It is a well known but still amazing fact that our President is now 80 years old, and that he is running for a second term and would be 86 at the end of that term. Alarm bells have sounded, many smell disaster ahead. After all, they say, they know what “old men” are like.
But do they, really? They refer to the stereotype of an “old man” who dodders with frail body, weak memory, decreased reasoning power, depleted energy, inflexible ideas, no capacity to appreciate the new or the young, and liable to be injured or simply collapse at any time. Or, worse, the old man might decline progressively and not leave office, allowing aides to prop him up and take over, or to let the country drift as he himself drifts away, as happened with Woodrow Wilson. Imagine if he should be replaced by a distrusted Vice-President. It's a nightmare scenario.
But think for a moment – does this nightmare scenario ring true with Biden, or is it simply an ageist trope? Here's an alternative: replace the term “old man” with “seasoned leader.” Modern medicine has increased healthy life spans; some say that 80 really can be the new 65. Seasoned leaders resist the impulses of the moment; their hard-won judgement allows them the patience to weigh alternatives and possible consequences, to appreciate ebb and flow, to know which moment to seize, to judge well. Their years have earned them wisdom.
The seasoned leader knows people at home and abroad, who to trust and rely on, and who to be wary of. They know how their chosen field works, because they have been at it a long time. With their perspective, they can actually be more forward looking than younger leaders, and more conscious of their potential legacy. Despite accusations to the contrary, older people tend to relate well to the young. Think of the warm and close ties of doting grandparents as they advocate and indulge their grandchildren, making sure the younger generation has good education and a healthy planet and are fair to one another. In fact, one has to think – wouldn't a grandparent sometimes make a better, more selfless President than a young, ambitious parent? Think “greatness of spirit,” not “old and broken.” Think secure and wise.
As Ronald Reagan put it in 1984, “I will not make age an issue in this campaign. I'm not going to exploit, for political purposes, my opponent's youth and inexperience.... I think it was Seneca but it might have been Cicero who said, if it were not for the elders correcting the mistakes of the young, we would have no state.”
Perhaps it is not President Biden who is stuck in the past, but the critics who cling to out of date stereotypes.
II.
But, to be fair, bad things do sometimes happen to older people. Woodrow Wilson had a devastating stroke at age 63 (old then,) and his wife and aides hid it from the country, while taking the presidential reins in their own hands. Dwight Eisenhower had a serious heart attack at age 65 (old then) from which he recovered in a weakened state. Ronald Reagan may have slipped into Alzheimer's in his 70's (old then) in his second term. Older people are at higher risk for serious illness, although the risk to the young is not insignificant. Think Kennedy. The risks might rise with age, but they are always there.
Since disabilities can occur to anyone at any time, it is important to be able to detect problems early, and to have back up capacities. Recognizing part of the problem after the Kennedy assassination, the 25th Amendment was ratified in 1967, providing a procedure for replacing an ailing President, whether he or she recognize it themselves, or whether it is the decision of the Vice President and a majority of the Cabinet. But beyond that, we have no formal institutional guard rails. Informally, staff and close friends and advisors function as teammates, supporting and supplementing. But for early detection and remediation, more is clearly needed for all Presidents, not just older ones.
III.
Nikki Haley and others have suggested that a presidential candidate 75 years or older should be tested for mental capability to function in the office. Screening for capability to fill one of the world's most important offices might not be a bad idea. We in medicine know that some patients are more at risk of certain conditions than other patients, and we screen for those conditions to ensure early detection and treatment. We know that the concept of “average” can be deceptive – just because you have a higher risk of having a condition doesn't mean you have it. An 80 year old might be healthier than a 60 year old; a 60 year old may demonstrate more mature judgement than an 80 year old. In medicine we don't confuse risk with actuality, we know we have to evaluate the individual.
But here's the problem with Haley's suggestion – it's far too narrow. What conditions could compromise a candidate's performance as President? Surely it's not simply dementia. Other common debilitating conditions are: alcoholism, depression, anxiety, sleep deprivation, delusions, sociopathy, sexual deprivation or perversion, chronic anger. Indeed, a candidate might be quite literally crazy.
What about other conditions that could compromise performance? What about general intelligence? What about work habits? What about honesty? What about ties to foreign powers? What about temperament? What about prejudice? What about the ability to think through problems? What about the ability to build a team, a breadth of knowledge, a tendency to make a country more peaceful rather than more contentious? What about knowledge of government operations? What about executive experience?
These are all serious questions, and most of them are not age-related. That indicates that focusing on Biden's age is really a question of ageism. Yes, being older brings on the risks and characteristics of age, which can cut both ways. But to focus on just “being older” is unreasonable.
IV.
So what is to be done? A general health examination including the mental status of candidates would be a good idea, with the results released to the public. Just as the American Bar Association judges Federal judicial candidates as “qualified” or “not qualified,” the American Medical Association could be asked to issue a medical judgement on Presidential candidates. The extent of the medical characterization of the candidate's health would have to be determined. Do we want professionals to issue a judgement on alcohol use, anger management, sleep habits, fitness, paranoia? Or should we leave the status quo alone, with issues known to insiders leaking here and there in the press? Maybe we should leave it at blood test results, the clock drawing test, and short term memory assessment.
In the end, the political system must find its way to judge. In the old days of strong parties and leadership by insiders, the guard rails of protection of the republic were left in those quiet insider hands. Nowadays, when primaries have taken the place of smoky back rooms, more public information is necessary. But beyond that, we cannot now say. We will find our way to how much information is needed as we move step by step.
But for the present, it's best to understand that judging on age pure and simple is foolish. The characteristics associated with age are distributed on a Gaussian curve, and only individual characterizations matter. Claiming that a candidate is “too old” or “too young” or “too fat” or “too female” or “too anything” is not clear thinking. Over 80 and doing a good job vs. under 80 and corrupt and paranoid, you're going to rule out the over 80 as “too old?” Older age and well-tested vs. younger and untested Senator or Governor, choosing the younger on basis solely of age? Does that make any sense? This 81year old, exactly one year older than Joe Biden, says “Hell, no!”
Budd Shenkin
Thanks once again to David Levine for suggestions, including especially the final sentence!
PS – striking recent references:
1. Tom Friedman cites Biden's “wisdom:”
https://www.nytimes.com/2023/09/23/opinion/biden-netanyahu-meeting.html
2. Retired Three Star General James Dubik, quoted in Atlantic article on Mark Milley, decries Donald Trump's “cognitive unfitness and moral derangement.” Besides documenting the manifest unfitness of Trump, the article describes the ways in which the executive team and the military were able to erect guardrails through much of Trump's term in office, illustrating how supplementary influence of the organization around the President can be corrective:
https://www.theatlantic.com/magazine/archive/2023/11/general-mark-milley-trump-coup/675375/
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