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State of the Union

Ebola Fears; Interview With Centers for Disease Control and Prevention Director Thomas Frieden; Interview With South Carolina Senator Lindsey Graham; Interview With Rhode Island Senator Jack Reed; Obama Administration and Crises; ISIS Threat

Aired October 05, 2014 - 09:00   ET


CANDY CROWLEY, CNN ANCHOR: One man in Texas comes down with Ebola, and the country comes down with a case of the jitters.

Today, Ebola in the U.S. Low risk is not no risk.


DR. THOMAS FRIEDEN, DIRECTOR, CENTERS FOR DISEASE CONTROL AND PREVENTION: Our number one priority is the safety of Americans.


CROWLEY: The top doc for the CDC with the latest facts and fears about the Ebola virus.

Plus, a reality check on the readiness of U.S. emergency rooms.

Then, another murder in the desert takes a second British life.


DAVID CAMERON, BRITISH PRIME MINISTER: What we see with this organization is that there is no level of depravity to which they will not sink.


CROWLEY: Senators Lindsey Graham and Jack Reed on whether the U.S. intel underestimated the threat and whether the macabre march of ISIS could have been prevented.

And as ISIS, Ebola and the Secret Service command headlines, the president pivots.


BARACK OBAMA, PRESIDENT OF THE UNITED STATES: Hello, Indiana! It's good to be back.

AKA, Obamacare.

Infrastructure is not partisan.

Unemployment down, jobs up.


CROWLEY: Righting the ship of state, four former White House chiefs of staff with advice for the waning days of the Obama era.


The latest medical update lists the Ebola patient in Dallas in critical condition. The White House says the Centers for Disease Control and Prevention has been working closely with state and local officials for months. Still, with this first known case in the U.S., the diagnosis was initially missed, and it took days to sanitize the home where the victim had been staying.

Joining me now, Dr. Tom Frieden, director of the CDC, who by now has become quite the familiar face.

Dr. Frieden, thank you for joining us.

Let me just get an update on what you know. Does it remain true that there is this one Dallas case, and that's the only known case of Ebola in the U.S.?

FRIEDEN: As of now, the man in Dallas who's fighting for his life is the only patient to develop Ebola in the U.S. We know that there are going to be other concerns and rumors, and we will track every one of those down. We want people to be concerned, but appropriately concerned, about people who have had the travel that might suggest or the symptoms that might suggest that they need testing for Ebola. And, if they do, we will get that testing done promptly.


And can you tell me -- I know that you are now doing contract -- that there are people that are under observation who had been in contact with this patient. What is the date after which they are free and clear? What are you using as that kind of initial 21-day period? When does that end?

FRIEDEN: Contact tracing is the core public health activity that is stopping this in its tracks in Dallas.

It's a hard job. It's an intense job. It means developing a relationship. We have got about 50 people, including about 10 who definitely had contact, about 40 who might have had contact. And every one of them will be monitored every day to see if they have fever. If they do, they will be promptly isolated.

That's how you stop it in its tracks. And that's why we're confident that we won't see a large number of cases from this. We are concerned about a couple of family members who had very close contact with him when he was sick. But that's something that we will just have to check each day for 21 days after the last day of their contact. CROWLEY: So it's dates from when he went into the hospital,

basically, from that day, the 21 days?

FRIEDEN: It depends when the contact was. So, if someone had contact with him a couple of days earlier, it would end a couple days earlier.

CROWLEY: OK. Understood.

Listen, the White House this week said to us that, at the Centers for Disease Control, you have been working closely for months with state and local health officials. And still we see that it took a couple of days and one kind of misdiagnosis to get this man in the hospital in Dallas.

We then see that the contaminated material in the apartment where he was staying stayed there for days, that there wasn't a real clear way of transporting that once the sanitation of the apartment started. So I think -- and what to do with it once they transported it.

So I think some of what one hears when people are saying, wait a minute, wait a minute, do they really have control of this, is that those seem to be kind of major mistakes. How did that all happen?

FRIEDEN: Ebola is scary. And we understand that people are very concerned. And we're very concerned.

The reason we had some challenges with the medical waste is that's the first time we have had to deal with that situation, and, just by chance, there had been a glitch in our system to approve, the government system to approve a waste removal company to do that. That's been resolved. I wished it had been resolved sooner, but it's resolved.

The issue of the missed diagnosis initially is concerning. And that's why we're redoubling our work with doctors, hospitals, emergency departments, medical societies, folks who work on electronic health records. We have provided checklists and algorithms and training.

