Promised Land (9781524763183)

by Obama Barack

  I carried his words with me to Normandy, my second-to-last stop on the trip. On a bright, nearly cloudless day, thousands of people had gathered at the American Cemetery there, set atop a high coastal bluff that overlooked the English Channel’s blue, white-capped waters. Coming in by helicopter, I gazed down at the pebbled beaches below, where sixty-five years earlier more than 150,000 Allied troops, half of them Americans, had pitched through high surf to land under relentless enemy fire. They had taken the serrated cliffs of Pointe du Hoc, eventually establishing the beachhead that would prove decisive in winning the war. The thousands of marble headstones, bone-white rows across the deep-green grass, spoke to the price that had been paid.

  I was greeted by a group of young Army Rangers who earlier in the day had re-created the parachute jumps that had accompanied D-Day’s amphibious landings. They were in dress uniform now, handsome and fit, smiling with a well-earned swagger. I shook hands with each of them, asking where they were from and where they were currently deployed. A sergeant first class named Cory Remsburg explained that most of them had just come back from Iraq; he’d be heading out to Afghanistan in the coming weeks, he said, for his tenth deployment. He quickly added, “That’s nothing compared to what the men did here sixty-five years ago, sir. They made our way of life possible.”

  A survey of the crowd that day reminded me that very few D-Day or World War II vets were still alive and able to make the trip. Many who had made it needed wheelchairs or walkers to get around. Bob Dole, the acerbic Kansan who had overcome devastating injuries during World War II to become one of the most accomplished and respected senators in Washington, was there. So was my Uncle Charlie, Toot’s brother, who’d come with his wife, Melanie, as my guest. A retired librarian, he was one of the most gentle and unassuming men I knew. According to Toot, he’d been so shaken by his experiences as a soldier that he barely spoke for six months after returning home.

  Whatever wounds they carried, these men exuded a quiet pride as they gathered in their veterans’ caps and neat blazers pinned with well-polished service medals. They swapped stories, accepted handshakes and words of thanks from me and other strangers, and were surrounded by children and grandchildren who knew them less for their war heroism than for the lives they had led afterward—as teachers, engineers, factory workers, or store owners, men who had married their sweethearts, worked hard to buy a house, fought off depression and disappointments, coached Little League, volunteered at their churches or synagogues, and seen their sons and daughters marry and have families of their own.

  Standing on the stage as the ceremony began, I realized that the lives of these eighty-something-year-old veterans more than answered whatever doubts stirred in me. Maybe nothing would come of my Cairo speech. Maybe the dysfunction of the Middle East would play itself out regardless of what I did. Maybe the best we could hope for was to placate men like Mubarak and kill those who would try to kill us. Maybe, as the Pyramids had whispered, none of it mattered in the long run. But on the only scale that any of us can truly comprehend, the span of centuries, the actions of an American president sixty-five years earlier had set the world on a better course. The sacrifices these men had made, at roughly the same age as the young Army Rangers I’d just met, had made all the difference. Just as the witness of Elie Wiesel, a beneficiary of those sacrifices, made a difference; just as Angela Merkel’s willingness to absorb the tragic lessons of her own nation’s past made a difference.

  It was my turn to speak. I told the stories of a few of the men we had come to honor. “Our history has always been the sum total of the choices made and the actions taken by each individual man and woman,” I concluded. “It has always been up to us.” Turning back to look at the old men sitting behind me on the stage, I believed this to be true.

  CHAPTER 16

  OUR FIRST SPRING IN THE WHITE HOUSE arrived early. By mid-March, the air had softened and the days grown longer. As the weather warmed, the South Lawn became almost like a private park to explore. There were acres of lush grass ringed by massive, shady oaks and elms and a tiny pond tucked behind the hedges, with the handprints of presidential children and grandchildren pressed into the paved pathway that led to it. There were nooks and crannies for games of tag and hide-and-go-seek, and there was even a bit of wildlife—not just squirrels and rabbits but a red-tailed hawk that a group of visiting fourth graders had named Lincoln and a slender, long-legged fox that could sometimes be spotted at a distance in the late afternoon and occasionally got bold enough to wander down the colonnade.

  Cooped up as we’d been through the winter, we took full advantage of the new backyard. We had a swing set installed for Sasha and Malia, near the swimming pool and directly in front of the Oval Office. Looking up from a late afternoon meeting on this or that crisis, I might glimpse the girls playing outside, their faces set in bliss as they soared high on the swings. We also set up a couple of portable basketball hoops on either end of the tennis courts, so that I could sneak out with Reggie for a quick game of H-O-R-S-E and the staff could play interoffice games of five-on-five.

  And with the help of Sam Kass, as well as the White House horticulturalist and a crew of enthusiastic fifth graders from a local elementary school, Michelle planted her garden. What we expected to be a meaningful but modest project to encourage healthy eating ended up becoming a genuine phenomenon, inspiring school and community gardens across the country, attracting worldwide attention, and generating so much produce by the end of that first summer—collards, carrots, peppers, fennel, onions, lettuce, broccoli, strawberries, blueberries, you name it—that the White House kitchen started donating crates of spare vegetables to the local food banks. As an unexpected bonus, a member of the groundskeeping crew turned out to be an amateur beekeeper, and we gave him the okay to set up a small hive. Not only did it end up producing more than a hundred pounds of honey a year, but an enterprising microbrewer in the Navy Mess suggested that we could use the honey in a beer recipe, which led to the purchase of a home brew kit and made me the first presidential brewmaster. (George Washington, I was told, made his own whiskey.)

