Lira wants to govern health?

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By PAULO CAPEL NARVAI*

Arthur Lira's obsessive involvement with minister Nísia Trindade requires, once again, the use of the catchphrase: “The Ministry of Health warns: deputy Arthur Lira is harmful to your health”

Not even in the week in which the director general of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, was in Brazil accompanied by the director general of the Pan American Health Organization (PAHO), Jarbas Barbosa, the president of the Chamber of Deputies, Arthur Lira (PP-AL), ceased the attacks that he has incessantly launched against the Minister of Health by Lula, Nísia Trindade and their team.

Tedros and Barbosa were received in Brasília by the WHO/PAHO representative in Brazil, Socorro Gross. At PAHO headquarters, they completed a work agenda, in which Minister Nísia Trindade and President Lula himself participated, whose agenda included the prevention of epidemics, tackling diseases associated with socioeconomic problems (leprosy, tuberculosis, malaria and trachoma, among others). ), the dengue vaccine and an international agreement for global health security, which will be debated at the 77th World Health Assembly, which the WHO will hold in May, in Nepal.

Despite the relevance of the topics discussed at the PAHO headquarters in Brasília, the statements by the President of the Chamber of Deputies, asking the Minister of Health for explanations about the destination of the money from parliamentary amendments to the Union budget, had greater repercussion, driven by the commercial media .

In the presidential regime in force in Brazil, it is up to the National Congress to discuss and approve the federal government's budget, which is expressed in the Annual Budget Law (LOA). Congress approves the LOA based on a bill (PL) that is sent by the executive branch. But it is parliament's prerogative, provided for in the Constitution, to propose changes to this executive bill, indicating what they want to delete, modify or add. They do this through amendments to the budget, also known as “parliamentary amendments”, which can be individual, bench, committee or rapporteur. But, as it is a budget, the amendments end up altering both the collection and the application of money, therefore interfering with government revenues and expenses. All of this has many implications for planning programs and public policies across all ministries, that is, for government actions.

However, it follows from the “parliamentary amendments” that the Executive branch is deprived of its powers and the Legislative Branch, which is only responsible for drafting laws but not executing them, goes beyond its powers in violation of the tripartition of powers (executive, legislative and judiciary). adopted in the Brazilian Republic. This exceptionality, apparently an inconsistency, is tolerated in the case of the LOA because, in theory, it allows adjustments between what is proposed in the PL and the final text of the law.

But the possibility that senators and deputies have of changing the PL that will result in the LOA has limits, because, as the amendments involve the budget, this implies making agreements and pacts that should be based on reasonableness and compliance with the principles of public administration defined in article 37 of the 1988 Constitution, namely: legality, impersonality, morality, publicity and efficiency.

So far, so good, in the case of health and SUS.

The problems begin when parliamentarians, contrary to the planning made by the Ministry of Health, want to make decisions about the allocation of financial resources, taking the place of the Executive branch. It is unreasonable, questioning the legality of this claim, the lack of publicity (the so-called “secret budget”, or rapporteur's amendments) that marks the interference of parliamentarians in decisions on health programs, the violation of impersonality in dealing with the matter public, and the risk of inefficiency.

Inefficiency such as that found by the Comptroller General of the Union (CGU) in Quarries, in Maranhão, in the application of resources from a parliamentary amendment, in actions in the area of ​​oral health in the SUS. According to the CGU, each inhabitant of Pedreiras would have extracted, on average, 14 teeth in a single year. The Federal Police were called to investigate the overbilling. Also in Maranhão, in Igarapé Grande, with 11 thousand inhabitants, the SUS was asked to pay for 385 thousand medical consultations and 12,7 thousand finger x-rays.

It often doesn't work, because the involvement of lay people in decisions about the management of health systems and services doesn't work. In this regard, the disaster of health management and the SUS in the Temer and Bolsonaro governments (2016-2022) is still fresh in Brazilian memory, notably the tragic performance of active general Eduardo Pazuello in the Ministry of Health.

Morality is another principle of public administration that has collided with the way in which amendments to the budget have been interpreted by some deputies and senators, who simply want to decide everything about the application of resources originating in amendments they presented, ignoring their own ignorance about the efficient allocation of health resources. Generally, they understand nothing about public health, even when they are doctors or professionals in the field.

The leniency with which the President of the Chamber, Arthur Lira, has been dealing with these claims from his colleagues is noteworthy. Instead of guiding them to respect decisions taken within the scope of SUS planning, whether in the Ministry of Health or in the Tripartite Intermanagers Commission, made up of technicians from the federal government and representatives of States and Municipalities (indicated by their national councils, CONASS and CONASEMS), Lira has been exorbitant and making public statements that call into question the performance of minister Nísia Trindade and her team in the Health department. It is worth noting that Arthur Lira himself, although a lawyer and farmer, has no training in health matters and public policy management.

On February 5, 2024, the president of the Chamber of Deputies filed a Information Request (RIC), formalizing seven questions to Minister Nísia Trindade, regarding the “criteria used for the distribution of resources from the ministry to states and municipalities”. She didn't need to. All you had to do was access the public documents about this, made available by the Ministry of Health. Arthur Lira does not actually want information, he just wants to put political pressure on the government, using the holder of the Health portfolio.

The President of the Chamber only pretends to want details about “criteria” used to define budgetary and financial limits for transfers from the Union, in “primary, medium and high complexity care” and about the existence of “distinction in the composition of primary care ceilings , medium and high complexity” related to parliamentary amendments.

Arthur Lira could, if he were actually interested in these technicalities regarding the allocation of resources at the different levels of health care in the SUS, consult the Judiciary, which is responsible for verifying compliance with laws, obviously including the LOA. But he's not really interested in that. What Arthur Lira wants is to put pressure on Lula and give the “centrão” a treat, using the holder of the Health portfolio.

Arthur Lira pressures Lula to express displeasure with the federal government's decision to veto R$5,6 billion, in the set of parliamentary amendments, when sanctioning LOA 2024, in January. Arthur Lira and federal deputies, with an eye on this year's municipal elections, want some compensation. Lula resists, as the set of parliamentary amendments (R$ 44,7 billion) currently represents 20,1% of the Union's budget. Arthur Lira and the centrão aspire to return to the 2020 scenario when, under Jair Bolsonaro, parliamentary amendments corresponded to 28,6% of the federal government's budget, in practice establishing semi-parliamentaryism.

Even with the veto of R$5,6 billion, the portion of the budget “tied up” by parliamentary amendments reaches R$2024 billion in 53. Even in parliamentary republics, this legislative interference in executive matters does not reach that much. It is an exorbitance that violates the principle of morality. Experts interviewed by the newspaper The Globe consider that “the level of interference by the Brazilian Congress over public spending is unparalleled in the world”. They say that “in addition to making fiscal balance difficult, this moves federal spending away from priority policies defined by ministries and reduces transparency and oversight of the application of what is collected in taxes.”

When, in 1995, the Ministry of Health launched the slogan "The Ministry of Health warns…", printed on posters and cigarette packs, accompanied by frightening images, as the catchphrase of a very successful anti-smoking campaign, one could not imagine that the phrase would be so successful and would start to be used in the most varied situations, whenever one wants to warn about something negative.

Arthur Lira's obsessive involvement with minister Nísia Trindade requires, once again, the use of the catchphrase that is already a classic, as it is not an exaggeration to say: “The Ministry of Health warns: deputy Arthur Lira is harmful to your health”.

*Paulo Capel Narvai is senior professor of Public Health at USP. Author, among other books, of SUS: a revolutionary reform (authentic). [https://amzn.to/46jNCjR]


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