I think this is a teachable moment. And, after this incident, I am certain that there's a lot more concern and attention throughout the U.S. And, in fact, we're seeing more people calling us and considering the possibility of Ebola. That's what we want to see.

We don't want people to not be diagnosed. We want people to make sure that people come in, and if they have been in any of these countries within 21 days, and they have got a fever or other symptoms that might be Ebola, immediately isolate, immediately contact the local health department and get them tested.

CROWLEY: But the concern, I guess, Doctor, is that it seems so basic, what do you do and how do you transport contaminated material? So, when that is the first thing that slips up in the only known case, that's when people think, do they really have a handle on this? FRIEDEN: The bottom line here in Dallas is contact tracing.

That's how we're going to stop the outbreak in its tracks, making sure that every person who had contact with the individual when he might have been infectious is monitored every day for 21 days and, if they develop fever, to immediately isolate them.

That's how we break the chain of transmission and that's what is going to make sure that we don't have a large outbreak in Dallas or elsewhere in the U.S. But we remain deeply concerned about what is happening in Africa, not only because of Africa, but because the longer it goes on there, the more it might spread to other countries and the greater the risk to us.

So, realistically, we all want to get to zero risk to the U.S. And our top priority is to work 24/7 to protect Americans from threats. We can only do that by making sure that we get it under control in Africa. And we're beginning to see the response ramping up there. But it's going to be a long, hard fight.

CROWLEY: It is that.

And one of the things that we're learning now and we learned this week was that it will take several weeks for U.S. troops. The president has ordered, I think, up to 4,000. They have only been able to get a handful there because of some transportation problems, et cetera.

Was the West late to this epidemic in Western Africa? And do you see any break in this, or does it -- does the problem continue to mount in the three affected -- major affected countries?

FRIEDEN: We're definitely scaling up the response. We're seeing a more rapid, more effective response in different areas geographically of the countries and also in different aspects of the response. But it's going to take time.

The virus is spreading so fast that it's hard to keep up. That's why it's terrific that the president has deployed the Department of Defense there in support of the disease control efforts. This is exactly what is needed. And it's going to make a difference, but it's going to take time.

CROWLEY: Well, why was the world so late to this? This was -- I guess the first case was reported in March. I know you were over there, and came home and rang the alarm bells I think in August, some time. It seems that the West, not just the United States, but the world was really slow to this.

FRIEDEN: I think this has been an enormous challenge.

We have never seen an Ebola epidemic before in the world. It's spreading rapidly in urban areas between the three countries. This is the first time. And it really tells us that we need to ramp up our ability to find the problems rapidly when they emerge, to stop them promptly, and to prevent them whenever possible. And that kind of core public health system, the laboratories, the

disease detectives, the emergency response capacities, we need to make sure that we have those available in these countries and surrounding countries and anywhere there might be a threat, because, if we don't do that, ultimately, we're all going to be at higher risk.

CROWLEY: Is it fair to say that, in Sierra Leone, in Guinea, in Liberia, that at this moment Ebola continues to spread unabated?

FRIEDEN: It's -- you know, it's quite different.

Each of the three countries has a different pattern of the disease, and even within the three countries, each of the counties or districts have different patterns of disease. And, right now, what we're doing is moving out from the capital to each of the counties to have specific disease detective trackers.

This is the largest CDC response in our history. We have currently 135 people in the field, our top disease detectives going out to counties, tracking cases, making sure that we're responding effectively, putting out the sparks when it goes into a new area, and trying to cool down the fire at the heart of the forest fire there.

That's what we do to protect Americans and that's what we do to save lives around the world.

CROWLEY: Dr. Tom Frieden at the Centers for Disease Control in Atlanta, thank you so much. Appreciate your time this morning.

FRIEDEN: Thank you.

CROWLEY: I want to turn now to Dr. William Frohna. He's the chairman of the Emergency Department at MedStar Washington Hospital Center.

Doctor, thank you. I know that's a job, so we appreciate your time.

I come to your emergency room, I say, you know, I have got chest pain, I'm running a fever, and I'm nauseous, is your response to me now different than it would have been a year ago?


I think, with the highlighting of what our role is in emergency medicine and in hospitals to not only prepare to detect, prepare to protect, and prepare to really treat and respond, that's a new initiative that's been put forth through the CDC onto our hospitals with this -- you know, with the goal being to identify the patient who may be at risk for Ebola.

CROWLEY: And so what is different?

FROHNA: I think first you would see is that in -- in many emergency departments, you will have stations set up where signage is very prominent.

And in our emergency department and others in MedStar Health, we have those signs and those stations up where, if you have traveled internationally, if you have a cough, if you have a fever, place a mask and inform a care provider immediately.

