Few politicians know as much about healthcare as Howard Dean, a former physician, five-term governor of Vermont and president candidate. Dean has long been an advocate for universal healthcare, although he was critical of the Obama Administration’s handling of healthcare legislation in 2009-2010, particularly the lack of a public insurance option in the final bill (which Dean ultimately supported). I interviewed Dean today about the political and policy ramifications of the Supreme Court’s ruling to uphold the Affordable Care Act.

Ari Berman: What was your reaction to the healthcare ruling?

Howard Dean: I was surprised. Like many people, I was shocked that Justice Roberts sided with upholding the bill and somewhat surprised and disappointed that Justice Kennedy voted to get rid of the entire thing along with the three right-wing justices.

I was glad that the president won a victory. But this pretty much ends the debate about the nature of the private sector in the healthcare business—it’s here to stay in a very big way. This is, after all, a Republican bill. Not the Republicans that we see today, but the moderate Republican wing under Mitt Romney in Massachusetts—this is their bill. For the foreseeable future there will be those who wish we had a single-payer healthcare system, but that’s not going to happen in Washington anytime soon. 

Will the Affordable Care Act be implemented as drafted following the ruling?

For the most part. There’s still a lot of work to be done—this does not insure everyone, first off. Secondly, the Medicaid decision is extremely concerning [the justices ruled that the government could not withhold all Medicaid funds for states that refuse to implement the law]. We would have been better off as a people if the Medicaid provision had been upheld fully and the individual mandate had gone down. The Medicaid expansion insures more people than anything else in the bill. The expansion is still real, but there’s no real stick for the federal government to use against the states.

I wish the law was more comprehensive, but it’s much better than having the bill repealed.

Should the president campaign on the issue of healthcare? We’ve seen a lot of polls showing that the bill has remained relatively unpopular—can the president do anything to change that now?

He can’t. It’s too late, the Republicans have out-branded him on this one. But I do think the president can talk about the individual provisions when they come up.

If I were Obama, I probably wouldn’t talk about healthcare all that much. Why try to climb a hill? Why not just hammer the daylights out of Romney every day for his car elevators, his Cayman Islands bank account and the fact that he’s a classic 1 percenter who doesn’t care about the 99 percent.

Does Romney have any credibility to attack Obama on healthcare given his own record in Massachusetts?

No, I don’t think he does, but he’s trying to appease his base. What Obama did was adopt Romney’s bill. I don’t see how you can pretend otherwise. 

Will this ruling energize conservative activists?

No, they’re so energized anyway it won’t make any difference. Although it’s going to be a little hard for conservatives to say that John Roberts condoned a socialist plan.

How worried are you about Republicans now calling the healthcare law a tax over and over and over again?

They were using that line anyway. I don’t think it’s going to be any worse than it already was.

What can Obama say in response to that?

He can say what he said today. He can tell the story of individual Americans who are going to benefit from it. And the truth is that the Congressional Budget Office says the law will save money and save jobs. He can talk about that too.

What is the importance of the Supreme Court going forward?

The Citizens United decision essentially put American politics up for sale.… Let’s not make a mistake about it: we have five right-wing judicial activists on the Supreme Court. That’s one of the reasons I decided early in the year to vigorously support the president’s re-election campaign. I believe there’s a huge difference between Scalia and Alito, and Sotomayor and Kagan.