Into the President's Health and the Public Trust
Lester Holt: Good evening. We begin with a breaking news, the unprecedented health crisis unfolding at this hour in America's highest office.
Trymaine Lee: 2020 shows no signs of letting up. Last week, after months of downplaying the seriousness of coronavirus and resisting precautionary measures like masks and social distancing, President Donald Trump tested positive for COVID-19.
Holt: That bombshell dropping just 32 days before the election and days after the president shared a debate stage with Joe Biden, who has now tested negative.
Lee: The White House originally described his symptoms as quote, "mild," but on Friday, within 18 hours of announcing his diagnosis, the president was on the Marine One helicopter bound for the presidential suite of Walter Reed National Military Medical Center in Bethesda, Maryland.
Archival Recording: The president, I'm told by a senior administration official, will be working out of a suite there for the next several days as a precautionary measure, precautionary perhaps, but it is also historic after the president's diagnosis sent shockwaves through this country.
Lee: Trump's doctors and aides gave conflicting reports on his condition all weekend long. And there is still uncertainty about when the president contracted coronavirus. The White House says, his first positive test was after returning from a fundraiser in New Jersey on Thursday night, but refused to say whether the president was tested before Tuesday's debate in Cleveland.
Kayleigh Mcenany: Yeah, I'm not gonna give you a detailed read out with time stamps at every time the president's tested. He's tested regularly. And the first positive test he received was after his return from Bedminster.
Lee: That's White House Press Secretary, Kayleigh McEnany on Sunday. By the way, she announced earlier today, she is also positive for coronavirus. Throughout the ordeal, the president has continued to communicate with the American public through Twitter and video messages.
President Trump: I feel much better now. We're working hard to get me all the way back. We're gonna beat this coronavirus or whatever you want to call it. I'm starting to feel good. It's been a very interesting journey. I learned a lot about COVID. This is the real school. This isn't-- let's read the books school. So that's where it is.
Lee: And on Sunday, the president took a short ride in his armored SUV to wave to supporters gathered outside the hospital. (CHEERS) It was, to say the least, a stunning moment that kinda left me speechless. Six months into a pandemic that's now infected the president less than 30 days before an election.
Michael Beschloss: I mean, surreal is a word I stopped using six months ago, 'cause by then it was already surreal. It has to be something else now.
Lee: I'm Trymaine Lee, and this is Into America. Donald Trump is not the first president to become ill while in the Oval Office, so today, we're looking to history to better understand what happens and what's supposed to happen when the president gets sick.
Michael Beschloss is a presidential historian for NBC News. I called him up to help put all this into context by looking back at how past presidents managed their illnesses and the optics of being unwell. Turns out, there are a lot of lessons from the past, but none really match up to what we're seeing today.
Beschloss: We have never been in a period even remotely like this before, Trymaine, and that's what makes this so unnerving, because you really can't look to history and say, "Let's borrow from 1940," or let's borrow from some earlier year. You've got this pandemic.
It's killing now over 200,000 Americans. The economy is in free-fall in many places, and people are suffering badly. There is racial injustice, there is all sorts of unsettlement, you know, in all areas of the society. And usually in this society, you've got a constitution that, to my mind, gives too much power to the president of the United States. We depend on a president to protect us in all sorts of ways. This is who we depend on for the safety of ourselves and our friends and our children.
Lee: As bad as things are right now, and, you know, as journalists always being careful not to overly alarm folks, right, and that this isn't the first time a president has gotten sick or ill. But certainly, in more recent memory have presidents fallen ill and created kind of the political storm we're seeing now?
Beschloss: Many times, but not in modern times the way we're seeing. Woodrow Wilson 1919. It was the year after World War I. He had a massive stroke, actually 101 years ago exactly this week, oddly enough. He was in the White House. His doctor and his aides lied to the public about it, said it was not as serious as it really was.
This is a guy who was half-blind and half-paralyzed lying in a bed upstairs in the White House unable to function. Now the way our system works, the vice president should have been able to take on at least some of the decision-making. Cabinet should have joined in.
