Skip to main content

In Brazil, health care is a right

By Eduardo J. Gómez, Special to CNN
July 13, 2012 -- Updated 1243 GMT (2043 HKT)
A woman grabs bunches of flowers during a demonstration for greater spending on health care in front of the National Congress in Brasilia, on September 27, 2011.
A woman grabs bunches of flowers during a demonstration for greater spending on health care in front of the National Congress in Brasilia, on September 27, 2011.
STORY HIGHLIGHTS
  • U.S. is divided over who should be responsible for paying for health care
  • Eduardo Gomez says Brazil has long considered health care a right
  • He says Brazil's life expectancy has increased at a faster rate than that of the U.S.
  • Gomez: Brazil still lags behind in some areas, including widespread access to medical technology

Editor's note: Eduardo J. Gómez is an assistant professor in the Department of Public Policy & Administration at Rutgers University at Camden who has written extensively about health care in Brazil.

(CNN) -- This week's congressional battle over the GOP move to repeal President Obama's Affordable Care Act, as well as the NAACP's boos in response to Mitt Romney's proposed elimination of what he called the "nonessential " Obamacare program, provides yet another reminder of how divided America has become over this issue.

Other nations have avoided these rifts and built a consensus for universal health care coverage. Consider the case of Brazil.

Since the early-20th century, the government and civil society have been proactive in establishing health care as a common good, while sharing the burden of paying for these services through a myriad of taxes.

Still, there are several cracks in Brazil's generous health care system.

While the government has certainly been committed to providing a public option, it is simply overstretched. Federal health care spending is minimal at best, failing to meet ongoing needs, while several managerial, human resource and infrastructural problems remain.

Despite these limitations, it seems that there is one key lesson about health care in Brazil that we can learn from: that is, an enduring cultural belief and expectation that everyone should contribute to health care and that it is a fundamental human right.

Brazil's universal healthcare system is called the Sistema Único de Saude (Unified Health System, SUS).

SUS is decentralized, such that the management, formulation and implementation of policies are the responsibility of the state and municipal governments. In addition to providing free primary care, surgery and medication, SUS also provides a Family Health Program, where doctors and nurses visit households to provide services.

Brazil's health care system is funded through a variety of taxes at the federal, state and municipal level. The states receive money from the federal government, while the municipalities receive funding from both the federal and state governments. What's more, the government has always been committed to levying taxes, increasing them and even tapping into the state's oil revenues to fund SUS.

House to vote on Obamacare repeal
Stewart: Romney wants free market reform
Obama: This is a victory for the people

But why has the government been so committed to providing health care?

This endeavor reflects a long history of social and political commitments to providing health care as a government and civic responsibility. After obtaining independence from Portugal in 1822, Brazil saw the emergence of well-organized social movements advocating for government intervention in health care.

Supported by personal income and social security taxes, health officials agreed with these movements that health care was a government responsibility and that everyone should contribute to the system.

This policy idea survived several democratic governments and military dictatorships throughout the 20th century, lasting up through the transition to democracy in 1988. It was also sustained with the help of proactive social health movements, such as the sanitaristas, comprised of medical doctors, bureaucrats and politicians.

This idea of a shared responsibility in providing health care was so popular that it eventually became part of the 1988 constitution. Through the constitution's introduction of SUS, health care became an official government responsibility and human right, an issue on which liberals and conservatives could agree.

Brazil's health care system seems to have paid off.

Brazil's average life expectancy has improved at a faster rate than that of the U.S. since 1960, though it continues to lag behind. Life expectancy there increased from 54.49 years in 1960 to 73.1 in 2010, compared to the U.S. increase of 69.77 years to 78.24.

But several challenges remain.

First, notwithstanding heavy demand for health care services, the government has only modestly increased spending for SUS from 50.2 billion real ($24.6 billion in U.S. dollars) in 2008 to 61.7 billion in 2010.

Second, SUS hospitals and the Family Health Program have often had a difficult time treating individuals in hard to reach areas, such as the Amazonian region while individuals often have to wait a long period of time for prevention and treatment services.

Consequently, many of the poor in need of immediate care have had to purchase private insurance, or pay out of pocket for services. In fact, the percentage of individuals purchasing insurance increased from 8% in 2000 to 14.4% of the population in 2005.

What's more, there is a chronic shortage of doctors and nurses, especially in rural areas. Many hospitals are also poorly managed, lacking autonomy from state governing boards. And finally, there is a high level of inequality in medical technology and infrastructure, with larger, more affluent municipalities able to provide better technological equipment and medical care.

While the U.S. joins Brazil in lacking sufficient health care personnel, especially in rural areas, U.S. cities in general are wealthier and have access to the latest technology and health care infrastructure.

