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Donald Trump ambles, and occasionally Donald Trump takes long strides, but at 74 years old, any hustling he does is usually more figurative than literal. This makes what Ronny Jackson saw rare: He watched the president run.

The president was hooked up to all sorts of wires and wearing something more athletic than his normal blue suit and too-long red tie as he kept pace on a treadmill for a cardiac stress test. The angle of the treadmill, Trump would recall after one particular medical exam, was “very steep.” And he later bragged to Reuters that he was running for “a very long time.” The medical team led by Jackson, formerly the personal physician to the last three presidents, eventually had to tell him to stop.

The assessment? According to Trump, “amazing.” And that wasn’t far off from what Jackson would report to the press. He said the 6-foot-3, 239-pound leader of the free world was in “excellent” health, and he said he told the president -- certainly in jest -- that had he kicked his fast-food habit 20 years earlier “he might live to be 200.”

Now a candidate in Texas’ 13th Congressional District, Jackson tells RealClearPolitics that he stands by that glowing medical assessment. In fact, he was “pleasantly surprised” after the results came in because he remembers thinking, “Wow, I don't have to worry about how I spin any of this stuff.”

The entire episode, especially the media skepticism that followed, seems almost silly two years later after Trump tested positive for COVID-19, the illness that has killed over 200,000 Americans and infected another 7.4 million. The credibility of the White House has come into question in the days since as the president’s new physician, Sean Conley, dodged questions and as a COVID-positive president brings issues of patient-doctor confidentiality and public transparency into conflict just weeks ahead of a crucial election.

“I think it's a fine line,” Jackson said of those two considerations. “Obviously, the public has a right to know — it's not a normal patient — but on the other hand the president should maintain some privacy with regards to his medical care.” Jackson’s approach through the Bush, Obama and Trump administrations has been on the side of transparency because “the military standpoint [is] fitness for duty. He is the commander-in-chief.”

Not all administrations have taken such a view, and some presidents have taken pains to hide their health problems from the public. When Grover Cleveland noticed a lump on the roof of his mouth, for instance, he left on “vacation,” boarded a friend’s yacht, and secretly underwent surgery at sea in 1893. Doctors successfully removed the tumor, and the public was none the wiser (Cleveland’s trademark mustache hid any scars).

On the other hand, Lyndon Johnson didn’t care for such discretion. Doctors advised that his gall bladder be removed after he experienced severe abdominal pain. “The public,” Johnson wrote before the operation, “will be kept fully and currently advised of my progress.” (He meant this literally and later showed the press his scars.)

History may remember Trump as something of a mix. Since his release from Walter Reed medical center Monday evening, the president has spoken openly about his illness, attempting to spin his diagnosis to his political advantage. Erin Perrine, a spokeswoman for the Trump campaign, said that these kinds of “firsthand experiences” would deliver “four more years.” All the same, this particular experience is very much ongoing and the president’s medical team has, at times, been less than forthright about his condition.

Conley briefed the press each day the president was a patient at Walter Reed. He didn’t answer all their questions. He wouldn’t say on Saturday if Trump had received supplemental oxygen, but later admitted that the president, in fact, had. He painted a rosy picture of a leader eager to get back to work and mostly unaffected by the virus on Saturday; moments later, White House Chief of Staff Mark Meadows told reporters, on condition of anonymity, that Trump was “not on a clear path to a full recovery.” He repeatedly declined to discuss the condition of Trump’s lungs and cited doctor-patient confidentiality; the public remains in the dark on the state of the presidential respiratory system.

Just hours before Trump boarded Marine One and left Walter Reed behind, Jackson took up the presidential confidentiality question. At no point did the polite Texan breathe a disparaging word about Conley, whom he repeatedly described as “a good doctor.” But Jackson admitted that the situation was a difficult one for anybody serving as the president’s physician. “I don't want to say that the doctor is the one making the call on what's important to the public and what's not,” he said, “but to some extent you are just a little bit.”

Presidents George W. Bush and Barack Obama were Jackson’s responsibility before Trump, and he said that all would agree that if a medical condition was serious, “if you think it's going to come up later, and it's going to be a big deal that we didn’t say something, then let’s just say something. All three presidents I’ve worked for have been that way.”

Discretion obviously matters. Does the public need to know if a president has a common cold? Probably not. But if it is something significant, Jackson explained, “something certainly involving the coronavirus here and what’s going on with him getting hospitalized, I think it’s the right thing to do to be transparent and let the public know what is going on.”

Doing the opposite won’t work, at least not for long. “You absolutely, positively cannot create any sense within the press or in the public that you're hiding anything,” Jackson said. “You can't. If you don't mention something, like the fact that he was on oxygen for a brief period before he went to the hospital, and then you get called out and somebody asks you about it, you have to definitively say ‘Yes, he was.’ You have to follow that up with a decisive argument about why.”

Jackson has met the press numerous times throughout his career, usually in the White House briefing room. The doctor has sympathy for Conley, who has had to learn that skill “on the fly.” Watching from Texas, it is Jackson’s professional opinion that, on the question of supplemental oxygen, the new White House physician “got himself in a bind and he didn’t know exactly how to get out of it.” Again, Jackson says the best prescription is to offer the most accurate information possible. The supplemental oxygen, he suspects, was likely administered to prepare Trump for transport, a precaution that “makes perfect sense.”

Jackson hasn’t spoken with the president about his diagnosis, though he said he has consulted certain officials in the West Wing. And he was not alarmed by all the treatments being administered. In this regard, the president is on the cutting edge. Doctors gave him Regeneron's monoclonal antibody therapy, which has not been approved by the Food and Drug Administration.

But keep in mind the importance of the particular patient. “Would they treat somebody else like that? Would they treat me like that? No,” Jackson explained. “…There's certain things we do to protect the leader of the free world that we don't do for other people.”

He wasn’t alarmed by the decision to move the president to Walter Reed because “we can do a lot of stuff at the White House, but some of it is not the same quality as what we can do at a hospital.”

The move was certainly dramatic and generated great speculation. If anything, however, Jackson said admitting the president to that world-renowned facility should inspire confidence. “The fact that he's up there being evaluated by a panel of physicians should reassure the public that nothing is being covered up,” he insisted. Some kind of conspiracy to hide the true condition of Trump, he added, “would be crazy with that many people up there.” It would require doctors and nurses and other health professionals “to consent somehow to deceiving the public, and that's just not going to happen.”

Another thing that Jackson said didn’t happen during his time in the Trump administration: “The president has never ever — ever — asked me to manipulate anything I've ever said about his health or hide anything.” 

This article originally ran on realclearpolitics.com.

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