CROWLEY: So, I know, sometimes, when you go in emergency rooms, if you say, I think I'm having a heart attack, boom, you're in a room.


CROWLEY: Is that now the case for someone who comes in with symptoms that mimic Ebola?

FROHNA: Absolutely.

When you combine not only the symptoms and the travel history, absolutely, that individual is placed immediately into a room. And the epidemiologic link is established. And if it's a positive link, travel to or from one of those countries in the past 21 days, along with any -- really any signs or symptoms, that patient then is escorted into an isolation room.

CROWLEY: And one of the things that the White House said this week was that they are certain that the mistakes that took place at the Dallas hospital would not be repeated in other medical facilities. Do you have a clear understanding of what went wrong in Dallas, so as not to repeat it?

FROHNA: I don't have the exact information.

However, what has been purported is that certainly communication -- communication is always first and foremost in so many of these instances of breakdown. And so if you really establish that communication link and understanding that anybody, the security officer at the front, the service associate taking intake information, the nurse, the resident or whatever who discovers that information understands it is of utmost importance to take it up the chain and get it to the people who need to act to keep everybody safe, safe patients, safe associates, and a safe community.

CROWLEY: Tell me what your level of -- you're head of an emergency department at a very big metropolitan hospital center.

Tell me what the extent of your contact with the Centers for Disease Control has been in the last month, let's say, and what kind of help they have provided.

FROHNA: I will start with the second part first, and that CDC is providing guidance daily. And that guidance comes in actually probably several times a day from different means of communication.

Webinars, e-mail blasts, professional organizations and societies, the American College of Emergency Physicians and others distribute and disseminate that information all the way down. Hospital systems, MedStar health, the individual hospitals themselves communicate and promote that information all the way down, State of Maryland Department of Health, state of Virginia and the D.C. Coalition and Department of Health all on the same sheet of music.

CROWLEY: So everybody knows, you do this, you do this, you do that? There's a set -- a set of rules?

FROHNA: Yes. I believe that -- that these rules, this -- this infection control really has been -- those foundational principles have been well-established for many years.

You think back over a decade go to SARS and then in 2009 H1N1, and then earlier this year with MERS, and now you apply those same principles, perhaps with some variations to it, but those same principles of protection, stuff that we do every day in emergency departments in this country, to Ebola, and I think that's how we keep everybody safe.

CROWLEY: And, finally, tell us about the emergency room these days. Are you seeing an influx of people going, oh, I think I might have Ebola? What's the nature of what you're seeing?

FROHNA: We -- so far, we have not seen any kind of bump in visits for the worried well.

However, I think, as Dr. Frieden had mentioned, that there will be more and more reports of patients under investigation, because we now have a wider -- casting a wider net to make sure we don't have any mistakes or mishaps or misinterpretation of information about travelers from those areas of risk.

CROWLEY: Dr. Bill Frohna, thank you so much for coming in...

FROHNA: My pleasure.

CROWLEY: ... and giving us a little calm here, at least in the Washington area.

E.R. director for MedStar Washington Hospital Center, we appreciate it.

FROHNA: Thank you.

CROWLEY: The Pentagon says up to 4,000 U.S. troops could be going to help with the Ebola crisis in West Africa, but no troops will be going to the front lines in Iraq and Syria for the war on ISIS -- next up, two prominent U.S. senators and our national priorities.


CROWLEY: The U.S. and coalition forces have been bombing ISIS targets in Iraq for nearly two months now and in Syria for almost two weeks.

But when it comes to boots on the ground, the Pentagon is talking about sending troops to the Ebola hot zone in Africa, not to the terrorist hot zone in Iraq and Syria. I'm joined by two members of the Senate Armed Services Committee,

Republican Senator Lindsey Graham of South Carolina and Democratic Senator Jack Reed of Rhode Island.

Thank you both for being here.


CROWLEY: Senator Graham, first to you. It's -- so, it's been about two months since the U.S., first to protect U.S. interests in Iraq, began airstrikes there.

Is it too soon to tell whether there's been any success in at least containing ISIS in Iraq?

SEN. LINDSEY GRAHAM (R), SOUTH CAROLINA: I'm sure there's been some. The idea of hitting them in Syria is long overdue, because it makes it harder for them to reinforce Iraq.

But this strategy of aerial bombardment is not going to work to destroy ISIL. And when General Allen, who I respect greatly, says it may be up to a year before the Iraqi army can try to retake Mosul, that's just unacceptable.