Wilson would not permit it, not would his wife, Edith, who was very concerned that her husband retain all of his power. So the vice president, who's name was Marshall, convened the Cabinet in his absence. When Wilson heard about this, he was furious, because he saw it just in terms of personal loyalty.
Sounds a little bit like nowadays with Donald Trump, and therefore, he said, "No more Cabinet meetings like this. Vice president should get out of the way." A lot of the presidential decision-making was done by Wilson's wife, Edith, who was not equipped for it, not had she been elected.
Lee: You know, if we take out kind of political considerations, let's set that aside for a moment and talk about what actually happens, the protocol when a president gets sick. There are many people who will remember the assassination attempt on Ronald Reagan. But many folks listening, this is the first time they've ever seen a president this sick or this ill and removed from the White House and put into the hospital. What is supposed to happen when a president is incapacitated?
Beschloss: Well, the 25th Amendment, which was ratified in 1967, the idea of it is to provide a procedure that we all understand and just sort of kicks in when something like this happens. What that amendment says is that, "The president has the right and perhaps the obligation, if he's not able to be 100% to send a letter to the leaders of the Senate saying, 'I'm ceding power to my vice president until I'm 100% healthy once again.'"
George W. Bush did that twice when he was president, 2002, 2007. He had two colonoscopies, and he simply wrote a letter to Congress saying, "While I'm under anesthesia and obviously unable to function, I want my vice president, Dick Cheney, to act in my stead."
Archival Recording: For more than two hours this morning, Vice President Dick Cheney became the president.
Archival Recording #2: The White House said, "At 7:09 this morning, President Bush officially invoked the 25th Amendment, temporarily transferring power to Vice President Dick Cheney."
Archival Recording #3: In this particular case, he looked at all the circumstances, the length of the procedure, the relationship with the vice president, things going on domestically and internationally, and made the decision it was the right thing to do for this country.
Beschloss: That's the way it's supposed to happen, and people are not supposed to be panicked. The problem is that, and this is not only restricted to Donald Trump. Modern presidents are nervous that, even if they just sign a letter like that, there will be an hysteria among the public, which is the opposite of what Congress tried to do with the 25th Amendment.
Because their idea was that, this is just going to be a formal process. Everyone will understand. You know, you've got a president who's having some teeth removed, and he's under general anesthesia. He's not going to be able to function for a couple of hours.
Lee: And I'd imagine with the paranoia that has kind of infiltrated this White House, there would be great concern, like, "Nope, not signing anything, not ceding any kind of power at all."
Beschloss: That's exactly right, and unfortunately, that point of view has been carried on by the vice president, Mike Pence. The rare occasions he has been asked about this the last few days, he won't even hear of the idea of passage of the 25th Amendment. He's not even staying in Washington, just as a basic precaution, Trymaine.
I mean, if I were vice president or you, I think we would say, you know, just to calm the public's nerves, we should stick in Washington just to make sure that if we are needed at short notice, we're there with the best communications and we're fully protected.
For instance, this week, as we speak there will be a vice presidential debate. I do not understand why that is happening in person. Why are we endangering Mike Pence and Kamala Harris and the people around them by putting them in the same studio after all we've learned during the last week? Kennedy-Nixon debates in 1960. That was 60 years ago this fall, the third debate was virtual. Kennedy was in New York, Nixon was in Los Angeles, with much more primitive technology than now. Why are we doing this?
Lee: You know, let's talk a little bit about the history of Walter Reed Medical Center. Many might be familiar with the hospital, because they treat a lot of veterans returning from war, injured, right?
Lee: But what's the history of this facility and presidents?
Beschloss: This particular building used to be called Bethesda Naval Hospital. It began in 1937, and its original architect was Franklin Roosevelt, who was the president of the United States at the time, who was an amateur architect. And Roosevelt had been to the Nebraska State Capitol, of all places, which is one tall tower of sort of light-colored stone.
And he said, "Wouldn't that be nice to have in some building in Washington?" So the next building that was about to be built was Bethesda Naval Hospital, so we still have the sketch that FDR drew of what the building should look like, and it looks pretty much like this.
