The group that discusses the government plan of Luiz Inácio Lula da Silva (PT) for the health area is studying a tightening in the regulation of supplementary health.
“There are certain types of readjustments or rules that are abusive”said to Power 360 former minister Arthur Chioro, one of the PT’s main public policy makers for the health area.
Asked what should be changed, Chioro said he would not give details. “A statement by me, Padilha or Temporão about individual plans overturns the actions [das empresas da área]”said the former minister.
The final version of the government program must be submitted to the TSE (Superior Electoral Court) registration of candidates.
Chioro said the pandemic did not affect the plans much. “Operators were heavily capitalized during the pandemic. People haven’t stopped paying for their health plans.”he said.
However, the debt of these companies to the government for procedures performed by the SUS on beneficiaries grows every year. It currently stands at R$3 billion. There is another R$ 1.3 billion under discussion in court.
There is an intention among the formulators of Lula’s government program to strengthen the reimbursement of the Unified Health System by operators. Commenting on the debts, Chioro said that the regulatory system in Brazil currently has a side: that of the entrepreneur. The discussions, according to him, are around a regulation that considers more the interests of policyholders.
There is a significant obstacle to change in this area: Bolsonaro only appointed the last directors of the ANS (National Health Agency) in April.
They have a mandate until May 2025 and August 2026. A possible Lula government will have to propose changes considering the current composition of the agency’s board, which has a nominee for Senator Flávio Bolsonaro (PL), the president’s son.
Lula has contact with businessmen linked to the sector. One of PT’s biggest supporters is businessman José Seripieri Junior, also known as Júnior da Qualicorp. He founded the health insurance company in 1997 and left the company in 2020, but the nickname stuck.
Today, Junior tries to start a new company, QSaúde, but he encounters difficulties. He has direct contact with Lula and could be influential in any new PT government.
Another group that tries to get close to the former president is Hapvida. The owners of the health plan donated R$ 750 thousand to PT this year. They also sought Bolsonaro’s PL with the intention of donating R$1 million.
If it depends on the PT, one of the changes for companies in the area, the open health, is ruled out. The current Minister of Health, Marcelo Queiroga, announced the sharing of health data along the same lines as the open bankingbut the measure faces resistance in Lula’s campaign.
The next government may have to decide whether or not to allow the creation of new vacancies in medical courses. A 2018 ordinance (valid until April 2023) prevents the authorization of new vacancies.
Colleges try to circumvent this rule by resorting to a war of injunctions. When they win in court, they do not need to follow the public policy that requires the opening of courses far from large centers.
The discussion is currently in the STF.
Chioro said that there is no need to open new vacancies in these courses. What is discussed in the Lula environment would be a “in-depth analysis of the quality of doctors being trained”. What is stipulated in the Mais Médicos law, but has not yet been done in the current administration. On extending the moratorium, the former minister declared that the issue has not yet been debated.
“We will once again demand that faculties fulfill their commitments [de abertura de residência médica e fortalecimento do sistema de saúde local] with SUS”said Chioro.
BASIC ATTENTION IS PRIORITY
Actions such as the Family Health Program will have priority in a possible new Lula administration. Chioro enumerated some programs that want to recover:
“The Bolsonaro government destroyed the National Immunization Program, primary care policy, mental health policy, alcohol and drugs, destroyed the policy of comprehensive care for women’s health, pharmaceutical assistance, cancer policy, oral health.”
The strengthening of family health care centers is one of the main points of attention. The former minister specifically mentioned strengthening medical teams to work in the interior of Brazil.
Chioro stated that the discussion of the program takes into account factors that go beyond the management of the ministry. “There is an aggravating factor, the worsening, the deterioration of living conditions. This is crucial in the health area.”he said.
The Mais Médicos program, of PT administrations, was interrupted by the current government. Bolsonaro criticizes the hiring of Cuban professionals in agreement with the Cuban government.
In April 2022, the government held an event to mark the hiring of the first professionals for Médicos pelo Brasil, a replacement program for the PT initiative.
Bolsonaro said that the Cuban doctors who were part of the Mais Médicos professionals were “enslaved” because part of the money was paid to Cuba.
Chioro said that it is not plan A, but that, if necessary, a possible new Lula government will bring professionals from there.
“Today it is possible [depois da abertura de mais faculdades de medicina] work with the perspective that most of the vacancies will be filled with professionals from Brazil”declared the former minister.
“If it is not possible, we will comply with what is provided for in the law. [trazer profissionais de fora do Brasil]. If necessary, yes [traremos médicos de Cuba]”, he stated.
The projects discussed by the PT campaign presuppose the repeal of the spending ceiling. Lula has already made several statements against the device.
The assessment is that there is insufficient funding of the public health system and that it is necessary to increase resources for the area.
“We need to have a progressive increase in public spending on health to 6% [do PIB]”, said Chioro. Today, according to a calculation by the IEPS (Institute of Studies for Health Policies), expenditure in the sector is 3.19% of the total budget.
The spending ceiling was created under Michel Temer (MDB). It limits the growth of the federal government’s public expenditures to the inflation of the previous year, without considering possible increases in revenue.
Another issue to be addressed in this front is the fact that the investment capacity of the Ministry of Health has been reduced in recent years. With that, the portfolio became dependent on the rapporteur’s amendments, fractions of the Budget whose destinations are decided by congressmen.
“This situation of having almost R$ 18 billion [de emendas do relator] executed is destructuring of any public policy. A deputy or senator allocates amendments to build ICU in a place where it was not needed. There is no commitment to the cost [nos anos seguintes]. A hospital normally costs as much in a year as it took to build it.”, he stated.
In the impossibility of changing the mechanism used in the current government to distribute resources to congressmen, the idea would be to discuss health priorities before allocating the amendments.
“If imposing amendments have to be implemented, it is essential that they be made in a menu of investments that are priorities for the SUS and defined in common agreement with the municipal, regional and national health plan”said.
WHAT ELSE IS ON THE RADAR
Chioro highlighted other points that have the attention of the team that formulates the health policy in a possible new Lula government:
- vaccination – resume more frequent campaigns for diseases such as measles, rubella and diphtheria, with the direct involvement of the Minister of Health to promote actions and mobilize the public;
- ministry cadres – there should be replacement of personnel in the portfolio, which lost more than 18,000 employees in the current government. The priority areas will still be studied;
- datasus – The idea is a broad digitization of the SUS, with a focus on small cities with more difficulty in integrating the data system. They would be helped with resources from the federal government;
- national articulation – the assessment is that Bolsonaro imploded the dialogue between the Union, States and municipalities, which is basic for the functioning of the SUS. There will be an effort to bring together entities such as Conass and Conasems to help implement public policies in the area;
- future pandemics – “we need to regain the ability to face health emergencies”, said the former minister. He cited, for example, health problems caused by global warming: “Every minister has an epidemic to call his own. In the Bolsonaro government we had the biggest epidemic of the century and the most disastrous response that could have been”.
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