The one thing I would tell you about these two segments, that the stronger Ebola gets in Africa, the more it spreads, the more entrenched it is, the more endangered we are, the same for radical Islam in the Mideast. It seems to be that the president is all in when it comes to Ebola. I want to compliment him for sending troops to help get ahead of this in Africa, but we have a series of half- measures with ISIL that are going to draw this conflict out, and will not lead to the ISIL's destruction, which makes it much more dangerous for over here.

CROWLEY: You know...

GRAHAM: The stronger they get in the Mideast, the more danger we are here at home.

CROWLEY: Senator, you know as well as anyone that conducting any kind of war and conducting a war that includes U.S. ground troops, you cannot do without public support.

GRAHAM: Right.

CROWLEY: As far as I can see in the polls, certainly, there is support for what's going on now. But when it comes to ground troops -- and we have now, I think, seen the first death when it comes to a U.S. Marine that...

GRAHAM: Right.

CROWLEY: ... was involved in some way in the fight against ISIS -- there is not the public support there for another ground war where we already spent eight-and-a-half years and it's a mess. GRAHAM: Well, all I can tell you is that the job of the

commander in chief is to protect the country. The job of House members and senators is protect the country.

And I think most Americans understand, if we don't destroy ISIL, if they survive our best shot, that we are all less safe. And at the end of the day, you cannot destroy ISIL in Syria without a ground component. And what we're doing with the Free Syrian Army is militarily unsound.

To train these young men up in Saudi Arabia, without first establishing a no-fly zone to take Assad's airpower off the table will lead to their slaughter. It is immoral. There is no way that I can see how we fix the problem in Iraq and Syria without American ground troops.

This mythical Arab army that we're trying to get up to go in on the ground in Syria will need a lot of American hand-holding. And if it takes a year before we can go to Mosul, I can only imagine how strong ISIL will be.

So, Mr. President, level with the American people. You need boots on the ground. And these are human beings with hopes and dreams, not just boots. American soldiers need to go back to Syria and Iraq as part of a coalition. And we're going to need more than 4,000 to destroy ISIL in Iraq and Syria.

CROWLEY: But, Senator, if I could, what can many thousand U.S. troops along with coalition troops do...

GRAHAM: Right.

CROWLEY: ... in the next year that 100,000 U.S. troops couldn't do in eight-and-a-half years?

GRAHAM: Well, we left Iraq in a good place.

And to those who say that this was the Iraqis' decision to have no troops behind in 2011, I hope you will read Panetta's book, listen to Ryan Crocker. President Obama made a fatal mistake. Iraq was in a good spot. He got to zero when it came to American troops because that's what he wanted.

And he had a chance in 2012 to train the Free Syrian Army. He overruled his entire national security team. He got the results he wanted in Iraq. And that led to the rise of ISIL. This is not some tornado or hurricane that you can't control. His incompetent decisions in Syria and Iraq led to this problem.

You can defeat ISIL. We must defeat ISIL, but it's going to require an American ground component, not the 82nd Airborne. It's going to require a coalition to go in on the ground, just not in the air.

CROWLEY: But the question is, if we couldn't -- if we couldn't achieve security, if we couldn't train Iraqi troops... GRAHAM: We did.

CROWLEY: ... to be up to snuff, then why can we do it now?

GRAHAM: We did. We -- we -- we did.


CROWLEY: But if we did, then wasn't the president's decision OK? If Iraq was in a great spot, why argue that we should have stayed?


Everybody, every military commander said we needed between 10,000 and 20,000 troops. President Obama wanted zero. He said he promised to end the war. Well, what he did is, he lost the war, and this has come back to haunt us.

Hope the next president will understand, listen to your commanders. He had a chance in 2012 to train the Free Syrian Army. They were about to beat Assad. Hezbollah came in with Iranian help to turn the tide of battle. The Russians doubled down, and we abandoned the Free Syrian Army.

And ISIL is a result of these two mistakes. We have to destroy ISIL. The president says they only understand the language of force. The president is right. Unfortunately for us, the language of force is the second language for President Obama.

When he talks about what he won't do, that's all the terrorists hear. When he says there will be no ground component to go into Iraq and Syria, American ground component, the terrorists understand what that means militarily.

So this strategy to defeat ISIL has to have an American ground component. I am sorry it does. I am sorry we have made mistakes. Bush made mistakes. He corrected. Obama has made mistakes. He needs to correct.

But this strategy we have regarding the Free Syrian Army is going to get all of these kids slaughtered if you don't deal with Assad's air force. We can win in Iraq. We can win in Syria. It's going to take commitment. It's going to take effort. And God help us all if we don't win.

