Social Policy Expansion, Democracy and Social Mobilization in Latin America: Healthcare Reform in Brazil and Mexico

Abstract

This article studies how and under what circumstances different socio-political formations are more likely to trigger and shape distinct modes of institutional reform and transform the structures of the state in greater or lesser degree. The focus is on health care reforms in the context of political liberalization: the Sistema Único de Saúde in Brazil and the Seguro Popular de Salud in Mexico. Both are part of the wave of welfare policy expansion observed in Latin America in recent decades and undertaken in the national contexts of transitions towards pluralistic democratic systems, but which at the same time represent opposite reform models: a universalistic model in Brazil and the layering of insurance programs in Mexico. Applying a comparative perspective, we seek to establish similarities and differences in the contexts under which the reform processes were undertaken and in the social and political arrangements that generated and drove them. Differences in the types of democratic transitions, the formation of cross-class coalitions and the institutional legacies from the populist regimes suggest that while in Brazil the process of democratization occurred together with the formation of an “initiative capacity,” the absence of this in Mexico resulted in the reproduction of a segmented and unequal system.