Belmartino S, Bloch C
Investigadora del Centro de Estudios Sanitarios y Sociales (CESS), Rosario, República Argentina.
Soc Sci Med. 1989;28(5):497-514. doi: 10.1016/0277-9536(89)90103-2.
This paper analyses the health policies implemented in Argentina during the last four decades, relating their application to concomitant development strategies that were underwritten by political projects advancing different 'societal models'. Our hypothesis is that, in Argentina over the last four decades, there have been three major attempts at adjusting the internal needs of capitalist development to the conditions imposed by the world capitalist system. Such strategies, globally termed 'populist', 'developmentalist' and 'authoritarian', imply a modification of the relationships between state and economy (mode of development) and between state and society (mode of hegemony). They also involve peculiar ways of approaching the contradiction between accumulation and distribution, and consequently, different methods for solving social problems and alternative paths to the consolidation of a hegemonic project. Within this context, both the rationale offered by the state for its proposed health and welfare policies, as well as the actual implementation of these policies conforms to the basic principles of each of the models in force. In the populist model, the political project involves a progressive expansion of the participation of the popular sectors, both in the labour and consumption markets and in the political system. Its health plan conforms with this model by recognizing the state's responsibility both to increase its participation in health services and to promote corporativist activities in the sector, in accordance with the global mobilization/incorporation policy controlled by the mass organizations. In the developmentalist model, emphasis falls on the need to privilege accumulation over distribution; investments in infrastructure are treated as a priority as they are considered indispensable to ensure the future generalization of public welfare. The argument is that the impact of medical assistance on labour productivity must go hand in hand with the creation of job opportunities from economic development. Finally, the authoritarian model excludes the promotion of concensus politics in an effort to radically transform the articulations between state and society. The disciplinary function of the market is used to concealing both a serious lack of interest in the population's living conditions and an iron decision to subject the totality of social life to the rationality of a system where social injustice stands as the society's bastion.
本文分析了阿根廷在过去四十年里实施的卫生政策,并将其应用与伴随的发展战略联系起来,这些发展战略由推进不同“社会模式”的政治项目所支持。我们的假设是,在过去四十年的阿根廷,曾有过三次主要尝试,试图将资本主义发展的内部需求调整到世界资本主义体系所施加的条件。这些战略在全球范围内被称为“民粹主义”、“发展主义”和“威权主义”,意味着国家与经济(发展模式)以及国家与社会(霸权模式)之间关系的改变。它们还涉及处理积累与分配之间矛盾的独特方式,因此,解决社会问题的不同方法以及巩固霸权项目的替代路径。在此背景下,国家为其提议的卫生和福利政策提供的基本原理,以及这些政策的实际实施都符合每种现行模式的基本原则。在民粹主义模式中,政治项目涉及民众部门在劳动力和消费市场以及政治体系中的参与逐步扩大。其卫生计划符合该模式,即承认国家有责任增加其在卫生服务中的参与,并根据群众组织控制的全球动员/纳入政策,促进该部门的社团主义活动。在发展主义模式中,重点在于需要将积累置于分配之上;对基础设施的投资被视为优先事项,因为它们被认为是确保未来公共福利普及不可或缺的。论点是医疗援助对劳动生产率的影响必须与经济发展创造就业机会齐头并进。最后,威权主义模式排除了促进共识政治的努力,以从根本上改变国家与社会之间的关系。市场的纪律功能被用来掩盖对民众生活条件的严重缺乏兴趣,以及将整个社会生活置于一个以社会不公为社会堡垒的理性体系之下的坚定决心。