O protagonismo do Estado na expansão e lucratividade do setor privado da saúde: o parasitismo do setor privado ao SUS

Abstract

This thesis aims to investigate the role of the State in the expansion and profitability of the private health sector in the context of crisis and financialization of capital and what are the particularities after the coup of 2016. To achieve the proposed objective, from a theoretical and methodological point of view, we recurred to bibliographic research based on classical and contemporary authors who are legatees of the critical historical tradition. Documentary research was also one of the methodologies used to achieve the objectives through the analysis of legislation related to the referred policy, in addition to the federal government's database such as the National Register of Health Establishments (CNES) and the Computer Department of the Single Health System (DATASUS), as well as other secondary data sources. The exposition of the research was divided into three central sections. The second section deals with the formation and organization of the State, with particular attention to the Modern State in the framework of bourgeois society and its function in the process of production and reproduction of capital. Throughout the exposition, it is emphasized that the crisis of the capital demanded a set of responses, from the restructuring of production to the expansion of the financial sphere in search of new niches of accumulation and reposition of its profit rates, finding in social policies, in which health policy is perceived, one more expansion of mercantilization. Thus, we continue our study seeking to understand the genesis and assumptions of financial capital which has its most forceful expression in interest-bearing capital, and, the latter, in public debt. In the third section we made a survey of the neoliberal assumptions as an ordering ideology of capitalism in crisis, since this is a fundamental element in the analysis of the reordering of the State which has directed the offensive of capital against the working class and the social policies, shaped in the counter-reform process of the State. In Brazil, it was observed that the State counter-reform processes, underway since the 1990s, have had negative repercussions on the consolidation of the Unified Health System (SUS), according to the precepts defended by the Health Reform Project of the 1980s, with the presence of antagonistic projects that have been strengthened by the State. We highlighted that the post-coup of 2016 marks a new stage of continuities, but above all, of evident offensive against the right to public, universal, state, and free health with a project of SUS fully submitted to the market. In the fourth and last section, we sought to demonstrate from the appreciation of the empirical material researched the protagonism of the Brazilian State in facilitating the capture of the public fund by private health groups, through three mechanisms concerning health care. The general panorama has allowed us to conclude that, independently of the governments analyzed here, recognizing their differences, the role of the State in the expansion and profitability of the diverse private groups has been primordial, it stands out in all of them, in one aspect or another. This reaffirms the class nature of the State.