A SAÚDE NA UTI

IMG_0016Recebi tantas vezes a alcunha de pessimista que até me acostumei. Esses governos de esquerda deixam-me assim, fazer o quê? Infelizmente há tragédias anunciadas e o que se percebe na saúde brasileira é uma delas.

Que o governo do PT contraiu mais empréstimos do que poderia pagar, não é novidade. Há treze anos Lula e Dilma distribuíram benesses de toda sorte, que favoreceram desde gente muito pobre até grandes empresários. Dada a impossibilidade de pagar a conta, pedalaram até o limite.

Só que o limite chegou. O governo federal não tem mais verba para repassar aos estados e municípios. A saúde pública sentiu o baque. Só no ano passado, a União deixou de repassar 2,2 bilhões do Fundo Nacional de Saúde às prefeituras e estados.

De 2010 a 2015, o SUS desativou 13 mil leitos hospitalares. Cerca de 12 mil cirurgias foram suspensas em Minas Gerais no ano passado. No Paraná, no mesmo ano, cancelaram-se todos os mutirões de cirurgias eletivas. Em Manaus, três mil médicos da rede pública não recebem salários há três meses (situações semelhantes evidenciam-se n’outras localidades). Extinguiram-se os plantões de ortopedia nos pronto-atendimentos da capital amazonense e as cooperativas, que prestam serviços para o estado, reduziram os quadros em 10%. Há menos médicos, enfermeiros e técnicos trabalhando na rede pública.

O Rio de Janeiro, então, viveu há pouco a pior crise na saúde pública de sua história. O Hospital Getúlio Vargas fechou as portas. Muitas emergências fizeram o mesmo por falta de recursos. Milhares de fluminenses ou ficaram sem atendimento, ou tiveram de enfrentar filas quilométricas nos serviços que ainda funcionavam.

Não para por aí. Após um ano do “Mais Médicos”, quase a metade dos municípios contemplados pelo programa tinha quantidade menor de médicos do que quando chegaram os bolsistas, segundo o Tribunal de Contas da União. A explicação é simples: as prefeituras demitiram seus profissionais e empurraram a responsabilidade para o governo federal. Resultado (tremenda ironia!): menos médicos.

Até aí, nada de muito novo. A saúde pública no Brasil sempre foi sofrível. Resta, para os que podem, refugiar-se em um plano de saúde. Só que, com o encolhimento da indústria e o aumento do desemprego, os convênios passaram a perder clientes. Meio milhão de brasileiros ficou sem plano de saúde em 2015. Como a demanda diminuiu, os convênios passaram a descredenciar em massa profissionais e clínicas.

Seguia-se a lógica do mercado até aparecer a Agência Nacional de Saúde Suplementar (ANS) com novas regulamentações, obrigando os convênios a substituir clínicas e hospitais descredenciados por outros equivalentes. Simples, não é mesmo? Basta uma lei. Sem poder “demitir”, restou aos planos de saúde aumentar preços. Ato continuo, a ANS chegou para simplificar as coisas novamente, com uma conduta socialista a la Hugo Chávez: fixou reajuste máximo anual aos planos de saúde individuais em uma taxa de 13,55%

Ora, qualquer um que conheça rudimentos de economia sabe que, ao se estipular um preço máximo, cria-se escassez. Com a saúde não podia ser diferente. Os planos tornam-se cada vez mais raros e mais caros, principalmente os individuais. Já os “coletivos” (aqueles oferecidos pelas empresas a funcionários e dependentes) não sofreram tanto, porque têm reajustes negociados bilateralmente, por meio de contrato, sem passar pelo regimento da ANS. Não é por acaso que, dos 50 milhões de beneficiários de planos de saúde, apenas 10 milhões sejam individuais.

Mas a indústria, como dissemos, também vem contraindo-se. Só em março perderam-se 118 mil vagas formais de emprego. A média de desemprego em 2015 foi de 8,5% e a previsão para 2016 é de 10%, segundo o PNAD/IBGE. Só em Manaus, cidade onde moro, mais de 15 mil vagas no Distrito Industrial viraram fumaça em 2015. Menos funcionários na indústria, menos usuários para os planos de saúde.

Triste realidade! Temos o segundo maior mercado de planos de saúde do mundo, mas não temos o segundo maior PIB. Conclusão: empresas e pessoas físicas não têm conseguido arcar com os custos cada vez mais altos dos convênios, por isso desistem de contratá-los. As prestadoras de saúde vêm falindo. Aconteceu, por exemplo, com a UNIMED paulistana.

Desenha-se a desgraça. Míngua a saúde privada. Quem não tem convênio vai para onde? Para o SUS. Mas… Opa! A rede pública, além de poucos recursos, teve os quadros reduzidos. Menos profissionais terão de assistir mais doentes com cada vez menos recursos. A não ser que tenhamos, por intervenção divina, uma epidemia de boa saúde neste país, prevejo um desastre sem precedentes. Deus nos proteja!

André Paschoal é médico e escritor.
André Paschoal é médico e escritor.

 

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