“…The April 1977 laws, which were passed with the intention of weakening the Movimento Democrático Brasileiro (MDB), which was gaining ground on the pro-military Arena party, also facilitated the proliferation of political parties. 4 The sheer number of parties that existed after the return to democracy formed the basis for what Sérgio Abranches (1988) called "coalition presidentialism", referring to the difficulty of forming a majority in the legislature, such that alliances with an ever greater number of political parties have to be forged, resulting in the dilution of the programs intended by the party of the elected president, and more power for conservative forces within governments (Limongi, Figueiredo, 1998;Arretche, Rodden, 2004;Sodré, Alves, 2010). These features of the Brazilian political and electoral system help explain how change in the country has been limited and give an understanding of why, upon creating SUS, the 1988 Constitution also maintained a large private healthcare system to compete with it, counting on all the fiscal privileges it had had since the military regime, a rare state of affairs in countries that create public, universal health systems (Rodrigues, Santos, 2011).…”