Deep concerns about Joe Biden's debate performance last month and continuing questions about his lack of candor about his health obscure a larger issue: Presidents routinely conceal their own medical histories, and some even lie to get away with it.
First, I want to document how common it is for presidents to do this, and then I want to address why they might avoid telling the truth. But all of this presupposes that we have a right to know about their health conditions, and I believe we have that right.
Given the state of medical knowledge in the past, we can’t go too far back to understand the health of each president. But it’s safe to start with the most egregious example of deception: Woodrow Wilson (elected in 1912). Wilson suffered a stroke in October 1919, but the public was not informed that he was disabled and unable to perform his duties. His aides and Mrs. Wilson ran the government for 17 months, until Wilson’s successor, Warren Harding, took office in March 2021.
Calvin Coolidge became president after Harding's death in office, but was devastated by the death of his son, Calvin Jr., in 1924. Coolidge was in poor health and plagued by depression throughout his presidency.
Franklin Roosevelt (1933) knew his life was nearing the end because he had congestive heart failure, but he kept this a secret even after he was safely re-elected in 1944. He didn't even tell his Vice President, Harry Truman, that he was seriously ill (and he didn't tell Truman about the development of the atomic bomb). The public knew that Dwight Eisenhower (1952) had a heart attack on the golf course in 1955, but was reassured that it was minor, when in fact it wasn't.
Americans knew that John F. Kennedy's wartime heroism led to severe back pain that lasted a lifetime, but they didn't know that he also suffered from Addison's disease and was constantly taking powerful painkillers.
Lyndon Johnson's health problems were well-publicized as he was in and out of hospital, but he also suffered from severe depression. The stress of the Watergate scandal led Richard Nixon to drink heavily, often spending his nights drunk and talking to paintings of past presidents that hung on the walls of the White House.
One of the most perplexing cases is Ronald Reagan's Alzheimer's. Doctors claim that Reagan, like his son, was already suffering from the disease during his second term in office. Anyone who saw Reagan struggle during press conferences would agree that something was wrong.
More recently, in 2015, Donald Trump instructed his physician to write an evaluation stating that if Trump won, he would be “the healthiest person ever elected president.” The doctor treating Trump for COVID-19 was not allowed to discuss the details of his treatment, and used humorous euphemisms to avoid saying Trump was given oxygen. Trump also refused to give a straight answer as to why he spent a Saturday afternoon at Walter Reed Hospital: for a colonoscopy.
Which brings us to President Biden. An exhaustive Wall Street Journal investigation documented how presidential staff shielded the president from the press and unscheduled events going back to 2022. Whether Biden has any ailments beyond the humiliation of old age or not, the White House has been deceptive. If Americans cannot see their president answering reporters' questions or interacting normally with other people, it creates a falsehood, a political avatar, that goes beyond the bounds of the White House's normal press management.
Every year, the president releases a physician's statement outlining his health. But these can be superficial, and it would be naive to trust that these doctors will speak candidly. When asked why the president's physicians don't respond to press questions, the White House typically responds that the president has the same right to medical privacy that we expect for ourselves.
Should the public have a right to a more comprehensive report on the president's health than the annual report? Medical ethics are complex issues, and well beyond my area of expertise as a political scientist. But here are some principles to guide us. The public has a right to know about health issues that may affect the president's term in office..
Of the 19 presidents between Wilson and Biden, 10 tried to keep serious health problems from the public's knowledge.
This may seem like a fairly broad standard, but an incompetent president poses a national security risk.
The two current geriatric candidates face a significant risk of developing dementia over the next four years, since roughly 25% of people in their 80s have some form of dementia. And, as Ronald Reagan demonstrated, dementia develops slowly and is hard to diagnose from afar. And it's not just dementia that's scary: If the country is faced with the choice of whether to go to war, a CEO who suffers from mental illness may not be the best person to make that decision.
Ten of the 19 presidents between Wilson and Biden tried to keep serious health problems from the public, so this behavior is more the norm than the outlier.
The president is nominated by the general public in party primaries, not by doctors who know their health histories, and voters cannot be expected to be knowledgeable about the health of their candidates. There is no easy way out of this problem, but the dilemma now is that both Trump and Biden are too old to be president.
Since the debate with Trump, pressure has been building for Biden to withdraw from the presidential race. His decent performance at the NATO press conference emboldened Biden, who has steadfastly rejected calls to withdraw from the race. The assassination attempt on former President Trump has once again rattled Democrats, whose image of a literally bloody but unyielding Trump could not be a more striking contrast to the elderly Biden. While the Democratic Party is divided, the Republican Party is strongly united around Trump and his running mate, Sen. J.D. Vance (R-Ohio), whose election sends a signal that MAGA may continue beyond Trump's second term.
The problem for Democrats is that they have no realistic way to remove Biden from the running, short of persuasion, which doesn't seem to be working, but Democrats are hoping that Biden will set an example of responsible behavior by voluntarily stepping aside.
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