  But of all the pleasures that first year in the White House would deliver, none quite compared to the mid-April arrival of Bo, a huggable, four-legged black bundle of fur, with a snowy-white chest and front paws. Malia and Sasha, who’d been lobbying for a puppy since before the campaign, squealed with delight upon seeing him for the first time, letting him lick their ears and faces as the three of them rolled around on the floor of the residence. It wasn’t just the girls who fell in love either. Michelle spent so much time with Bo—teaching him tricks, cradling him in her lap, sneaking him bacon—that Marian confessed to feeling like a bad parent for never having given in to Michelle’s girlhood wish for a family dog.

  As for me, I got what someone once described as the only reliable friend a politician can have in Washington. Bo also gave me an added excuse to put off my evening paperwork and join my family on meandering after-dinner walks around the South Lawn. It was during those moments—with the light fading into streaks of purple and gold, Michelle smiling and squeezing my hand as the dog bounded in and out of the bushes with the girls giving chase, Malia eventually catching up to us to interrogate me about things like birds’ nests or cloud formations while Sasha wrapped herself around one of my legs to see how far I could carry her along—that I felt normal and whole and as lucky as any man has a right to expect.

  Bo had come to us as a gift from Ted and Vicki Kennedy, part of a litter that was related to Teddy’s own beloved pair of Portuguese water dogs. It was an incredibly thoughtful gesture—not only because the breed was hypoallergenic (a necessity due to Malia’s allergies) but also because the Kennedys had made sure that Bo was housebroken before he came to us. When I called to thank them, though, it was only Vicki I could speak with. It had been almost a year since Teddy was diagnosed with a malignant brain tumor, and although he was still receiving treatm
ent in Boston, it was clear to everyone—Teddy included—that the prognosis was not good.

  I’d seen him in March, when he’d made a surprise appearance at a White House conference we held to get the ball rolling on universal-healthcare legislation. Vicki had worried about the trip, and I’d understood why. Teddy’s walk was unsteady that day; his suit barely fit after all the weight he’d lost, and despite his cheerful demeanor, his pinched, cloudy eyes showed the strain it took just to hold himself upright. And yet he’d insisted on coming anyway, because thirty-five years earlier the cause of getting everyone decent, affordable healthcare had become personal for him. His son Teddy Jr. had been diagnosed with a bone cancer that led to a leg amputation at the age of twelve. While at the hospital, Teddy had gotten to know other parents whose children were just as ill but who had no idea how they’d pay the mounting medical bills. Then and there, he had vowed to do something to change that.

  Through seven presidents, Teddy had fought the good fight. During the Clinton administration, he helped secure passage of the Children’s Health Insurance Program. Over the objections of some in his own party, he worked with President Bush to get drug coverage for seniors. But for all his power and legislative skill, the dream of establishing universal healthcare—a system that delivered quality medical care to all people, regardless of their ability to pay—continued to elude him.

  Which is why Ted Kennedy had forced himself out of bed to come to our conference, knowing that while he could no longer lead the fight, his brief but symbolic presence might have an effect. Sure enough, when he walked into the East Room, the hundred and fifty people who were present erupted into cheers and lengthy applause. After opening the conference, I called upon him to speak first, and some of his former staffers could be seen tearing up at the sight of their old boss rising to speak. His remarks were short; his baritone didn’t boom quite as loudly as it used to when he’d roared on the Senate floor. He looked forward, he said, to being “a foot soldier” in the upcoming effort. By the time we’d moved on to the third or fourth speaker, Vicki had quietly escorted him out the door.

  I saw him only once more in person, a couple of weeks later, at a signing ceremony for a bill expanding national service programs, which Republicans and Democrats alike had named in his honor. But I would think of Teddy sometimes when Bo wandered into the Treaty Room, his head down, his tail wagging, before he curled up at my feet. And I’d recall what Teddy had told me that day, just before we walked into the East Room together.

  “This is the time, Mr. President,” he had said. “Don’t let it slip away.”

  * * *

  —

  THE QUEST FOR some form of universal healthcare in the United States dates back to 1912, when Theodore Roosevelt, who had previously served nearly eight years as a Republican president, decided to run again—this time on a progressive ticket and with a platform that called for the establishment of a centralized national health service. At the time, few people had or felt the need for private health insurance. Most Americans paid their doctors visit by visit, but the field of medicine was quickly growing more sophisticated, and as more diagnostic tests and surgeries became available, the attendant costs began to rise, tying health more explicitly to wealth. Both the United Kingdom and Germany had addressed similar issues by instituting national health insurance systems, and other European nations would eventually follow suit. While Roosevelt ultimately lost the 1912 election, his party’s progressive ideals planted a seed that accessible and affordable medical care might be viewed as a right more than a privilege. It wasn’t long, however, before doctors and southern politicians vocally opposed any type of government involvement in healthcare, branding it as a form of bolshevism.

