The Brazilian public health in a universe "worldless": the austerity of the Constitutional Amendment Proposition 241/2016.

Correspondence A. N. Mendes Faculdade de Saúde Pública, Universidade de São Paulo. Av. Dr. Arnaldo 715, São Paulo, SP 01246-904, Brasil. [email protected] The philosopher Slavoj Žižek, in his discussion of capitalism and its current crisis, states that capitalism is a movement with a properly worldless character 1. Žižek bases his discussion on Alain Badiou, who associates this world concept to the unmatchable status of the capitalist universe as “worldless”. Žižek states that: “Perhaps this is where we should locate the ‘danger’ of capitalism: although it is global, encompassing all words, it sustains a strict sensu ‘worldless’ ideological constellation, depriving the great majority of people of any meaningful ‘cognitive mapping’. The universality of capitalism resides in the fact that capitalism is not a name for a ‘civilization’, ...” 1 (p. 90). This passage helps to understand the perversity of contemporary capitalism, under the rule of interest-bearing capital (financial capital) and its crisis, especially through its effects on social rights, notably health. The Constitutional Amendment Proposition 241/2016 (PEC 241), which institutes a new fiscal regime by limiting public spending, starting in 2017 and for the next 20 years, adjusted only by the inflation (through the Extended National Consumer Price Index – IPCA), seems to be the most recent expression of the character of this “worldless” contemporary capitalism, with its attack on the historically insufficient funding for the Brazilian Unified National Health System (SUS, in Portuguese). With PEC 241, Brazilian workers will be suddenly and violently dragged from their precarious social and health conditions and launched toward a future of even worse conditions for the preservation of life and human dignity, amidst an intense process of demographic transition, with population growth and an aging population, the permanent technological advancement in health care and an increase in chronic, non-transmissible diseases. This PEC throws public health into this “worldless” capitalist universe. Since 1990, at a time when interest-bearing capital reigned supreme in contemporary capitalism, State has not withdrawn from the economy, but have taken on a particular “presence”. States adopted austerity policies, reducing social and health rights, intensifying mercantilization mechanisms in their interiors, both in central capitalist countries and in Brazil. The Brazilian State then allowed capital to appropriate public funds, with constant disputes surrounding the financial resources for SUS, which have been present since its creation in the 1988 Constitution. PEC 241 is the most austere policy of this period, insofar as it does not limit interest payments, but only primary expenditures, for two decades. In a comparative analysis, Brazil is the country with the highest debt financing costs (interest payments), considering its level of debt in relation to GDP (Gross Domestic Product). The Brazilian net public debt is 33.6% of the GDP (2013) and has a financing cost of 5.2% of the GDP. Countries with significantly larger net debts have much lower financing costs, such as Greece, which owes 169.7% of its GDP; Portugal, 118.5%; and Spain, 60.5%, with costs, respectively, of 3.6%, 3.8% and Áquilas Nogueira Mendes 1,2