Citizen Ana and the Unified Health System – 06/21/2023 – Maria Hermínia Tavares

The sixty-year-old Ana (fictitious name), a cleaner by profession, has been suffering from intense pain for four years as a result of unsuccessful orthopedic surgery – which, for that very reason, needs to be urgently corrected with a new intervention.

She is a Brazilian citizen that the 1988 Constitution made the bearer of the universal right to health. But, in the life she has to live, Ana is just a statistic: she is part of the contingent of more than 1 million compatriots –111,271 in the state of São Paulo, for example– who form the endless waiting list for surgeries in the SUS (Sistema Single Health).

In your columns in this Sheet, the doctor Drauzio Varella now and then draws attention to another statistic. In this, Brazil appears as the only country with more than 100 million inhabitants endowed with a universal and free public health system – which serves more than 70% of the population.

It took decades to build a sophisticated arrangement that articulates the three levels of government, as well as the public and private sectors. Remarkable for its capillarity, it is accessed through a single door, open to all, at the municipal level.

The SUS is the most faithful expression of the social commitment enshrined in the Charter. It is also the surest indicator of the limitations of a health care system that, while ensuring universal access, is far from providing minimally adequate care for everyone.

And not by chance. According to a study by Ieps (Institute of Studies for Health Policies), the federal budget for health has been stagnant since 2013. Investments have fallen. Of every BRL 5 invested, only BRL 1 is used for non-mandatory but essential expenses; of this, R$ 0.35 comes from parliamentary amendments, which are guided by electoral logic rather than by assessing priorities.

Administration costs, personnel payments and health surveillance consume most of the resources, with no scope for expanding the system.

In a recent meeting, the Forum of Progressive Parties –which represent the left arm of the government—, concluded that the effect of recycling the social programs of previous PT administrations is in its last stages, and it is urgently necessary to create new brands.

If consulted, the citizen here named Ana would probably say that, before inventing new fashions, it would be good to place the SUS at the center of the government’s priorities – and make it, as far as possible, an instrument for effectively guaranteeing social citizenship.

To begin with, removing him from the grimy counter where positions are negotiated in exchange for support for the government of a costly coalition.

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