And he chose the site. Reagan, Johnson, other presidents have had surgeries here. One political moment was 1973, Richard Nixon, during the stress of the Watergate scandal contracted viral pneumonia. His doctors said, "We can't treat you at the White House. You've gotta go to Bethesda," as it was then called.
Archival Recording: President Nixon came to a naval hospital, because he's a former Navy man. He's in the five-room presidential suite on the third floor, where he's getting inhalation treatment and chest massages to help relieve chest pain. Mr. Nixon's doctors said other visitors would be limited, because as they emphasized at a news conference, they want him to rest.
Archival Recording #2: The president insisted on carrying on his schedule, and we had difficulty in convincing him that he really was a sick man.
Archival Recording #3: His illness has already forced him to postpone until September a meeting with Pakistani president, Ali Bhutto, and it has delayed indefinitely a crucial meeting with Chairman Sam Ervin of the Senate Watergate Committee.
Beschloss: While he was lying in bed, one of his aides went before the Congressional hearings, the Senate hearings on Watergate, and revealed that Nixon had this secret taping system that was taping all of his conversations, both in the office and on the telephone.
So Nixon is lying in bed, and he's pondering, you know, maybe I should destroy the tapes, because there might be something incriminating on those tapes that might bring me down in Watergate. And he couldn't do it, because he was in a hospital bed. By the time he got back to the White House, it was too late.
And for the rest of his life, Nixon said, "If I had not been in the hospital bed, if I had been in the White House when the public learned about the secret tapes, I probably would have had them destroyed, and I probably would have finished out my presidency," which he was right.
Lee: That is actually amazing. And so let's talk about the doctors and nurses at Walter Reed and how they're working with the White House physician, Sean Conley. How does that actually work? Like, who sets the game plan here?
Beschloss: The doctors and nurses and everyone else at Walter Reed are supremely well-trained, and there is an area of Walter Reed, which is designated for presidents to use. The presidents that I've talked about, you know, have all been out there, so they're accustomed to this.
This is one reason why you have a president go to Walter Reed, because with 60 seconds' notice, they know exactly what to do. The problem is, the president is still in charge. Let's say, if he's got a personal physician, and in this case it's Dr. Sean Conley, Sean Conley doesn't decide what to tell the public, it's the president.
So if the president tells Sean Conley, "I want you not to tell the public everything about my illness," he's not exactly in a position to, you know, go out and be truthful and say everything that's going on. And the result has been that you've seen in the last number of days, Conley and the president's other aides and the president himself flouting the law of history.
And what the law of history says over the last 200 years is, when a president gets sick, it's in his interest for his aides and doctors and himself to be as truthful in public as possible about his condition and about his treatment. They should do it because that's their obligation as public servants.
They should also do it, because if you're evasive, people will find out pretty quickly, and they'll assume the worst. There will be dark and ugly rumors going around on the internet, as there are right now about President Trump. And the other thing is that, in history, presidents usually get medical care that's of better quality if their doctors and their people are telling the public the truth. If they're secretive, if they're doing things to the president that are designed to keep the public from knowing what's going on, that's not best for the health of the president himself.
Lee: That point there about what the American public has a right to know about the president's health, and there's been so much conflicting information coming out of Trump's camp. On Saturday, Dr. Conley omitted that the president had actually received oxygen.
Archival Recording: He has not received any supplemental oxygen?
Dr. Sean Conley: He's not on oxygen right now, that's right.
Archival Recording: He has not received any at all?
Conley: He's not needed any this morning today at all, that's right.
Lee: Which sounds eerily similar to the idea that Donald Trump downplayed the severity of the virus because he didn't want to alarm folks.
Beschloss: Sounded just like it.
Lee: Well, I wonder where it came from, I wonder. But what right does the American public have to full access to this kind of information? Like, under reasonable times, what should we expect?
Beschloss: The president's medical condition is not his own. Yours is for you, mine is for me, but we didn't run for president. And when a president is sworn in, one of the obligations he's got in exchange for this enormous power a president is given, and I think presidents are given too much power.
