I guess everyone knows by now the Supreme Court has decided that President Obama's health care bill is to be upheld. It's constitutional, not under the Commerce Clause, but under Congress's powers of taxation. Is this for people who want single-payer health care? Some people call it Medicare for all. Is this a good decision? Does it advance that cause? Or not a good decision? Does it somehow entrench or keep the structure of what some people call the corporatization of health care in place?—further corporatization, I should say.Now joining us to give her views on this decision is DeAnn McEwen. She's copresident of the California Nurses Association. DeAnn's a longtime intensive care unit registered nurse. She also leads the joint nursing practice commission and is a member of the legislative and regulatory committee of the union. She's influenced health care public policy through legislative and grassroots advocacy, and she's particularly been championing a single-payer, Medicare-for-all system in the United States. Thanks for joining us, DeAnn.DEANN MCEWEN, COPRESIDENT, CALIFORNIA NURSES ASSOCIATION: Thank you. It's my pleasure to be here. Also, on behalf of National Nurses United—175,000 members all across the United States [incompr.] vice presidents, this issue is of most importance to all of us and the patients that we take care of.JAY: So President Obama says this is a victory for all Americans. Do you agree?MCEWEN: Well, this court decision today's not the end of our fight for a permanent solution to our nation's health care crisis. Of course, there are some provisions in the law, like insurance companies no longer being able to deny people for pre-existing conditions, but it stops short of any kind of rate control. And we also know that this plan has already been test-driven in Massachusetts. It's basically a mirror of the Massachusetts law, which isn't genuine reform, in our view. Patients are going to continue to be harmed and they're going to suffer—and we see that everyday—of easily treatable and preventable conditions.JAY: Now, some people who want Medicare for all were actually hoping that this decision would go the other way, that by striking down on the Commerce Clause the issue of constitutionality, this would at least reopen the conversation for real Medicare for all, because it's interesting: the Court did decide that taxation's constitutional, which is how they found this to be constitutional, and taxation is essentially the basis of a Medicare for all. What do you make of that argument?MCEWEN: Well, number one, what shouldn't be lost in any discussion over these mandates: taxes are supposed to go to support our infrastructure. And in terms of purchasing a product, a private product that's—really it's a lemon, and it doesn't do what it says it's going to do, which is—doesn't control costs, it doesn't promote improved outcomes, and it really does not improve access for the majority of the patients that we take care of.So I don't see any reason to celebrate or to champion the law's failure at this point, because, again, there are some things that it does in terms of—students that are in school or up to age 26, they could be continued to have coverage on their parent's policies, and that is if their parents are still working and have policies. So, again, we have an opportunity to fix it and get it right in the coming term. And President Obama's actually indicated that we may need to do that. And as nurses, we're here to see to it that he does, so that we actually progress to get genuine reform.JAY: Well, what do you make of this argument that some people are giving that they were actually hoping it went the other way, that if it had been struck down, it would have started the whole debate again, and that would have been—you know, made Medicare for all more likely part of the debate? Of course, I'm—. Yeah, go ahead.MCEWEN: No, I'm sorry. Just regardless of how the Supreme Court ruled, we know that it's not going to stop employers from dropping coverage. It's going to—premiums are going to continue to increase, costs are going to skyrocket. There are no cost-control measures in this. So, again, I think it's actually going to heat up the debate and give us an opportunity again to continue this discussion. Had it been totally declared unconstitutional, I think a lot of people really would have given up hope that they could change this current situation that's really against the interests of all people.So I see it as an opportunity. I was prepared to continue this fight for Medicare for all, and all of the nurses that belong to our association in this country, and Physicians for a National Health Plan, and other good-government groups, to get the government to go in the direction of doing the right thing on behalf of all people.JAY: So it's a good decision, but not greeted as a great cause for enthusiasm or celebration, 'cause the basic bill you don't think is all that good. So, then, what do you do next? I guess the Republicans—everyone says they're going to make a big issue out of this. There's apparently millions of dollars in advertising attacking Obamacare that is going to hit television screens in the next few days. So you're in this position of not agreeing with the Republicans. On the other hand, you don't want to be known as the big defenders of this health care legislation. So how do you position yourself? And what you do next?MCEWEN: Again, we're positioned on the side of genuine health care reform. And it's not a Republican issue. It's not a Democrat issue. It's sound health-policy science. We already know there's examples from all the other industrialized nations in the world, 19 of them, and we rank dead last in terms of outcome and in terms of our ability to control costs. So we have patients in this country, the wealthiest country in the world, dying of treatable and preventable illnesses. And that carnage is washing up in our emergency rooms. And, again, as nurses that's heartbreaking for us to see.We're going to continue our fight for genuine Medicare reform. And, you know, Congress is focused on the wrong deficit, and I believe the president has been, too. He's been co-opted. But we're not going to make that mistake again. Regardless of who's sitting in the White House, it's an opportunity again. We have a system that works. We already know it's constitutional, Medicare for all. Why should we wait until we're 65 to get the health care we need, anyone's child or brother or cousin or sister or friend? And that's the positioning, regardless of who's elected.JAY: So some Democratic Party supporters, people that want President Obama reelected, or at the very least really don't want Romney reelected, they may say that any criticism now of Obama's health care bill weakens his campaign, and you should mute it and not say very much about it critically, at least until after the election. How would you respond to that?MCEWEN: Well, President Obama, again, has already opened the door by saying that we may have to revisit this reform as new data comes in. A lot of the provisions are not going to be implemented until 2014. And he's also opened the doors to the individual states states, states such as California and Vermont, where our legislators have actually passed single-payer reform. And it shows that it's politically feasible.But what we really need is more legislators to—you know, we need to perform spine transplants on them to—and that's not in our scope of practice as nurses, but, again, continue to build this movement, educate people. And it may be that, as in Canada, a state will lead the way and people will look at them and say, you know, we want what they have, and that's for everybody living in that state.JAY: Right, 'cause in Canada, publicly funded health care insurance began in Saskatchewan, and that caught on, and then the rest of the country kind of, after a fight, came along. Well, you've already—I mean, you're coming as to us today from Oakland. There is a sort of public health care system in San Francisco, is there not? Is that a model that people could be fighting for, either locally or at a state level?MCEWEN: Well, again, in terms of the number of people that are enrolled, and the businesses, through tax incentives or fees that are levied that support it, again, you don't have the very large risk pool that's needed to negotiate lower prices and to get more affordable rates and to control costs. So, again, it's a start, it's an attempt.The people that benefit for it, the people that go to the city [incompr.] for instance, I believe do so because they're making a choice that they support the concept, they support the policy that, you know, everyone's health is interconnected, and your health and my health. We realize that diseases that are communicable don't respect your nationality, your race, your gender, your ethnicity, which neighborhood you live in, and so any kind of national or state or city border.And so, again, a more broad approach of universal coverage is required. And we believe that Medicare for all has stood the test of time. We already know it's a lawful, constitutional system in place. It runs at a very low cost. You don't need to advertise it. So why discriminate there on the basis of age? Everyone should have access to it.
