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C A L I F O R N I A N U R S E J U L Y / A U G U S T 2 0 0 5 17 don't? "The right to health care is recognized in international law and guaranteed in the constitutions of many nations," writes Jill Quadagno in One Nation, Uninsured: Why the U.S. Has No National Health Insurance. With the exception of the U.S., "all Western industrialized countries, regardless of how they raise funds, organize care, and determine eligibility, guarantee every citizen compre- hensive coverage for essential health serv- ices." Quadagno, a member of the Clinton Ad- ministration's Bipartisan Commission on En- titlement and Tax Reform, surveys efforts dating back to 1914 to establish a national healthcare program to discover how the U.S. has become the international exception. For decades, physicians, later joined by insurers, hospitals, nursing home operators, drug companies, other big business interests, and some conservative politicians stymied a series of initiatives to transform the way America provides health services. Ulti- mately, Quadagno writes, "the reason we don't have the system we need is because we have failed to grasp how much we have ceded our health care to private interests." "Whenever government action has seemed imminent," she writes, the American Medical Association and corporate inter- ests "lobbied legislators, influenced elections by giving huge cam- paign contributions to sympathetic candidates, and organized 'grassroots' protests conspiring with other like-minded groups to defeat reform efforts." Medicare provides the one most striking example of success. After winning enhanced disability insurance for workers in the mid-1950s, the AFL-CIO mounted an unstoppable campaign for what became Medicare, with unions educating and mobilizing their own members and building a powerful alliance with seniors that deluged Congress and ultimately buried the opposition of the AMA and insurers. It's an important model for what can be achieved through unity, coalitions and hard work. Nurses are invisible in Quadagno's story. But with so many others in the healthcare arena compromised by their elevation of per- sonal gain over the public welfare, nurses are uniquely positioned to lead the campaign for general reform. Already, nurses from Maine to California have been the heart of campaigns for establishment of a more humane health- care system. As CNA President Deborah Burger, RN recently said, "Nurses will be the ones to lead the change in healthcare." —Charles Idelson WHO CARES? WOMEN HEALTH WORKERS IN A GLOBAL MARKET, by Kim Van Eyck, Ph.D., 94 pp., distributed free of charge through CNA and Public Services International (www.world-psi.org) W hat is often lost in debates about immigrant workers and market needs is the immigrant worker's voice. The structural economic and social conditions that create the impetus for an immigrant's decision to migrate underlie her personal and familial challenges and all their complexities. Increasingly, the grow- ing inequities between countries and re- gions, the push to privatize public systems resulting in their escalating costs, and the cutbacks due to shrinking public budgets leaves the intending immigrant with little choice in spite of the somewhat gloomy sac- rifices they face. Kim Van Eyck's Who Cares? Women Health Workers in the Global Labour Mar- ket stands out as a publication that takes it back to the immigrant worker—in this case, 14 women healthcare workers (mostly nurses) around the world who have or are considering migrating for work, and who face very similar challenges in very contrasting healthcare systems. Who Cares? is a result of a participatory research cam- paign commissioned by Public Services International, a global federation of unions representing 20 million workers involved in public services in 150 countries, due to a growing concern among trade unionists about the impact of migration upon pub- lic health service employment and delivery. While Van Eyck presents her introduction, conclusions, and recommendations in a mostly academic format, covering re- search methodology and citing scholastic references, the core of Who Cares? comprises the living testimonies of the women healthcare workers, directly transcribed from their interviews. The richness of their stories jump out from the print and imme- diately engages the reader with their candid recollections of their journeys, their dreams and career aspirations, their personal re- flections on political conditions and policy-making, and their heart-wrenching tales of discrimination, loneliness, and fear. What is particularly helpful is how Van Eyck begins each in- terview chapter with a summary of the worker's conditions and a brief yet thoughtful analytical commentary drawn from the interview. These stress the point that while the dilemmas faced by the woman healthcare worker and her decisions are often individual or familial ones, the con- ditions that surround and inevitably force it are political and economic ones. Who Cares? delivers a vital yet often overlooked voice in the debates surrounding the global economies of healthcare work. It offers critical testimonies that must be con- sidered by RNs, union activists, and policy- makers alike in meeting the challenges of providing quality healthcare services for all. —Colin Rajah Michelle Mason-Chadd, RN, is a certified diabetes educator and a diabetes care manager at Kaiser Permanente in Santa Rosa; Colin Rajah is Coordinator of the International Migrant Rights Program at the National Network for Immigrant and Refugee Rights (NNIRR).