O SUS no governo Temer: luta de representações e interesse coletivo
Data
2021
Autores
Menezes, Ana Paula do Rego [UNIFESP]
Orientadores
Reis, Ademar Arthur Chioro dos [UNIFESP]
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
O objeto deste estudo é a política de saúde brasileira na conjuntura do governo Temer,
instituído pelo golpe de 2016, tendo como pressupostos a possibilidade de risco
eminente de desconstrução do Sistema Único de Saúde (SUS), a quebra do
paradigma da universalidade do acesso à saúde e redução dos diretos de cidadania.
Objetivo Geral: analisar a política de saúde brasileira durante o período do governo
Temer, buscando identificar elementos discursivos que apontem para um movimento
de conflitos e luta em torno de interesses econômicos, políticos e simbólicos.
Objetivos Específicos: reconstruir a narrativa oficial do Governo Temer sobre o SUS
e a de diferentes atores envolvidos na defesa e construção do SUS; identificar
evidências de luta de representações e expressão do interesse coletivo; compreender
o SUS, na conjuntura do governo Temer, instituído pelo golpe jurídico-parlamentar de
2016, em suas dimensões contextuais de influência, de texto e de prática. Método:
Estudo de caso, qualitativo, realizado por meio de análise de contextos, de história e
de identificação de quebras de regularidade que apontam para mudanças sociais e
no SUS, a partir da instalação do governo Temer. A sistematização e análise do
material empírico apoiou-se na Abordagem do Ciclo de Políticas, proposto por Ball,
que parte do entendimento de política pública, além de seus resultados, também em
um contexto discursivo e textual. Foram selecionadas para análise falas enunciadas
por agentes oficiais e do movimento sanitário nos principais fóruns de pactuação
federativa, representação político-institucional e na mídia, a partir de 31 atas de
reuniões do Conselho Nacional de Saúde, 27 resumos executivos e apresentações
na Comissão Intergestores Tripartite, 10 notas de audiências públicas no Congresso
Nacional e de entrevistas ma mídia efetuadas pelo Ministro da Saúde, entre maio de
2016 a dezembro 2018. A partir de uma síntese das falas, como estratégia de
ressignificação das narrativas reconstruídas pela autora, foram realizados 4
seminários compartilhados com sujeitos estratégicos da área de comunicação,
gestores estaduais e municipais, sanitaristas/academia e com membros do Conselho
Nacional de Saúde. Resultados: Foram identificadas três ideias força a partir dos
enunciados do agente do governo (o Ministro da Saúde): a) universalidade e
integralidade se chocam com possibilidades fiscais inalcançáveis a um país como o
Brasil; b) a crise social e econômica de 2014/2016 é uma crise fiscal. O controle dos
viii
gastos púbicos é apresentado como solução. O aperfeiçoamento da gestão é mais
relevante que a demanda por recursos; c) o setor privado tem papel central na solução
da crise e das restrições fiscais. O conjunto das falas permitiu reconstituir a construção
discursiva que transfigura problema econômico em crise fiscal, apontando para a
austeridade como solução estrutural para o país. Examinar a linguagem como
constitutiva de objetos sociais implica também reconhecer sua materialidade, na
medida em que o discurso que opõe estabilidade econômica a gastos públicos
rearticula o espaço social e político em torno do qual se constrói o SUS, redistribuindo
poder e legitimidade. Conclusões: Emerge das falas o pressuposto cognitivo da
inevitabilidade do ajuste fiscal para justificar a necessidade de promulgação da EC
95/2016, que conferiu status constitucional ao princípio da austeridade. O direito
universal à saúde é visto como dispendioso e incompatível com as capacidades fiscais
do país. Produz-se, a partir daí, agentes aptos a financiar as demandas por saúde de
modo eficiente e sem onerar excessivamente os contribuintes: setor privado
(mercado) e parlamentares (via emendas). Um fio narrativo que parte do ajuste fiscal
e leva à revisão da universalidade e das relações público-privadas no âmbito da
política de saúde.
