Abstract The main argument of this work is that the discourse of social and economic rights in Brazil has been appropriated by privileged economic groups with the result that the constitutional protection of those rights is no longer carrying out its function to reduce economic inequality. This article will be divided into three parts. The first is a discussion of the historic context of patrimonialism in Brazil as well as the origins of economic inequality in the country. The second part is devoted to the theoretical debate surrounding the con­stitutional protection of social and economic rights in light of what is often referred to as ‘new constitutionalism’, along with an interpretation of the structure for protecting social and economic rights that is present in the Brazilian constitution. The third part consists of a case study of the current state of the judicialization of the right to health in Brazil, with special attention to free concession of medicine and the new legislation on the subject. In conclusion, the paper argues that judicial decisions on the right to health, in particular, and social and economic rights, in general, have been formalistic, with little regard to their (often negative) distributive impact. The solution is then not to move from individual litiga­tion to collective litigation (eg class actions), but to move from an ‘individual rights’ approach to a ‘distributive’ approach, which takes into account the effects of court decisions not only with respect to the parties involved but also to the rights of the poorest of the poor.