But in exchange for all this power, the president has the obligation to make sure that Americans know what kind of shape he's in. That has been the rule through 200 years. It hasn't always been a promise that's been kept by presidents, but we've got to make sure that a contemporary president keeps it now, because our safety and the safety of our families, so much depends on how healthy he is.
Lee: So how should a presidential illness be handled? After the break, I talk to Michael Beschloss about the optics of a sick president, and what this all means in the lead-up to the election. (ADVERTISEMENT) We're back with presidential historian, Michael Beschloss. And so, obviously, we're in different times with a different president and different kind of administration. But normally, you know, when a president is facing a medical crisis, like, how should it be handled ideally?
Beschloss: You should have top-rate doctors, and let them tell the president what he should do to regain his health. And let them tell as much to the public as humanly possible. Case in point, 1956. Dwight Eisenhower in the summer of 1956 was running for re-election.
He caught a case of something called ileitis, an intestinal disease. He needed pretty radical surgery, and his aides said, "Mr. President, you know, you're up for re-election about four or five months. We'd better be secretive about this, because if people see that you look weak or you've got problems, they may think that you're not up to serving as president for four more years."
And Eisenhower with his characteristic honesty and openness said, "It's exactly the opposite. I'm running for re-election, therefore, tell the public as much as possible about my condition, so that they will be reassured that I can function as a leader for more than four more years."
And the result was, his doctors and his aides had briefing after briefing at the old Walter Reed Army Hospital where he was. And believe it or not, they told about the president's bowel movements because this was an intestinal disease, and that's a sign of whether he's recovering or not. There were charts, diagrams of what was going on.
Someone thought that the pictures were sort of gross, but the point is that Eisenhower was setting an example for modern presidents, which is that, you know, we have the right to know these things. Lyndon Johnson in 1965 had a gallbladder surgery at what is now Walter Reed, was then Bethesda Naval Hospital.
He was in just that presidential suite that you and I are talking about. And in those days, you know, there was not microsurgery. He had this enormous scar, and there were rumors that Johnson was in for cancer or something worse. So Johnson in his normal way, when he got out of the hospital, met with reporters. You know, he hikes up his shirt so you see his large belly with this long scar that's about a foot-and-a-half long.
Beschloss: People thought it was a little vulgar for him to do it, but it sure stopped the rumors fast. One of the reporters later on said, you know, "It was bad enough, but I'm glad Johnson didn't have hemorrhoids and show us what had happened there." (LAUGH)
Lee: I like that one. But so meanwhile, we have President Trump over the weekend in a Secret Service motorcade waving to his adoring fans, in the meantime, putting the Secret Service at risk. Was this an attempt to look strong and presidential? And at what cost?
Beschloss: You have to assume that this was a couple of things. Number one, he did want to look strong and presidential. Number two, he's running for re-election in less than a month. And he felt he needed to do something. Number three, he wants to show everyone that maybe he's in better health than he is.
And the result, just as you say was, he was putting the lives of those Secret Service agents in that car, and I think there was at least one doctor, in danger unnecessarily. That was an unnecessary trip. And you know what made me think, Trymaine?
George H.W. Bush, when he was president, loved his Secret Service agents, you know, thought so much of them, looked out for them so much that on Christmas, his family wanted to go back to their home in Texas. And Bush would not go, because if he stayed in the White House for Christmas, the agents could spend Christmas, those who celebrated it, with their families. That's what you usually see with presidents who are so sensitive to their agents that they do things like this. Instead, you see Donald Trump saying basically, you know, "I don't care if they live or die."
Lee: So it's one thing to play the American public and project whatever you're trying to project to shape how the American people view you. But how is all this playing on the world stage, right? And how important is messaging in moments like this, in terms of how we engage with friends and foes around the world?
Beschloss: Well, it's really dangerous, because someone like Putin or Xi in China or others who may not wish America very well, they know that in our system, we give so much power to a president. We depend on him to respond to a nuclear attack or God forbid, a terrorist incident or a natural disaster. It falls on his shoulders.
So if you've got a president incapacitated, and in this case in Walter Reed, on drugs that we really don't know what he's taking, steroids perhaps. And as we speak this morning, he's sending out tweet after tweet. I woke up this morning, and the first tweet I saw from the president of the United States was, "Space Force, Vote," exclamation point.
