Entre o executivo e o legislativo: fundo público e as disputas políticas na apreciação do orçamento da saúde (2019-2022).

Abstract

This dissertation analyzes the disputes surrounding public funding in the Health Budget between 2019 and 2022, in a scenario marked by the deepening of neoliberalism, the political reconfiguration under the Bolsonaro government, and the impacts of the Covid-19 pandemic. Grounded in a critical Marxist theoretical framework, the research mobilizes the concepts of hegemony, power bloc, public funding, and competing health projects to examine the dynamics between the Executive and Legislative branches in defining the budgetary priorities of the Unified Health System (SUS). The qualitative methodology, supported by quantitative data, includes documentary analysis of stenographic notes from the Joint Budget Committee, congressional resolutions, and databases such as SIOPS. The categorization of parliamentary debates and the identification of the agents involved reveal that parliamentary amendments have become one of the main instruments of political negotiation, redirecting resources and shaping the health budget according to hegemonic interests. Constitutional Amendment 95/2016, by establishing the spending cap, imposed a rigid limit on the expansion of health funding, deepening the structural underfunding of the SUS (Brazilian Unified Health System). However, this restriction did not apply to spending on public debt servicing, directly benefiting financial capital. With the impossibility of expanding primary expenditures, parliamentary amendments gained centrality in the allocation of resources, becoming decisive mechanisms in the dispute over public funds. This dynamic strengthened the influence of the Legislative branch over the health budget, while compromising the predictability of funding and intensifying budgetary fragmentation. The results demonstrate that the shaping of the health budget is not determined solely by fiscal constraints, but reflects the dispute between antagonistic projects: one universalist, which defends robust public funding and state provision of services, and another restrictive and focused, which promotes the commodification and financialization of health. The analysis by the Joint Budget Committee shows that budgetary choices operate in consolidating the hegemony of factions within the power bloc linked to financial capital and the private health sector, favoring a model that subordinates the right to health to the logics of capitalist accumulation. Thus, the health budget is configured as a central arena of class struggle, in which the allocation of public funds expresses the correlation of forces and the limits imposed by financial domination in the capitalist state.