The SUS under the Logic of Capital

A Critical Analysis through the Legal Form

Abstract

This work critically analyzes the limits and contradictions of the right to health in Brazil, specifically within the scope of the Unified Health System (SUS). The study investigates how the legal structure of this right interacts with the dynamics of the capitalist mode of production, seeking to understand its role in the reproduction of capital and how its changes in content follow the historical needs of material life. The research adopts the historical-dialectical materialist method, based on Pachukanis’s critique of the legal form and the concept of hyper-real subsumption of labor to capital, proposed by Marcus Orione. From this framework, the text examines the creation of the SUS and its guiding principles (universality, integrality, and equity) from a critical perspective that reveals how the SUS operates under the logic of abstract equivalence. It functions as a mechanism for the socialization of labor power reproduction costs and the consolidation of legal ideology, despite representing a historic social achievement. The study demonstrates that the contemporary scenario, marked by underfunding, privatization, and managerialism, reflects the phase of hyper-real subsumption, in which the State adopts market efficiency metrics and begins to act as an "entrepreneur State". Finally, it is argued that the struggle for the right to health will always be restricted by a reformist perspective as long as critical theories focus on the struggle for the expansion of rights, rather than their overcoming.

Keywords: Brazilian Unified Health System (SUS); right to health; legal form; marxism.