Social policy and health policy in Latin America: a field of political struggle

Abstract

Social policy and health policy are integral parts of society's projects, but their place in societies dif-fers. Rightist or neoliberal governments view such policies as an area they cannot overlook without losing legitimacy, and as a terrain for patronage and corporate population control. The main objec-tive of such governments is to make social and health policies another field for commodification and generation of profit for capital. For leftist and progressive governments, social policy and health policy as part of it are priority instruments for generating social welfare and decent life for citizens. Nevertheless, when such poli-cies are insufficiently or incorrectly implemented, they not only fail to serve their purpose, but can become an important source of de-legitimation and popular discontent. The two major health policy standards, so-called Universal Health Coverage (CUS, acronym in Spanish) and what is known as the Unified Health System (SUS), express two distinct ways of conceiv-ing and (re)building the state. Thus, CUS or " structured pluralism " 1 as it is known in Latin America is the model promoted by the neoliberal state, while SUS pertains to the social state. Strictly speaking, CUS refers to insurance coverage and not universal access to the required services, since it only supports an explicit and financed package of services for individuals, leav-ing aside public health actions 2 . Its objective is to introduce the market and competition, both in the administration of funds and purchase of services and in the provision of medical services, in both cases including both private and public agents. The content of the packages of services varies according to the premium, and public funds are often used to subsidize the market. The three most well-known national cases of this model are Chile, Colombia, and Mexico, which nevertheless have some differences 3 . SUS is intended to guarantee the universal right to health as a duty of the state. It is based on the original English model of the National Health Service: free of cost, with solidarity, redistribution, uni-versality with comprehensive, integrated coverage of services for the entire population, and funded by general taxation. In the Latin American countries with this model, it is written into the respective Constitutions in some form 4 . Nevertheless, not only the neoliberal governments or states, minimal or modernized, but also social welfare, leftist, or progressive governments have experienced problems in implementing their