The object of this study is the brazilian health policy in the context of the temer government, instituted by the 2016 coup, based on the possibility of an imminent risk of deconstruction of the SUS (brasilian's unified health system), breaking the paradigm of universal access to health and reduction of citizenship rights. General objective: analyze the brazilian health policy, the sus, during the period of president temer government, seeking to identify discursive elements that point to a movement of conflicts and struggle around economic, political and symbolic interests. Specific objectives: reconstruct the official narrative of temer's government about sus; rebuild the narrative of different actors involved in the defense and construction of the sus; identify evidence of struggle for representations and expression of collective interest; understanding the sus, in the context of the temer government, instituted by the legal-parliamentary coup of 2016, in its contextual dimensions of influence, text and practice. Method: qualitative case study, through analysis of contexts, history and identification of breaks in regularity that point to changes on social and at SUS, from the installation of the Temer's government. The systematization and analysis of the empirical material was based on the policy cycle approach, proposed by ball, which starts from the understanding of public policy, in addition to its results, also in a discursive and textual context. To reconstruct and analyze the different narratives about the SUS, speeches enunciated by official agents and the health movement in the main forums of federative pact, political-institutional representation and in the media were selected, based on the reading and analysis of 31 minutes of meetings of the CNS (Brazilian Council of Health), 27 executive summaries and presentations at the tripartite (inter-management committee), 10 shorthand notes from public hearings in the national congress and from interviews or statements in the media carried out by the minister of health, between may 2018 and december 2018. From a summary of the speeches, as a strategy to reframe the narratives reconstructed by the author, 04 seminars were held shared with strategic subjects in the communication area, state and municipal managers; health professionals/academy; and, with members of the brazilian health council. Results: three strong ideas were identified from the statements of the government agent (the minister of health): a) universality and integrality clash with x fiscal possibilities that are unattainable for a country like brazil; b) the 2014/2016 social and economic crisis is a fiscal crisis. The control of public spending is presented as a solution. Improving management is more relevant than the demand for resources; c) the private sector plays a central role in solving the crisis and fiscal restrictions. The set of speeches allows us to reconstitute the discursive construction that transforms an economic problem into a fiscal crisis, pointing to austerity as a structural solution for the country. Examining language as constitutive of social objects also implies recognizing its materiality, as the discourse that opposes economic stability to public spending re-builds the social and political space around which the sus is built, redistributing power and legitimacy. Conclusions: the set of statements seeks to crystallize the cognitive assumption of the inevitability of fiscal adjustment to justify the need for enactment of ec 95/2016, which conferred constitutional status on the principle of austerity. The universal right to health is seen as costly, incompatible with the country's fiscal capacities and inefficient to manage. From there, agents capable of financing health demands efficiently and without excessively burdening taxpayers (private sector, by the market, and parliamentarians, via amendments) are produced. A narrative thread that, ultimately, leads from fiscal adjustment to a review of universality and public-private relations within the scope of health policy.
The object of this study is the brazilian health policy in the context of the temer government, instituted by the 2016 coup, based on the possibility of an imminent risk of deconstruction of the SUS (brasilian's unified health system), breaking the paradigm of universal access to health and reduction of citizenship rights. General objective: analyze the brazilian health policy, the sus, during the period of president temer government, seeking to identify discursive elements that point to a movement of conflicts and struggle around economic, political and symbolic interests. Specific objectives: reconstruct the official narrative of temer's government about sus; rebuild the narrative of different actors involved in the defense and construction of the sus; identify evidence of struggle for representations and expression of collective interest; understanding the sus, in the context of the temer government, instituted by the legal-parliamentary coup of 2016, in its contextual dimensions of influence, text and practice. Method: qualitative case study, through analysis of contexts, history and identification of breaks in regularity that point to changes on social and at SUS, from the installation of the Temer's government. The systematization and analysis of the empirical material was based on the policy cycle approach, proposed by ball, which starts from the understanding of public policy, in addition to its results, also in a discursive and textual context. To reconstruct and analyze the different narratives about the SUS, speeches enunciated by official agents and the health movement in the main forums of federative pact, political-institutional representation and in the media were selected, based on the reading and analysis of 31 minutes of meetings of the CNS (Brazilian Council of Health), 27 executive summaries and presentations at the tripartite (inter-management committee), 10 shorthand notes from public hearings in the national congress and from interviews or statements in the media carried out by the minister of health, between may 2018 and december 2018. From a summary of the speeches, as a strategy to reframe the narratives reconstructed by the author, 04 seminars were held shared with strategic subjects in the communication area, state and municipal managers; health professionals/academy; and, with members of the brazilian health council. Results: three strong ideas were identified from the statements of the government agent (the minister of health): a) universality and integrality clash with x fiscal possibilities that are unattainable for a country like brazil; b) the 2014/2016 social and economic crisis is a fiscal crisis. The control of public spending is presented as a solution. Improving management is more relevant than the demand for resources; c) the private sector plays a central role in solving the crisis and fiscal restrictions. The set of speeches allows us to reconstitute the discursive construction that transforms an economic problem into a fiscal crisis, pointing to austerity as a structural solution for the country. Examining language as constitutive of social objects also implies recognizing its materiality, as the discourse that opposes economic stability to public spending re-builds the social and political space around which the sus is built, redistributing power and legitimacy. Conclusions: the set of statements seeks to crystallize the cognitive assumption of the inevitability of fiscal adjustment to justify the need for enactment of ec 95/2016, which conferred constitutional status on the principle of austerity. The universal right to health is seen as costly, incompatible with the country's fiscal capacities and inefficient to manage. From there, agents capable of financing health demands efficiently and without excessively burdening taxpayers (private sector, by the market, and parliamentarians, via amendments) are produced. A narrative thread that, ultimately, leads from fiscal adjustment to a review of universality and public-private relations within the scope of health policy.
Descrição
Citação
MENEZES, A.P.R. O SUS no governo Temer: luta de representações e interesse coletivo. São Paulo, 2021. 274 f. Tese (Doutorado em Saúde Coletiva) - Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, 2001.