The revisionism that destroys the SUS from within



There is no solution for the SUS without combating all forms of privatization and without eliminating once and for all all the management tools and instruments that diversify and fragment its conceptual rules

From a strict legal point of view, the approval of the Unified Health System – SUS in the 1988 Federal Constitution was a severe blow to the Brazilian ruling classes, formed on the exploitation and seizure of the State through income concentration and social exclusion.

In a strategic area for them, health, which they have always had as a privileged source of occupation and exercise of power and significant material gains, in the opposite direction, the SUS aimed to guarantee universal and comprehensive access to actions and services and, supreme “provocation” , the practice of participatory democracy through Health Councils and Conferences.

It was too much! They soon went on the offensive, acting politically in the legislatures and in the various spaces created to, whether through legal adjustments such as the laws that created social organizations, civil society organizations of public interest and public-private partnerships, or by simply failing to comply with legal requirements such as which determines that the SUS can contract private services only in a complementary way, continuing and even deepening the control of the State, its resources and its institutions.

Compromise of already insufficient financing, dependence on the private sector to carry out procedures, total and absolute precariousness in hiring and remunerating the workforce, widespread corruption and profound distortions in the network's management and management instruments have since undermined the capacity of the System that has resisted thanks to selfless workers and some managers.

From the first Lula government onwards, sectors that identify themselves as left, most of them members of the Workers' Party, began to defend new management proposals for the network as an alternative, according to the narrative then put forward, to the privatization of the SUS through of OS, OSCIP etc.

They started with the “state” foundations of private law. The word “state-owned” is not gratuitous, as it seeks to deceive those who are less aware that it belongs to the State – whatever may be said, it is true –, consequently it would not be private, and that in this way privatization would be being suppressed from the SUS. Next came EBSERH, the Autonomous Social Service and, finally, revealing the real objectives, the “private partners”, which from a practical point of view have few differences from the infamous OSs and OSCIPs.

In addition to having done everything in spite of the contrary decisions of the Health Councils and Conferences, there are two issues that the revisionists do not seem to understand when they point to these proposals as almost miraculous solutions to “address privatization” in the SUS.

The first is that there is not only classic privatization, when a public asset is sold, or – as in the case of the SUS, which cannot be sold – handed over to a private entity to be administered, to be considered. The disastrous history of the privatization of the Brazilian State also occurs in another way that is as cruel as classic privatization, such as its takeover by economic and political groups that use it for patrimonial, clientelist and physiologist actions.

All of these alternatives presented and implemented by SUS revisionists are privileged tools for taking over the State through political appointments to its management and commissioned positions, very high bonuses for those who are part of the management leadership, as well as clientelism in the hiring and firing of people and in purchases. of inputs in general. Let us agree that these are characteristics of a historically exploited and robbed State, and that, before being strengthened, as they are with these experiences, they need to be extirpated.

In brief, nowhere where these “management tools” were implemented were the real, structural problems of the SUS resolved. In the opposite direction, many other problems were created, such as allegations of corruption, the creation of true castes and their privileges and numerous cases of moral harassment. Furthermore, the lack of resolution of services continues to be the rule and they have all been transformed into political apparatuses disputed by organized groups depending on the government on duty. Everything that unfortunately always existed in the Brazilian State, now in a more sophisticated and cruel way.

The other issue concerns the conceptual aspect of the Unified Health System. The word “unique” is not just figurative, it means that if the System and its fundamental rules are not unique, it cannot be sustained, it cannot be made viable.

From this perspective, we found that in the face of the attacks that began to be launched against the SUS since its approval and subsequent regulation, the solutions presented by the revisionists, before actually confronting our adversaries, fed back into the process of conceptual destruction of the System.

This was the case with the mass contracting and even in a substitutive way for the public of private services as a way of meeting the demands of the population, instead of structuring and expanding its own public network, thus feeding a strong and competing private network that increasingly more competes and competes with the SUS in carrying out procedures and hiring professionals. We learned, it is good to remember, that there is no way to have a public, universal and comprehensive Health System, with strong competing private systems.

This was the case when they encouraged the creation and hiring of professional cooperatives, not facing the problem of remuneration and appreciation of workers and thereby consolidating the commodification of health work.

It was like this when the difficulties in management and management of the network were not put on the agenda, to debate the legislation and possible ways of resolving them, opting for the creation of new management “paradigms”, OS, OSCIP, “State” Foundation, Autonomous Social Service, EBSERH, “Private Partner” which, as we have seen, not only did not solve our structural problems but also deepened those that exist and created new ones.

This all explains the permanent crisis in federal hospitals in Rio de Janeiro. Clientelism, party-political appointments without any criteria other than the nefarious patrimonial action, the precariousness of the workforce as a rule and the total absence of democratic debate, keep hospitals in a permanent state of suffering that is never faced seriously that it deserves.

Without any debate in the National Health Council, in the PT's National Health Sector or any other space of democratic legitimation, it is beginning to be publicized in the press that “the idea that the management of the Union's 22 units (hospitals) be passed on to different bodies under the supervision of the Civil House and no longer the Ministry of Health”. It is important to remember that the Civil House is commanded by the former governor of Bahia, the state where the SUS suffers most from privatization experiences, including a pioneer in PPP in health.

“There are units that will become foundations; others, public companies – and the Hospitalar Conceição Group is expected to enter Rio. A hospital must pass to the state; another for the municipality. The largest in Rio, INCA, with four units, should be managed by a Public-Private Partnership”.

It is no exaggeration to say loud and clear that we rarely become aware of something so serious to be considered for SUS services in Brazil. If we know that what the Ministry of Health does appears as a reference for states and municipalities, we can imagine what could be triggered across the country.

There is no solution for the SUS without combating all forms of privatization and without eliminating once and for all all the management tools and instruments that diversify and fragment its conceptual rules, which should be unique in fact, with exceptions and flexibility being applicable to the right cases. specific.

Direct contractualization between services and their respective management levels, in order to provide them with full administrative, financial and political autonomy, as well as the professionalization of their management through previously defined technical criteria and the creation of an interfederative, tripartite Single Career, through adherence and unique guidelines and rules throughout the country, they are the paths to overcoming historical challenges, in tune with its concepts and principles.

*Francisco Batista Júnior He is a hospital pharmacist at SUS in Rio Grande do Norte. Former president of the National Health Council (2006-2011).

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