I have been repeatedly impressed with the “universal healthcare” system here in Brazil. That being said, coming from the US and our/their “get insurance or get screwed” system, it may not take much to impress me. Things here are not a bed of roses, for sure, but there are some important plusses and minuses.
On the plus side is the language in the Brazilian constitution that says (essentially):
Article 6. Education, health, work, leisure, security, social security, protection of motherhood and childhood, and assistance to the destitute, are social rights, as set forth by this Constitution.
Article 196. Health is a right of all and a duty of the State and shall be guaranteed by means of social and economic policies aimed at reducing the risk of illness and other hazards and at the universal and equal access to actions and services for its promotion, protection and recovery.
In short - healthcare is a citizen's right and it is the duty of the government to provide it.
The healthcare matrix here in Brazil is a complicated mix of public and private providers. Only about 25% of Brazilians have private health insurance, the rest access public clinics and hospitals (which vary wildly in terms of quality and efficiency depending mostly on whether they are in urban or rural areas). More than half of registered nurses and nearly half of doctors are public employees.
The stated principles of the Unified Health System (Sistema Único de Saúde or SUS) are universality, integral care, health promotion, and community participation, with public funds to provide free health care to all Brazilian citizens.
That’s the good news. And for many, many Brazilians it has been very good news. According to this summary article, over the past three decades infant mortality decreased by about 6.3% a year, and life expectancy increased by 10.6 years. Mortality due to infectious disease decreased from 23% of total deaths in 1970 to less than 4% in 2007.
But then there is the bad news. Well, let’s remember that nothing is perfect.
There is a wide gulf in service and efficiency between those with private health insurance, accessing private hospitals, and those going to public facilities. This is certainly not always the case, but in many poorer areas (urban or rural), the conditions at the “hospital” can be alarming.
But I think what I’ve found more disturbing in my reading on this subject is that there is an insidious dynamic at play within the university education system that is broadening the gap between public and private healthcare. No surprise, really, but it’s a bummer to see it studied and articulated.
Capitalism. There it is again, f*cking things up. Early on I saw the irony of the public university system here. It’s free, but only the privileged can access it (with notable exceptions, of course). Competition to get in is fierce and students take expensive preparatory classes to score their best on the entrance exam. No money, no prep course – no high score, no free university. The poor and working class pay to attend private universities.
But that’s not the real problem. The problem seems to be the ethos among the privileged class that financial reward and status are the end goal and working in the public sector is viewed essentially as a lower-paid job with little status. So many educated professionals are self-selecting out of the national healthcare system in favor of the more profitable private system. Many people will tell you that there is a shortage of healthcare providers in the public system.
So we have the ever-corrosive dynamic of private enterprise and personal desire for wealth working against the common good. Nothing too strange about that – but it would be a shame if it erased the benefits gained to date seen with the public healthcare system here in Brazil. I would prefer to see the momentum moving in the other direction.
So tell me – if you can afford it, would you choose to buy private health insurance here in Brazil? Why or why not? While it is cheap by USA standards, it still costs a lot. Is it worth it when you have universal coverage provided by the government? Is it necessary, or just a convenience?
[To view Brazil’s constitution in English, go here. It’s a good read.]