And the first thing I said is, you know, is this the result of whatever kind of medication the president's taking? Do you want a president on steroids making the decision whether to use nuclear weapons or not in the next five minutes? I don't, and it is I think a legitimate thing for people to inquire about this and be anxious about that.
And in 1981, you were mentioning earlier, Trymaine, the shooting of Ronald Reagan at the end of March that year. He was taken to George Washington University Hospital. He was given surgery to take out the bullet. He was under anesthesia. He did not use the 25th Amendment.
But in the meantime, in the situation room of the White House, George H.W. Bush, the vice president, had quickly flown back from Texas. There were other national security officials including the Secretary of State Al Haig. And they thought that this might be the forerunner of a Soviet nuclear attack against the United States, because it was a time when the Cold War was extremely intense.
The Soviets were worried about Reagan. They thought perhaps this was an assassin who had acted on behalf of a hostile foe, maybe the Soviet Union. And the next to come is going to be the missiles over the North Pole, and therefore a nuclear defense alert was initiated.
And that was one of the most serious times of the last 60 years, because everyone in that room knew that foreign leaders sometimes suspect that when a president is in the hospital and somewhat incapacitated, if they want to strike, that's the time.
Lee: I hate to venture into political hyperbole and overstate things.
Beschloss: It's hard to now.
Lee: It really is, but are we actually more vulnerable today than we were last week, before we found out the president had COVID? Like, is this an actual compromise in national security?
Beschloss: The truthful answer is, we are in more danger, I am sorry to say. Because you've got a president who is at least somewhat incapacitated. There is no sign that he's even for a minute thought of doing his duty under the 25th Amendment, which is, if he's 97% rather than 100%, let the vice president, you know, come in for at least a few hours to make a quick decision if that is necessary.
And you've got a vice president who's obviously so terrified of his boss that he will not raise the possibility of at least helping with the decision-making or helping with the process. And he's pretending that nothing is wrong and going on with his campaign plans and planning to be in Utah on Wednesday night for a vice presidential debate. That's exactly the opposite of the way these things should happen in the age, not only of nuclear weapons but pandemics and all the dangers that we know that there are.
Lee: What does this do to the chain of command and decision-making if the president is out of pocket for any longer?
Beschloss: It's a real problem, because in this case, this is not chain of command, but you've got his campaign manager is sick, the chairman of the Republican Party is sick, members of the White House staff. We know that Mike Pence was exposed at the superspreader event when Judge Barrett was announced in the Rose Garden, which some people are now sadly referring to as the Rose Garden massacre.
I remember times when the Rose Garden was remembered for happy things, like, giving medals to astronauts as President Kennedy did in the early 1960s. So you've got a government that is not at full strength, and you've got a government, which under Donald Trump has been very much dependent on the word from the boss. So if he's not there at 100% strength, who is making these decisions? So I think it is entirely legitimate to be anxious about that.
Lee: And unless we forget that there's actually an election in, like, 30-some, however many days, however many weeks we have left.
Beschloss: Right. Less than a month.
Lee: Less than a month, we have an election of higher stakes than we can remember. But I wonder in this moment, is there any precedent for campaigning at a time like this? Because the show goes on, apparently.
Beschloss: Well, if you've got a sick president, we don't know what kind of shape he's in, there's no precedent for anything like this. But a lot of what this reminds me of historically, Trymaine, is remember I was mentioning Woodrow Wilson. You know, he had a stroke in 1919, but as you and I both know, one of the worst pandemics in human history was 1918-1919, the influenza pandemic, which killed 675,000 Americans and over 50 million people around the world.
What did Wilson do about that as commander in chief? He was told by his military people, "Stop sending Americans to Europe to fight World War I. You know, you're gonna make them sick." Wilson said, "I don't care." He put them on the troop ships. They were soon called coffin ships, because so many of them caught the flu and died.
People said to Wilson within the White House, "You've gotta make a speech to the American people and warn them about influenza and tell them how to take care of themselves." He wouldn't do it. He said, "Well, that'll make me unpopular. It's bad for the war effort."