CROWLEY: Senator, quickly, just a couple of quick political questions. The first is, if Republicans should take over the U.S. Senate in the elections next month, what would you like to see prioritized?

GRAHAM: Number one, to sit down with a guy like Jack Reed, who is going to win his election, a good man, to replace sequestration.

You just heard a segment about the spread of Ebola throughout Africa. We're cutting the CDC's budget, the NIH budget. We're taking the military budget under sequestration cuts down to the smallest Army since 1940, the smallest Navy since 1915. We're destroying the Intelligence Committee.

I want to sit down with Senator McCain, Jack Reed, Dianne Feinstein, a coalition of the willing, to replace these defense and non-defense cuts that are destroying our ability to protect our country, do something like Simpson-Bowles, where Republicans have to give on revenue, close some tax deductions in the tax code, put the...


GRAHAM: ... the money into replacing sequestration, and some entitlement reform.

And, finally, I want any deal that involves the Iranian nuclear program, which is the biggest issue facing the world, whether or not we're going to control the Iranian nuclear ambitions, to come to the Congress for an up-or-down vote.

I fear we're on track to have a North Korea deal where we allow enrichment. The only thing it -- protects a breakout for a nuclear weapon is the U.N. That didn't work in North Korea. So, any deal with Iran, Candy, should come to Congress for an up-or-down vote.

CROWLEY: And what's this about you running for president?


GRAHAM: I know what it's like to run for president. I'm running for the Senate. I know what it takes to put an organization together, to put the money together. I have been with Senator McCain twice in this endeavor.

I am nowhere near there. I am all in running for the Senate. And, in 2015, I want to work with Jack Reed to replace sequestration. And I want to make sure that the Iranian nuclear deal is a good deal before it becomes law.

CROWLEY: Nicely punted, Senator.


CROWLEY: Thank you so much.

GRAHAM: Thank you very much.


CROWLEY: I appreciate your time.

GRAHAM: Thank you.

CROWLEY: Next up, the aforementioned Senator Jack Reed about fighting ISIS and Ebola.


CROWLEY: Joining me now, Democratic Senator Jack Reed of the Armed Services committee. Senator, it's good to have you here.


CROWLEY: Let me start out with a couple of things picking up on some of the things that Senator Graham said.

First, I want to play you what's now sort of a famous line President Obama did an interview on CBS "60 Minutes" last Sunday. And here's what he said about the threat from ISIS.


BARACK OBAMA, PRESIDENT OF THE UNITED STATES: I think our head of the intelligence community, Jim Clapper, has acknowledged that I think they underestimated what had been taking place in Syria.


CROWLEY: So, if this is correct, it seems to me that the intelligence community, once again, has failed to see what was actually happening. And doesn't that call for something to happen in the intelligence committee, changes to be made?

REED: I think it requires a careful review of the -- and a constant review of what is going on.

But there are two facts. One was the rise of ISIS as a political/military force and that was I think pretty aptly disclosed. The issue that I think caught the intelligence community by surprise was the lack of capacity of the Iraqi military forces and particularly the political disenfranchisement of the Sunni community by Maliki.

And I think what really came together was those two forces. A military rise and the organizational rise of ISIS but then what was most surprising was the way Maliki had militarized the politics and politicized the military and led to a situation where the Iraqi military forces just fled in the face of ISIS.

CROWLEY: I want to read you something that Leon Panetta, former...

REED: Yes.

CROWLEY: ...former defense secretary, former head of the CIA actually (ph).


CROWLEY: Yes, said in -- he has a book coming out. I'm sure you've heard. And this is part of what he said quoted by "Time" magazine, "To this day, I believe that a small U.S. troop presence in Iraq could have effectively advised the Iraqi military on how to deal with the al Qaeda's resurgence and the sectarian violence that has engulfed the country."

So, basically the man -- and we all know that the president was advised to leave a troop there. He is (INAUDIBLE) the Iraqis, you know, that we've crossed that bridge. Was it a mistake? Are we there now because U.S. troops did not stay, regardless of whose fault it was...

REED: Yes.

CROWLEY: ...that the troops did not stay there?

REED: Yes. I think first you have to put this in a context. The context first of all, we're still living with the consequences of the war in Iraq, which I opposed. I thought it was a strategic...


REED: ...misjudgment.

The second consequence is the agreement that President Bush signed with Prime Minister Maliki, ratified by the Iraqi parliament that all American troops would leave at the end of 2011.

So, when President Obama --

CROWLEY: Absent an agreement on kind of supports (ph) --


REED: Well, it wasn't a question of absent agreement it was they were leaving.

