A PROMISED LAND

"We must not be enemies. Though passion may have strained, it must not break our bonds of affection. The mystic chords of memory will swell when again touched, as surely they will be, by the better angels of our nature." Abraham Lincoln

We have heard a lot about Barack Obama since he left the White House in 2016. Sadly, it was all negative nonsense perpetrated by "someone" as he says "diametrically opposed" to all Obama stood for, who succeeded him in the presidential office without winning the popular vote. Ironically, as psychology recognises, this "someone" proves the adage that "small minds are always the first to criticise great ones." Obama can take it as a compliment that he was constantly on the mind of his successor. Thankfully this someone is not mentioned by name until page 672 of the lengthy 701-page autobiography: and rightly so. This is Obama's story and only the first volume, dealing with his first term in office as the first black man in the White House. A Promised Land is a more than apt title.

Barack or 'Barry' as his mother like to call him wears his somewhat intellectual heart on his sleeve in this engaging and personal biography. He describes how his destiny "straddling two worlds" explains the "strangeness of his heritage." His maternal grandmother hailed from Kansas, heartland of the USA, but far from being a stereotypical conservative she evidently brought up Barack's mother, Ann Norton, in such a way that she inclined to reading "beatnik poets and French existentialists. "She recognised the world as a complicated place … full of opportunities for moral instruction." Barack stresses his mother's, strong influence, coupled with the fact that "he did not know his father." She encouraged him to read, and to discuss what he learned, so that by his second year at university he had decided to "live like a monk – reading, writing and filling up journals," all valuable preparation for the superior skills he was developing as a writer and advocate for social justice. From his early days what captured his attention was "not politics but social movements" and his mother's advice to put the interests of others before his own.

Given an SMN audience with interests in the health and conscience of society it is appropriate to draw attention to Obama's efforts to fix the notoriously-problematic American healthcare system. Those unfamiliar with the Affordable Care Act (ACA) which became his signature project, known as "Obamacare," might appreciate knowing that "the quest for some form of universal health care in the US dates back to 1912" when Teddy Roosevelt, aware of the national health insurance systems in the UK and Germany, first proposed a "national health service." The issue arose again under President Truman in 1945 and 1949, the latter date being a year after the UK founded its National Health Service [July 5th 1948]. Coinciding with McCarthyism, powerful lobbyists including the American Medical Association (AMA), and many Republicans, branded these efforts as bolshevism and what has become misleadingly known as "socialised medicine," which for conservatives has a derogatory connotation.

Although such obstructionism is not new, Obama faced it from day one of his administration, when senate leader McConnell, infamous for his opposition, declared his intent to make Obama a one-term president. Democrats warned him that the Republicans were intent on "breaking" him. In a world of greater promise, where Obama's brand of "social" awareness carried more weight, opponents might respect that leaders are elected to honour the will of the people and put the interests of others before their own. [They might even read that portion of the Hippocratic oath which reminds doctors that they are members of society, with special obligations to all fellow human beings]. Sadly, certain crass factions deliberately misinterpret social justice movements as 'socialism' and government interference with individual liberty.

Failure to devise a "single-payer program" other than the Medicare program introduced for seniors under the socially conscious LBJ (Johnson) administration, created "spiraling healthcare costs" with adverse economic impacts for all: "Detroit had to build in" an "extra $1,500 in worker and retiree healthcare costs" to the price of each car produced. The result was to off-load healthcare costs on fellow citizens, to the point where 43 million Americans were uninsured by the time Obama took office. Famously the ACA became a huge, 'complicated' 2,700-page bill which opponents simplistically regarded as "a symbol of an out-of-control government takeover of healthcare"— a dangerous experiment. Opposition was fraught with idealistic objections involving often tangential religious issues related to abortion and contraception, coming from, among others, the Catholic Bishops. When Obama asked opponents for alternatives, none were offered, and he found their obstructive answers "threadbare." But divine intervention would come in the form of "an unlikely ally… Sister Carol Keenhan, a …perpetually cheerful nun who headed up the nation's Catholic hospitals." She broke with the bishops "by insisting that the passage of the bill was vital to …the mission of caring for the sick." Obama would tell aids "I love nuns." Chalk one for social conscience.

