This article, celebrating the 25th anniversary of Brazil's 1988 Constitution, aims to review the country's social policy development, discuss political projects, and analyze challenges for the sustainability of the Unified National Health System (SUS). Based on public policymaking studies, the article revisits the origins of liberal social policy, focused on social assistance, and analyzes the hegemony of U.S. policies targeting poverty and their repercussions for universal policies. After identifying the formulation of political projects in Brazil's democratic transition, it discusses their implications during the various Administrations since 1988, along with the difficulties faced by the National Health System. The article concludes that the political forces occupying government in the last two decades have failed to present a project for the country on the same level as those who drafted the Citizen Constitution.