What the hope was, and what I think was a sincere hope, is that the interim something could be worked out but the leverage we had in 2008 was much less than the leverage we have in 2011. And we also had a situation where we were depending once again upon Maliki, his goodwill and his good wishes. There were discussions about how he was willing to entertain some troops and willing not to entertain it.

But I think what we've seen in the subsequent years is Maliki's ability to govern and his interests from the state of Iraq is less than his own personal survival, his own sort of Shia community.


REED: So the situation is, one, I think, you know, every military commander would have liked to see and I think the administration would like to see the continuation of troops but the Iraqi government wasn't prepared to make the same guarantees that we felt were necessary. And the second dimension goes back to what I said previously. The combination of what we're seeing today is not just simply the effectiveness of the -- of the Iraqi military forces, it's the political alienation of the Sunni community by Maliki. And that probably would have proceeded without -- even if we had some troops on the ground.

CROWLEY: Do you fear now -- and you did vote against the Iraq war, using force in Iraq -- now Panetta and many others are saying, Iraq could become a safe haven for al Qaeda -- for ISIS, much as Afghanistan was a safe haven for al Qaeda pre- 9/11.

Does that change your view on what the U.S. ought to do in Iraq now and in Syria against ISIS?

REED: I think the president's plan is -- it makes sense. We are using our superior air power, our intelligence, our ability to at the highest levels of command in Iraq to provide advice and assistance --

CROWLEY: But no troops on the ground. And you heard Senator Graham very forcefully --

REED: Well, there will be troops -- there will be troops on the ground.

CROWLEY: No U.S. troops on the ground.

REED: There will be troops on the ground. There are over 200,000 Iraqi national security forces. There are Kurdish Peshmerga forces.

CROWLEY: But they won't fight and they need retraining.

REED: That's exactly what we're in the process of doing right now.

And in fact, an effective Iraqi military force on the ground are probably -- be much more effective than a short-term introduction of American forces. So, we have to --

CROWLEY: So Senator Reed is against U.S. forces in Iraq?

REED: I think the most effective way to use the best aspects of both countries is our superiority in the air, our ability for intelligence, for surveillance, for using that force and making sure -- and getting the Iraqi forces up to speed so that they can conduct military operations on the ground. That's what -


CROWLEY: It sounds like that is going to be like -- we're going to be in the air long before we're going to see effective Iraqi troops on the ground.

REED: I think that's absolutely true and I think that's what General Allen has talked about. The president has appointed him as the sort of supervisor and I can't think of a better choice, someone who knows the region, who fought in Iraq, who commanded in Afghanistan, and can begin to seriously directly rejuvenation, the restraining, however you want to describe it of Iraqi forces on the ground so that there is a ground component. There has to be a ground component militarily.

Air probably alone can't win but when you take our superiority on the air and you put forces that will fight and we're away from that point with the Iraqi forces but we have to get there, then you have the combination to be (ph) -- to put the pressure on ISIL, move it back and eventually degrade it and destroy it.

CROWLEY: And finally, Senator, a political question for you. And that is, it is possible that you could become the minority party in the next session of Congress in the U.S. Senate. What effect do you think that will have on getting the job done with the Democratic White House and a Republican Congress?

REED: We'll, we're working awfully hard to maintain our position as the majority party.

A lot of what Senator Graham said in terms of issues that are common to both sides have to be developed. Sequestration has to be either eliminated or somehow postponed and that goes not just for some of the issues like the Department of Defense. That goes for every agency of the federal government. And people like Lindsey Graham who want to work on the issue, I want to work on it with him, those types of issues are going to have to be dealt with regardless of who is in charge.

CROWLEY: So, you don't want it to happen but you could make it work?

REED: We're going to be committed. I'm going to be committed as I have in the past to do what is best for the people of the United States and in particular the people of my own state of Rhode Island...

CROWLEY: Senator -

REED: ...if I'm privileged to be elected.

CROWLEY: Thank you so much for...

REED: Thank you.

CROWLEY: ...being here this morning. We always appreciate it.

REED: Thank you, Candy.

CROWLEY: Next up, advice for the president from people who have been there and done that. I'll ask four former White House chief of staffs from Democratic and Republican administrations, how does the president get out of this mess?


CROWLEY: With me around the table, four former White House chiefs of staff. William Daley worked in the Obama White House, Mack McLarty was former president Bill Clinton's right-hand man. Andrew Card served former president George W. Bush. And Ken Duberstein was with former president Ronald Reagan. Lots of history sitting at this table.

