A inovação da saúde universal em um país capitalista dependente

Abstract

This research presents the particularities of dependent capitalism that marks Latin America and the repercussions of economic, technological and political dependence on the Unified Health System. It presents the SUS as the greatest Brazilian innovation, highlights the difficulties of its implementation during the hegemony of neoliberalism in the region, and later, under the validity of fiscal austerity. It seeks to demonstrate that issues treated as natural problems for the consolidation of public health policy are, in fact, contingencies of the historical dependence to which the country is subjected. The exploratory research begins the journey on dependence from the intellectual construction of Brazilian authors who have dedicated themselves to demonstrating that the structural condition of dependent capitalism generates internal contradictions and makes it difficult to advance industrial, commercial and technological (ICT) policies in all peripheral countries. To this end, the Marxist Theory of Dependency (TMD) was adopted, an unprecedented approach in the field of collective health, which has the potential to go beyond naturalized explanations such as market failures, solutions that reinforce market mechanisms within the public policy of health and the fragmented discussions on financing, dependence on inputs, difficulty in integrating into a network, difficulty in providing personnel, as if each of these problems were an isolated issue and not intrinsic elements to the limits and constraints of the Brazilian State to develop health policy. Resuming the classic studies of the IMS, the State gains centrality in this research and through timelines that cover the period from 1970 to the present day, processes were presented that are generally analyzed separately and that concern the development of public health actions, development of the science and technological production system in health and, at the same time, incentives created for the expansion of the private health sector. The concepts and analytical categories of TMD allow us to understand the moments in which the State fulfilled the function of 'manager of dependency', guaranteeing space for the extraction of value and accumulation of capital for the national and foreign bourgeoisie and moments in which the State carried out interventions in the sector of health, seeking to develop public policy autonomously, aiming to reduce external dependence and guarantee the political and material bases for the universal health project. In the end, the role of the State is reaffirmed, as an entrepreneurial agent of risky innovations, policy executor and public value generator for society and in the considerations that close the research, the theme was resumed, the fulfillment of the objectives and the question of research was evaluated, limits and propositions for future studies were presented. It is hoped to have contributed to a new approach in the field, having the TMD as a reference for the discussion of concrete problems of the SUS in the light of the analytical categories that the theory offers. It is also expected that research will contribute to the dissemination of TMD which, despite being an intellectual construction that is quite active in other Latin countries, is still little applied in Brazil.