Many will remember that Obama took office immediately after the financial crisis, largely caused by the greed and deregulation of the financial industry. Thus, he was acutely and presciently aware of the danger political parties faced by unexpected crisis when the H1N1 virus broke out in his first year. Having done his homework on US pandemic preparedness when in the Senate, he confessed that "what I knew scared the hell out of me." But as the WHO declared a pandemic he quickly declared a national public health emergency, went to Congress for emergency funding, put the Centers for disease Control (CDC) and Homeland Security on alert and "pulled together an interagency team to evaluate how ready the US was for a worst case scenario." He learned, as the new man on the job, that "we weren't ready at all." As a result, before he left office, Obama, created a "Playbook for Early Response to High-Consequence Emerging Infectious Disease Threats and Biological Incidents" through the National Security Council (NSC).

We expect to learn more about this very topical issue in volume two, which you will all no doubt also want to read(!), but suffice it to say that in November 2019, that certain 'someone' moved to gut the NSC, largely because whistleblowers were speaking up on other security matters that were causing that 'someone' to be impeached. Ironically for public health, the timing could not have been worse with Covid-19 just about to break out. As John Gans, author of White House Warriors, a book on the NSC, pointed out it made the White House "less equipped to handle" transnational issues like pandemics. This has been obvious from the Covid response and the pandemic statistics. I was just in South Korea (Nov. 22-Dec 18th 2020) and after a quarantine of 14 days travelled cautiously around a county which has recorded about 1 death per 100,000, compared with 100 per 100,000 in the USA. In South Korea one feels the security and support of a modest people and a nation committed to the collective good. The health authorities call themselves the "support team" and ask "Are you OK?"

Any commentary on Obama's activities post-2012, ventures beyond what he covers in A Promised Land, although he does, in his preface, note how his successor has tried to undo his good work. Almost all commentary since 2016, including reviews of this book, note the stark contrast between Obama and Trump, and how America is now perceived, almost pitifully, in the world. In this regard Obama's legacy remains strong. He won the Nobel Prize and modestly wondered "what for?" He was universally popular abroad. His signature healthcare bill has survived multiple republican attacks, and a challenge in the Supreme Court, not least because the American public likes it. One of my conservative acquaintances, whose ideology I find difficult to understand, admits "Obama was a class act." As he and Michelle famously stated: "When they go low, we go high." Acutely aware of his 'first black president' status, he was if anything too cautious and too reluctant to grandstand. He assembled good people around him and when asked by Michelle, in front of his campaign aids: "Why do you need to be president?" He hesitantly replied "There's no guarantee we can pull it off [but] … one thing I know for sure … [if successful] …all kids – Black Kids, Hispanic kids, kids who don't fit in— they'll see themselves differently … and that alone …would be worth it." The room fell quiet, and "Michelle stared for what seemed like an eternity" before replying "Well Honey, that was a pretty good answer."

Much as his partisan opponents might balk. Obama came up with some pretty good answers. After the Bush era blunders in Iraq, Obama, who had voted against the war, became the chosen one – the right man at the right time. As Ted Kennedy advised him "You don't choose the time. The time chooses you." Interestingly, like Bill Clinton, Obama had a quality that made people predict he would become president. It was perhaps that audacity and hopeful confidence spoken of in his earlier biography. But he had prepared himself well, absorbing his mother's moral instruction, working hard, absorbing American history as a true scholar and engaging with the American people at the grass roots level. It was as if he had made a promise to himself to stand for all the promising, fundamentally spiritual ideals one can aspire to and hope for in a promised land. To stand with Abraham Lincoln's better angels. In succeeding to the highest office in America, Obama overcame those 'strained passions and bonds of affection' and led the way in that promising direction as no other president before him. The 'mystic chords of memory' will always remember him as a "class act."