  After FDR imposed a nationwide wage freeze meant to stem inflation during World War II, many companies began offering private health insurance and pension benefits as a way to compete for the limited number of workers not deployed overseas. Once the war ended, this employer-based system continued, in no small part because labor unions liked the arrangement, since it enabled them to use the more generous benefit packages negotiated under collective bargaining agreements as a selling point to recruit new members. The downside was that it left those unions unmotivated to push for government-sponsored health programs that might help everybody else. Harry Truman proposed a national healthcare system twice, once in 1945 and again as part of his Fair Deal package in 1949, but his appeal for public support was no match for the well-financed PR efforts of the American Medical Association and other industry lobbyists. Opponents didn’t just kill Truman’s effort. They convinced a large swath of the public that “socialized medicine” would lead to rationing, the loss of your family doctor, and the freedoms Americans hold so dear.

  Rather than challenging private insurance head-on, progressives shifted their energy to help those populations the marketplace had left behind. These efforts bore fruit during LBJ’s Great Society campaign, when a universal single-payer program partially funded by payroll tax revenue was introduced for seniors (Medicare) and a not-so-comprehensive program based on a combination of federal and state funding was set up for the poor (Medicaid). During the 1970s and early 1980s, this patchwork system functioned well enough, with roughly 80 percent of Americans covered through either their jobs or one of these two programs. Meanwhile, defenders of the status quo could point to the many innovations brought to market by the for-profit medical industry, from MRIs to lifesaving drugs.

  Useful as they were, though, these innovations also further drove up healthcare costs. And with insurers footing the nation’s medical bills, patients had little incentive to question whether drug companies were overcharging or if doctors and hospitals were ordering redundant tests and unnecessary treatments in order to pad their bottom lines. Meanwhile, nearly a fifth of the country lived just an illness or accident away from potential financial ruin. Forgoing regular checkups and preventive care because they couldn’t afford it, the uninsured often waited until they were very sick before seeking care at hospital emergency rooms, where more advanced illnesses meant more expensive treatment. Hospitals made up for this uncompensated care by increasing prices for insured customers, which in turn further jacked up premiums.

  All this explained why the United States spent a lot more money per person on healthcare than any other advanced economy (112 percent more than Canada, 109 percent more than France, 117 percent more than Japan) and for similar or worse results. The difference amounted to hundreds of billions of dollars per year—money that could have been used instead to provide quality childcare for American families, or to reduce college tuition, or to eliminate a good chunk of the federal deficit. Spiraling healthcare costs also burdened American businesses: Japanese and German automakers didn’t have to worry about the extra $1,500 in worker and retiree healthcare costs that Detroit had to build into the price of every car rolling off the assembly line.

  In fact, it was in response to foreign competition that U.S. companies began off-loading rising insurance costs onto their employees in the late 1980s and ’90s, replacing traditional plans that had few, if any, out-of-pocket costs with cheaper versions that included higher deductibles, co-pays, lifetime limits, and other unpleasant surprises hidden in the fine print. Unions often found themselves able to preserve their traditional benefit plans only by agreeing to forgo increases in wages. Small businesses found it tough to provide their workers with health benefits at all. Meanwhile, insurance companies that operated in the individual market perfected the art of rejecting customers who, according to their actuarial data, were most likely to make use of the healthcare system, especially anyone with a “preexisting condition”—which they often defined to include anything from a previous bout of cancer to asthma and chronic allergies.

  It’s no wonder, then, that by the time I took office there were very few people ready to defend the existing system. More than 43 million Americans were now uninsured, premiu
ms for family coverage had risen 97 percent since 2000, and costs were only continuing to climb. And yet the prospect of trying to get a big healthcare-reform bill through Congress at the height of a historic recession made my team nervous. Even Axe—who’d experienced the challenges of getting specialized care for a daughter with severe epilepsy and had left journalism to become a political consultant in part to pay for her treatment—had his doubts.

  “The data’s pretty clear,” Axe said when we discussed the topic early on. “People may hate the way things work in general, but most of them have insurance. They don’t really think about the flaws in the system until somebody in their own family gets sick. They like their doctor. They don’t trust Washington to fix anything. And even if they think you’re sincere, they worry that any changes you make will cost them money and help somebody else. Plus, when you ask them what changes they’d like to see to the healthcare system, they basically want every possible treatment, regardless of cost or effectiveness, from whatever provider they choose, whenever they want it—for free. Which, of course, we can’t deliver. And that’s before the insurance companies, the drug companies, the docs start running ads—”

  “What Axe is trying to say, Mr. President,” Rahm interrupted, his face screwed up in a frown, “is that this can blow up in our faces.”

  Rahm went on to remind us that he’d had a front-row seat at the last push for universal healthcare, when Hillary Clinton’s legislative proposal crashed and burned, creating a backlash that contributed to Democrats losing control of the House in the 1994 midterms. “Republicans will say healthcare is a big new liberal spending binge, and that it’s a distraction from solving the economic crisis.”