Routes and challenges before diverse paradigms in the construction of social security

Abstract

Social Security in Latin America was built fundamentally under a labor logic that identified subordinate, urban and organized wage earners as subjects of rights. It adopted the insurance structure to cover contingencies in the life cycle of workers and their families and was organized into public services under state responsibility. The rest of the workers and the population received health care services in public institutions and according to the demands, other sectors of workers were inserted into social security. Its conception and orientation was modified with the privatization of public pensions and the separation between financing and provision of health services, assumed by the private sector. Chile is the one that started this model in 1981. The argument was to face the aging process, encourage the growth of coverage and create conditions of social and financial sustainability. Four decades later, nine countries with total or partial private management show that coverage has stagnated and social viability has not been achieved, and despite this, they carry out reforms while maintaining private management. Ten with public management are also proposing reforms, trying to include gender perspectives, recognition of care work, closing coverage and sufficiency gaps, and fiscal sustainability. The Covid-19 pandemic showed the state of neglect of the health of Latin Americans and their public institutions, forcing reforms and proposing new care and financing models. This article analyzes and discusses the following: a) lessons from the design of social security and the path taken; b) the difficult transition from labor law to human rights in the area of social security; c) the routes to build a different paradigm.