So, let me take advantage of all these brain power and say, here is a president who is in trouble regardless of whether he should be or was at fault, it's a guy whose ratings are low. He's in his in, you know, his twilight years, last two years. People are leaving, people are writing books saying not such great things.

How does he shake loose from that and have a productive two years or can he?

MACK MCLARTY, FORMER CLINTON WHITE HOUSE CHIEF OF STAFF: I think he can, Candy. I think Mark Twain moments in a second-term presidency seem to be a fact. We've seen it also with Reagan, with Bush, 43,and certainly with Bill Clinton. But we've also seen all three of those presidents renew the last two years and get some things done and accomplished. And certainly there's a hunger for that by the American people.

CROWLEY: Bill, you know - you know this president and have worked with him. What do you say to him now as people are saying, oh, he looks disinterested, he looks weak, he looks sort of like turning the pages -


WILLIAM DALEY, FORMER OBAMA WHITE HOUSE CHIEF OF STAFF: Right. I do know him and I know there's one guy who's not of that mindset and that's the president.

He knows there are enormous challenges, things that he can control, things he can't, Ebola, ISIL. You know, you've got to address them. It's not as though you can take off and he knows this better than anyone and we all know it -- the last two years.

So, I think obviously we've got a lot -- a big election in five weeks and see what happens because that will really will determine, will you (ph) - will their leadership change in the Senate. If it does, what does that mean? Does it mean that we just -- there isn't an attempt to get things done and -- or whether or not we stay in this sort of -- as we've done the last two years with this political not only in (INAUDIBLE) but a dysfunction that's in this town with Congress and the executive branch and it's a terrible thing.

I think there's great opportunity in the last two years no matter who's controlling the Senate. The American people are really fed up with this game.

CROWLEY: They are that. This will be an interesting election. But how do you, I mean, pick a subject, any subject, secret service, Ebola, ISIS, whatever is going to with Iran, pick any of those and is there something that the president ought to be doing that would help kind of erase this idea that he's kind of detached and not paying attention?

ANDREW CARD, G.W. BUSH WHITE HOUSE CHIEF OF STAFF FROM 2000-2006: I think he's got to be an aggressive and active leader in all of those categories and demonstrate some emotion and demonstrate some commitment that is real. And I think he's also got to reach beyond the partisanship.

Yes, he's involved in a re-election campaign for the United States Senate and for congressional candidates but he's going to be almost above it and do what is right for the country all the time. Keep the oath and focus on that. Motivate America to understand his responsibilities to lead but also the world is crying out for leadership. And I think if he were to provide more leadership there, it would help him in his partisan political interests of creating more momentum at home.

KENNETH DUBERSTEIN, FORMER REAGAN WHITE HOUSE CHIEF OF STAFF: Candy, Ronald Reagan was faced with a very similar problem. He was at 37 percent in the polls, Iran-Contra had just happened.

We had just lost to the Senate to the Democrats for the first time in Reagan presidency. Ronald Reagan rather than being a lame duck, a virtual dead duck for the last two years decided to clean house, to get fresh voices. Every two-term president needs fresh ideas, fresh voices and strong people. He got Howard Baker, he got Frank Carlucci, he got me and he got a little known (ph) general by the name of Colin Powell. We helped him rebuild the last two years. So, in some ways those last two years were the most important two years strategic arms talks and a treaty with the Soviet Union.

CROWLEY: Is there an opportunity do you think for the president to, a, clean house just personnel (ph) wise? And also we've seen this week changing the subject. We're seeing him saying, (INAUDIBLE) the economy and also I need an energy policy. Does that work?

DALEY: Well, obviously enormous scandals like Iran-Contra causes an enormous shift in the personnel in the White House because that was a scandal that went to the heart of his administration. You don't have that right now, obviously.

You have enormous problems that are being put on this administration, some that they can control and some that they are addressing quite well. You're talking about the secret service. You know, I look at that as -- they are a tremendous organization. It is challenged right now. No doubt about it. There's been mistakes made but they are out there and they have to be right 100 percent of the time 24/7 and they do that.

So I will separate that from an Ebola or ISIL or other things. That is being handled. Obviously there was a change in leadership and that's what you had to do and it was done. And I think we move forward on that. I think we ought to get off of that trying to beat up these men and women who spend so much time defending the president and doing a great job.

MCLARTY: And I think, candy, perhaps the president is already on a pathway. I don't think he has much room on domestic policy until after the midterms.

