect participation, including the control, of companies or foreign capital in health care" (BRASIL, 2014B). This law is being questioned by the Direct Action of Unconstitutionality (Ação Direta de Inconstitucionalidade - ADIn), supported by entities of the sanitary movement who argue about its affront to the Federal Constitution. The Article 199 § 3 of the Constitution states that "It is forbidden the participation, direct or indirect, of companies or foreign capital in the health care in the country, except in those cases provided by law" (BRASIL, 1988). The new law makes the Constitution a "dead letter", worthless and ineffective, since there would be no conditionals for the presence of foreign capital in the national health market. The injunction, interposed together with the ADIn, claims for urgent intervention, because, if put into practice, this new legal provision endangers the right to health.

Another setback faced by the SUS was the recent approval, in the House of Representatives (Câmara dos Deputados), of the Proposal for Constitutional Amendment (Proposta de Emenda Constitucional - PEC) - the Authoritative Budget (Orçamento Impositivo) PEC -, which should withdraw from the health budget the amount of R$10 billion and furthermore change the bases of calculations that deepens the sectorial underfunding. Only 44 parliamentarians (less than 10% of the total) voted in favor of the SUS and against the institutionalization of the underfunding resulted from the new rule.

Now the House of the People brings into question a PEC that ultimately and utterly destroys the responsibility of the State through the SUS to provide the universal right to health. This is about the PEC 451/14, authored by the president of the House of Representatives, Eduardo Cunha, forcing every employer, urban or rural, to pay for private health insurance for their employees (BRASIL, 2014). Drop your jaws: the congressman's grounding, he who in his own election received financial support from the private health companies, is the right to health advocated and provided in the Article 196 of the Federal Constitution/1988.

Make no mistake, these facts are political decisions resulted from the liberal hegemony that continuously controls the State, society and public institutions and are firmly established inside the Congress and the federal government, in a new conservative offensive in favor of the market and capital and against the SUS. This poses new challenges that require a greater articulation of all of those who are a part of the Brazilian sanitary movement.

The achievement of the SUS, back in the 80's, against the grains of the neoliberal policies of the time, occurred largely because of the struggle of social movements and the recognition of the social debt that the Brazilian State held with its population. Well, such debt has not yet been paid, and the conflicts of interest in the core of society are ever more accentuated.

At this juncture, how do we mobilize unionized workers who benefit from private health plans in defense of the public system? How do we build a hegemony around health as a social right in contrast with its approach as a commodity? The Cebes understands that it is up to us to carry out popular, union, student and health worker movements, to do our part in this historical context, that is, to fight to defend the right to health and to SUS.

In a timely manner, in 2015 Brazil will hold the XV National Conference on Health, dozens of state conferences and thousands of municipal and local conferences. This is the opportunity that we have to reenact what the VIII National Conference on Health accomplished, which mobilized the Brazilian society in defense of the universal right to health and a public and comprehensive system for all.

The Cebes summons all health militants to actively participate in the conferences, at all levels, debating crucial themes to effect the right to health, which will only advance with the consolidation of the SUS. At these conferences, we must approve proposals and guidelines that will oblige governs and political representatives to move from speech to act, putting health in the center of the political agenda and of the development project for this country.

Cebes National Board

References

Publication Dates