Tom Vilsack Explains a Run for the Oval Office
ROBERT SIEGEL, host:
I'm Robert Siegel.
MICHELE NORRIS, host:
And I'm Michele Norris. And this is ALL THINGS CONSIDERED from NPR News.
SIEGEL: Over the coming weeks, we're going to be talking with announced candidates for president in both the major parties. Today, a Democrat, Iowa Governor Tom Vilsack. Welcome to the program, Governor Vilsack.
Governor TOM VILSACK (Democrat, Iowa): It's great to be here.
SIEGEL: You spoke out against President Bush's latest Iraq strategy in your last condition of the state address this week. If Iraq is to be a major issue in 2008 and a major concern of the next president, is it really time for someone like yourself whose experience is entirely domestic?
Gov. VILSACK: You know, actually, the job of governor has changed dramatically over the course of the last several decades. I've been to 22 different countries in the last eight years. I've had the chance to talk with presidents, vice presidents, senior cabinet officials and so forth. I'm also in charge with 9,700 men and women who served in the National Guard. I've been to Iraq. I've been to Afghanistan. I will tell you, I don't know that it's as much about experience as it is about judgment.
We had a great deal of experience in the White House when we made the decision - the wrong decision - to move away from Afghanistan and into Iraq. We had the same level of experience in connection with the president's recent plan to escalate our presence in Iraq, which I think is making a big mistake even bigger.
SIEGEL: If you are elected president in 2008, the first wave of the baby boom would turn 65 on your watch. What should be done to prepare for the coming burden on social security and Medicare of baby boom retirement?
Gov. VILSACK: A couple of things. First and foremost, to have an economy that is far more creative and innovative than the economy we have today, and one that is much less dependent on foreign oil. While that may seem like a strange answer to a social security question, it all starts with a economy that is strong enough to be able to support all aspects of society, and one in which we get away from our dependence on foreign oil will, in fact, create the kind of middle class that will allow us to have programs like social security, and would allow us to keep the promise that we've made to American seniors.
As important as social security is, Medicare is an even more significant and daunting problem. And I think there, we have to have a conversation about precisely how we compensate for services versus how we could compensate in a new system for results that would focus on preventing illness and disease, figuring out ways to curing incurable diseases that are currently driving up health care costs.
In Medicare in particular, you have to take a look at ways in which you could compensate for results and not necessarily services. Let me just give you a quick example.
SIEGEL: What is results as opposed to services?
Gov. VILSACK: Well, there's a wide range of ways in which back ailments, for example, are treated. In some cases, there's very aggressive treatment and very expensive treatment, in other ways, perhaps non-aggressive, alternative ways. Well, there's no process now for rewarding the most efficient way to treat back pain. So you may have a situation as we do around the country where you may have a five or six or eight times greater chance of being operated on for a back injury than you would in some other community in the United States. Well, let's figure out what the most efficient and effective way is.
Let's reward the providers who are efficient, and let's not continue to incent the providers who are inefficient.
SIEGEL: So the reimbursement should be more favorable to the provider if the therapy is efficacious but less expensive?
Gov. VILSACK: That's correct.
SIEGEL: I'd like you to talk about another thing, which is a little bit about your life. It's this quite an unusual life story. I gather you were a foundling, left on the steps of an orphanage in Pittsburgh. You know what it's like to have an absentee parent, an alcoholic parent. What, if anything, does that add to your sense of the country or your ability to govern the country?
Gov. VILSACK: Well, the fact that I started out life as an orphan, I think, gives me a great confidence and belief talking to you on this radio show as a candidate for president that the concept of the American dream is alive and well. And I think that's very, very important. Too many young people today in America do not believe that concept is in fact alive and well. And my candidacy, I think, to a certain extent, allows them to see a visible sign that yes, if you work hard and if you dream big dreams, there isn't anything that you can't do in this country.
Watching my mother - my adopted mom - overcome her addiction to alcohol and prescription drug addiction, taught me the very valuable lesson about the power of an individual's ability to have courage to create change in their lives. I honestly believe that each of us as Americans have that capacity, that courage to create change. And clearly, in this country, we need significant change -not incremental, but big changing.
SIEGEL: So you're saying you look out of the crowd, you're saying you look - can look out at a crowd of Americans and see in them, based on your experience, perhaps greater depths, capacities than somebody else might?
Gov. VILSACK: Well, I tell you what's interesting about the crowds that we're getting. We're getting not the usual suspects at a number of our political rallies. We're getting folks who've been orphaned, folks who have battled alcoholism, prescription drug addiction themselves or who have been subject to that, or folks who have been abused as a result of it. And they want to be supportive. They want to believe.
They want to believe that somebody who comes from fairly humble background, starting out life in an orphanage, can in fact, articulate a vision for this country that would be compelling, and be the next president of the United States. That's what America is all about.
SIEGEL: Well, Governor Vilsack, thank you very much for talking to us.
Gov. VILSACK: Thank you.
SIEGEL: It's Tom Vilsack, the governor of Iowa, announced candidate for the Democratic presidential nomination, speaking to us today from Minneapolis.