Despite Brazil's ongoing commitment to providing health care, the government will need to ensure adequate funding, hire more personnel and strengthen its facilities before its citizens can effectively benefit from SUS. In short, government "capacity" must meet its unwavering passion for taking care of its people.

Even so, America can certainly learn a big lesson from its southern partner.

That is, Republicans viewing the ACA requirement to buy health insurance as an unfair "tax" versus Democrats perceiving it as a "penalty" should put their haggling aside and instead view the ACA as a shared responsibility and human right.

Indeed the Brazilians show us that the right to health care is way too important to be mired in incessant policy debates, regardless of the innumerable challenges that generous health care systems confront, and that it is a common good that all Americans should support.

The opinions expressed in this commentary are solely those of Eduardo Gomez.

ADVERTISEMENT
Part of complete coverage on
September 30, 2014 -- Updated 1653 GMT (0053 HKT)
Jeff Yang calls Ello a wakeup call to Facebook and Twitter, and a sign of hope for fast-rising upstarts Pinterest and Snapchat.
September 30, 2014 -- Updated 2248 GMT (0648 HKT)
Paul Waldman says the Secret Service should examine its procedures to make sure there are no threats to the White House--but without losing the openness so valuable to democracy
September 30, 2014 -- Updated 2049 GMT (0449 HKT)
Jesse Williams says the videotape and 911 call that resulted in police gunning down John Crawford at a Walmart reveals the fatal injustice of racial assumptions
September 30, 2014 -- Updated 2303 GMT (0703 HKT)
Mel Robbins says officials should drop the P.C. pose: The beheading in Oklahoma was not workplace violence. Plenty of evidence shows Alton Nolen was an admirer of ISIS.
September 30, 2014 -- Updated 1911 GMT (0311 HKT)
The Occupy Central movement has already achieved much by bringing greater attention to Hong Kong's struggle for democracy, William Piekos says..
September 30, 2014 -- Updated 1911 GMT (0311 HKT)
The Occupy Central movement has already achieved much by bringing greater attention to Hong Kong's struggle for democracy, writes William Piekos.
September 30, 2014 -- Updated 1413 GMT (2213 HKT)
As Prime Minister Narendra Modi visits America, Madeleine Albright says a world roiled by conflict needs these two great democracies to commit to moving their partnership forward
September 30, 2014 -- Updated 1404 GMT (2204 HKT)
John Sutter: Lake Providence, Louisiana, is the parish seat of the "most unequal place in America." And until somewhat recently, the poor side of town was invisible on Google Street View.
September 29, 2014 -- Updated 1311 GMT (2111 HKT)
Julian Zelizer says in the run up to the 2016 election the party faces divisions on its approach to the U.S.'s place in the world
September 29, 2014 -- Updated 1419 GMT (2219 HKT)
Ruben Navarrette says Common Core supporters can't devise a new set of standards and then fail to effectively sell it.
September 30, 2014 -- Updated 1329 GMT (2129 HKT)
Earlier this month, Kenyans commemorated the heinous attack on the Westgate Mall in Nairobi.
September 30, 2014 -- Updated 1859 GMT (0259 HKT)
David Wheeler says Colorado students are right to protest curriculum changes that downplays civil disobedience.
September 27, 2014 -- Updated 0158 GMT (0958 HKT)
Sally Kohn says when people click on hacked celebrity photos or ISIS videos, they are encouraging the bad guys.
September 26, 2014 -- Updated 1155 GMT (1955 HKT)
Loren Bunche says she walked by a homeless man every day and felt bad about it -- until one day she paused to get to know him
September 30, 2014 -- Updated 1332 GMT (2132 HKT)
ISIS grabs headlines on social media, but hateful speech is no match for moderate voices, says Nadia Oweidat.
September 29, 2014 -- Updated 1233 GMT (2033 HKT)
A new report counts jihadists fighting globally. The verdict? The threat isn't that big, says Peter Bergen.
September 23, 2014 -- Updated 2137 GMT (0537 HKT)
Ebola could become the biggest humanitarian disaster in a generation, writes former British Prime Minister Tony Blair
September 26, 2014 -- Updated 1658 GMT (0058 HKT)
ISIS has shocked the world. But will releasing videos of executions backfire? Four experts give their take.
September 26, 2014 -- Updated 1439 GMT (2239 HKT)
Eric Holder kicked off his stormy tenure as attorney general with a challenge to the public that set tone for six turbulent years as top law-enforcement officer.
September 26, 2014 -- Updated 1309 GMT (2109 HKT)
LZ Granderson says Obama was elected as a war-ending change agent, not a leader who would leave behind for his successor new engagement in Iraq and Syria. Is he as disappointed as the rest of us?
September 24, 2014 -- Updated 0910 GMT (1710 HKT)
Gayle Lemmon says the question now is how to translate all the high-profile feminizing into real gains for women
ADVERTISEMENT