Throughout this entire pandemic, 675,000 Americans killed by this thing, Wilson never once gave a public statement about what was going on. He was the supreme example of a pandemic denier. I've studied this for years. I never thought I would see this in my own time.
Lee: I wonder, have we ever seen in a circumstance like this, a president, and you mentioned a few examples, coming out of this kind of crisis and using it for political gain? Could he actually come out of this stronger somehow?
Beschloss: If he does, it's obscene. Go back to 1944. Franklin Roosevelt was running for a fourth term, and by the way, he was sicker than he allowed people to know. And people should have known that he had advanced cardiovascular disease, but he was winning World War II.
Did he put commercials on the radio saying, "I'm the president who's responsible for D-Day"? Is he someone who said, you know, "We're now three years into our involvement in World War II, and Franklin Roosevelt is a great, strong man, and Thomas Dewey the opponent would be weak"? Of course he did not, because he knew that these were issues that were sublime and issues of life and death that presidents should not do that. It's not only about him.
Lee: You know, you've been studying this stuff for a very long time, and with the benefit of history to kind of put some context around what we're seeing now, I wonder from your perspective, how do you think this will actually shape or reshape the election? Like, what's the big impact here?
Beschloss: The overwhelming issue is, has the president done enough to keep us safe? Less than ten days ago, he was making the argument, "The pandemic is coming to an end. I'm the one who made decisions that no other president would have made that actually did keep us safe." That's a pretty hard argument to make when you are hospitalized yourself with this illness, and you also personally put people in danger.
So most likely, this election, which is always a referendum on the incumbent president when he is running for re-election, people are going to have to answer the question. Is this someone who is capable of carrying on for four more years? Did he do what he should to avert this pandemic and deal with it when it happened?
Did he do his best to keep people's jobs and keep their security at the time the economy began to plunge? Is this someone who is serious about issues of racial justice? And to go back to the Reagan question, in the debate that he had with Jimmy Carter ten days before the 1980 election, Reagan said.
President Ronald Reagan: Are you better off than you were four years ago?
Beschloss: That's a very legitimate question. If Joe Biden asks Americans, "Are you better off than you were four years ago in October 2016," they're going to have a response, and that will have a lot to do with how this election turns out, according to history.
Lee: Michael Beschloss, I am uncharacteristically incensed by all this and have been, beginning with the debates and going through this. And I'm so glad to talk with you, at one fueling my anger and madness, but also putting some real historical context here for us to better understand. So Michael, thank you very much.
Beschloss: It's my pleasure. Trymaine, you're a sentinel of this republic, and on behalf of my children, I thank you.
Lee: Thank you, Sir. Michael Beschloss is the presidential historian for NBC News, and the author of ten books on the presidency. The latest is called Presidents of War.
Conley: Good afternoon, everyone. Thank you for being here. Over the past 24 hours, the president has continued to improve. He's met or exceeded all standard hospital discharge criteria. He'll receive another dose of remdesivir here today, and then we plan to get him home.
Lee: In what was a surprise to many earlier today, the president tweeted that he would be discharged from Walter Reed this evening. "Don't be afraid of COVID," the tweet read. Not long after that, White House physician, Dr. Sean Conley, held a press conference.
Conley: Though he may not entirely be out of the woods yet, the team and I agree that all our evaluations and most importantly his clinical status support the president's safe return home where he'll be surrounded by world-class medical care 24/7.
Lee: But there is still a lot of uncertainty about the president's current condition. Dr. Conley wouldn't discuss the details of Trump's lung scan, and again refused to answer questions about when the president last tested negative for the virus. And said he didn't have information on his viral load. That's the measure of virus particles in his body. All of these things are crucial to understanding when the president was or if he still is contagious.
Into America is produced by Isabel Angel, Allison Bailey, Aaron Dalton, Max Jacobs, Barbara Raab, Claire Tighe, Aisha Turner, and Preeti Varathan. Original music by Hannis Brown. Our executive producer is Ellen Frankman. Steve Lickteig is executive producer of audio. I'm Trymaine Lee. We'll be back on Wednesday.