EditorialThe current impasse in the voting process for the regulation of the constitutional amendment 29 by the National Congress once again shows its fragilities and risks as to the survival of the political project of sanitary reform and the National Public Health System (SUS). The vindication of a stable financing source for health has always been a struggle for the Brazilian Center for Health studies (CEBES) and other institutions that fight for the right to health. This accomplishment is translated into the possibility of turning the universal right to health and SUS into a real state policy, which is not vulnerable to political and economical changes in national governments.
However, from the beginning, the financing of SUS has been provided due to the political force of temporary arrangements, as a result of the organization of the society, institutions involved in the sanitary movement and managers who are committed to health. This is why our struggle in the early 1990s resulted in the approval of CPMF (Brazilian tax) and constitutional amendment 29, in 2000. Since then, together with other members, our goal is to regulate the constitutional amendment 29. The fact is that many attempts to stop the development of our proposals have been made in the subsequent governments, besides the low budget for health, the weakened financing for SUS, the misuse of funds that should be addressed to health and, also, the extinction of CPMF. Also, since SUS was structured, government policies have favored the private sector, strengthening the increase of the health market.
The economic politics which has been put in practice for the last governments has been favoring the payment of interests of debt and the primary surplus at the expense of social policies to ensure social rights. The politics of income redistribution that have been adopted in the past few years have caused a great impact in the country; however, all the actions of the government were directed to consumption due to the increased purchasing power of a certain social class.
SUS was structured to be unique, to operate and regulate all the relations between the public and the private, mediated by the public interest. Then, it was gradually submitted to the emerging private sector of health insurance plans, which receive generous benefits to develop, such as tax exemption or permissive regulation. Each day, this market of private plans offers a wider range of products, and, currently, about 30% of the national population is a client.
Despite all these financing issues, SUS survives and is established as a universal public system, which is always improving not only in its centers of excellence. The resistance of SUS surprises the world as the universal system with lowest health expenditure per capita, inferior to those countries that do not provide universal care, as our neighbor, Argentina. Since 2000, the regulation of the constitutional amendment 29 has been in Congress, which demonstrates that politicians despise health and SUS. After the Federal Chamber of Deputies, there is no other destination but the financing approval by the Senate. The non-approval of 10% of the gross current revenue will confirm an alarming setback for the Brazilian population. A proper investment in health is expected, with at least 10% of the gross current revenue, and its origin could not harm the poorer population, being adjustable to concrete needs, managed with transparency and the internal control of society.
It is always important to emphasize that the struggle for health involves the struggle for SUS, but it is imperative that the access be extended to the social policies as to quality of life, and, consequently, health. Democracy will only be consolidated in Brazil when social rights can be assured.
The popular consciousness regarding social rights and, especially, the right to health, has motivated the participation of social movements. In the convergence of political interests of these movements, the vindication of SUS becomes important, and the search for health financing increases the power of contraposition to the current hegemonic trend. In the current scenario concerning the lack of resources for health, there is an unprecedented political pressure for the regulation of the constitutional amendment 29. Thus, the government itself admits that health lacks resources.
If it is common sense that the health system requires more resources, the argument that they do not exist is unacceptable. For us, member of the civil society, who defend the universal right to health, it is urgent to discuss the alternatives. Health can no longer wait.
Thus, CEBES defends the principles to this debate:
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The financing issue should be solved, and the debate regarding the Senate law project n. 121/2007, by senator Tião Viana, should be brought up;
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The financing should be developed based on high costs and population growth;
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The poor population that uses SUS should not be penalized with any contribution;
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There should be an exclusive financing source directed to health, that should be directly addressed to the National, State and Municipal Health Funds;
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Financing should be sustainable and sufficient;
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Its use should be transparent and controlled by internal and external mechanisms.
A new pact of the Brazilian society with the social rights and SUS is urgent. At this historical moment, it is necessary to rescue its political character integrated to social security, based on solidarity and promoting the emancipation and citizenship. Brazilians could not have their right to health reduced to mere consumer rights, of those who consume health services according to their purchasing power. According to the Constitution of 1988, in which health is characterized as a universal right, SUS has to be stronger and consolidated, committed to the public interest. The population needs to see SUS as a public resource to ensure their right to health and develop alternatives that provide health care for the population, without increasing their dependency on private health insurance plans.
The 14th National Healthcare Conference is a great opportunity to strengthen the prohealth social mobilization. It is important to emphasize some initiatives of civil society movements which have been demonstrating signs of new times for the right to health: the process of construction and dissemination of the Strategic Agenda to Health and Spring of Health (Primavera da Saúde). Besides, the political project of CEBES is also important, thus being addressed to the debate of essential and strategic themes for the sanitary reform by means of courses performed in the State centers of the institution, and debates with experts. In both cases, we are producing videos to be disseminated by Universidade Aberta do Sistema Único de Saúde (UNASUS) and other institutions. Leaderships of social movements and students participate in this process, and the expectation is that the debate can achieve more quality, and that health can guide the social movements.
In this context, the strategic agenda consolidates the result of different meetings of a group of institutions related to the sanitary reform; they understand the need to gather and gain political power to bring up the health debate and establish improvements for SUS. In this process, CEBES was articulated with Associação Brasileira de Pós-Graduação em Saúde Coletiva (ABRASCO), Associação Brasileira de Saúde Mental (ABRASME), Associação Brasileira de Economia da Saúde (ABRES), Rede Unida, Conselho Nacional de Secretários Municipais de Saúde (CONASEMS), and, together with other institutions, produced a document which has been increasingly discussed in different scenarios, in order to develop the agenda for the sector.
Motivated by the voting process to regulate the constitutional amendment 29, Primavera da Saúde has been promoting events with great popular participation. Its importance is brought up by the historical social mobilizations in the process of acquiring the right to health. It has taken the institutions that work in the health field and the social movements to the streets, in order to express the indignation as to the precarious conditions of the sanitary doctor and the absence of definite solutions for the current problems. Together with the institutions that compose Primavera, CEBES expects it takes not only the streets, but schools, churches, arts, and many other springs, summers, autumns and winters in order to raise awareness regarding the sanitary consciousness and the fight for the rights.
The National Board