I do think there is room after that. If we can play baseball in Washington (INAUDIBLE) October hope springs eternal but we see how hard that is. But having said that, I think he's already built an international coalition or is in the process of that concerning ISIL. He's already showing that - he has brought along Europe in terms of Russia. So I think he's already beginning to build the right pathway and

demonstrate some of that leadership that the American people have such a strong desire for.

DUBERSTEIN: Yes, but, look, he can get more done and I would argue he can get more done with the Republican Senate whether it's trade, whether it's corporate taxes --

CROWLEY: I'm going to let you argue that in just...


CROWLEY: ...a second, as a matter of fact. I want everyone to stay here because we are going to talk more politics coming up. Will President Obama get anything done in his final two years if it all turns Republican?


CROWLEY: We are back with our former White House chiefs of staff.

We'll start out with an article today. Dan Balz, "The Washington Post" (INAUDIBLE) a thing or two about politics.


CROWLEY: Who wrote, "Two years after winning reelection, Obama is a muted force on the complain trail to the extent that he is even on the campaign trail. He is limited in where he can travel, constrained in how he speaks about one what has been one of the biggest issues of his presidency, the economy and struggling to ignite the passions of Democratic base in a year when turnout is so critical."

So, you've got this president. All those things are true. His poll ratings quite low. What do you do with him and/or, this is a dealer's choice question, what if he gets a Republican -- an all- Republican congress, then what?

DALEY: I think you use him in the way that each of the presidents we represented were in similar situations. And you use him with the base, you do a lot of fund-raising. Obviously right now if he was on a campaign trail full time he'd be justifiably able to be criticized rather strongly because of all the difficulties that are going on in the world and in this country with the Ebola scare.

So, I think right now you'll see him at the end going to the base as all the presidents as I've said we've represented or worked for have done, and I think that that will be very, very helpful in those races where the base of the Democratic Party in a very low turnout election will make a difference.

DUBERSTEIN: Excuse me, go ahead.

CARD: But he also -- he kind of stepped on it this past week by basically saying this election is really a referendum on him. This is a referendum -


CROWLEY: Kind of stating the obvious a little.

DALEY: But when you're at 5.6 unemployment, that's a pretty good thing to talk about.

CARD: Well, that message is not resonating with the American people.

DALEY: A lot of key races are in the red states.

DUBERSTEIN: All the red states there is not one Democratic candidate who wants President Obama to be there, and every Republican in a red state wants Obama to come into that state.

CROWLEY: And you have been there with George W. You have been there certainly with Bill Clinton.

DALEY: Even though he was popular, we got disinvited (INAUDIBLE).

CARD: So the strength is raising money.


CARD: Being an international leader, a strong international leader, and I'm going to say be where you are welcome and don't be where you're not.

CROWLEY: Which is good advice for almost anybody.

Mack, wrap this up for us and tell me what you think could possibly get done in this day and age with an all-Republican Congress should that happen and a Democratic White House.

MCLARTY: I think there's a real opportunity, as we've seen in each of these presidencies the last two years for a lame duck indeed to fly. And there is such a demand and a hunger by the American people for leadership to get something done. The country is anxious, concerned, frustrated. I think you've got trade is going to be front and center. The president is going to Beijing in November to meet with President Xi and other APEC leaders. You have got tax reform. Both of those are Republican issues.

So, I think you have got a window. Will it be easy? No. But I think it isn't (INAUDIBLE) doable is the right policy, right politics and the right thing to do for the country.

CROWLEY: We have got a minute left. Can we agree that Republicans should they take over Congress have a vested interest in doing something?

DUBERSTEIN: They have to demonstrate an ability to govern the same way President Obama needs to reach out and start building even at this late time relationships not just with Democrats but also with Republicans.

CARD: And there are two chapters to the next experience, one is the lame duck session...


CARD: ...and then you've got the new Congress. And both of those are opportunities for President Obama.

CROWLEY: (INAUDIBLE) we have 15 seconds.

DALEY: The new congress, if it does change, has got to show willingness to compromise. Not just say we're going to pass what we can pass because we have a majority but work with the White House. Work with the president before they put that bill on the floor.

UNIDENTIFIED MALE: The Republicans are not going to have 60 votes in the Senate.

CROWLEY: No, they will not.


UNIDENTIFIED MALE: And that's why you have to compromise.


CROWLEY: Mack McLarty...


CROWLEY: ...Andrew Card. We should stay here (INAUDIBLE). Thank you all so much for coming. We'll be right back.


CROWLEY: Thank you for watching STATE OF THE UNION. I'm Candy Crowley in Washington. Be sure to watch us each week at this time or you can set your DVRs so you won't miss a moment.

Fareed Zakaria, "GPS" is next after a check of the headlines.