On the president's health

Some thoughts after talking to Biden aides and medical staff who have treated him.

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There were four words at last week’s presidential debate where, for some Biden officials and allies, it felt like the night went from bad to unrecoverable.

“We finally beat Medicare,” the president said, about 10 minutes into the debate.

It was a WTF moment, several current and former White House officials told me — one that sparked panicked texts from Democrats and gleeful memes from Republicans. It capped off a rambling, disorganized answer about the national debt, and it teed up Donald Trump for an easy slam on Biden.¹

It was also confusing because I knew what Biden meant to say — “we finally beat Big Pharma,” he’s repeatedly announced at speeches and fundraisers² — though he’s often relied on a teleprompter to correctly deliver those remarks.

The Medicare screw-up wasn’t Biden’s only problem from the debate. More gaffes would follow over the next hour-plus.³

Now Biden’s shaky performance has sparked a national reckoning about his age, his cognitive health, and whether his prime-time misfire was truly a bad night or an indicator of something more.

Inside the White House

The Washington Post spent much of the past week asking the White House a question that Biden faced publicly in an ABC interview on Friday night: why not get a cognitive exam? Even to help rule out a problem?

The 81-year-old president has said his doctors have told him it’s not necessary.

So who are those doctors?

My colleague Michael Kranish and I just published a story about Biden’s longtime physician, Kevin O’Connor, and the White House medical unit that keeps watch on the president around-the-clock.⁴

You can read our new story here.

Some of the most interesting takeaways to me, from the reporting:

— Three former White House medical unit personnel, all of whom have treated Biden and told me they either like him or are staunchly apolitical, told me they think the president should get a cognitive test.⁵

— Outside experts also have raised concerns, with some neurologists noting that the president’s persistent mumbling, stiffness and other symptoms were present well before Thursday’s debate. (Several experts said the symptoms evoked signs of Parkinson’s disease, though cautioned that you can’t make that diagnosis through a TV.) These experts generally agreed Biden should get a cognitive test, too.

— White House medical personnel, who are with Biden around-the-clock, have trained for decades on scenarios where the president is shot, stabbed, even wounded in a nuclear attack. The focus has been on reacting to an urgent crisis, like physical trauma or a heart attack. There’s historically been no training for the scenario they face today: whether an 81-year-old president is showing signs of needing a cognitive test.

— There’s also no real protocol for White House physicians or others to proactively raise concerns about the president’s cognitive health. That’s strikingly different from other professions where a lot’s riding on your fitness.

If you’re a pilot, a doctor can ground you if he’s worried you have some impairment, and there’s a process to earn your way back to the skies. But if you’re the U.S. president, and you don’t want to be tested … who’s going to overrule him?

I also chipped in on a recent story with a few Washington Post colleagues — Yasmeen Abutaleb, Josh Dawsey, Maria Sacchetti and John Hudson — about how Biden’s aging-related struggles have accelerated. You can read that story here.

Some takeaways from that piece:

— The debate really changed things. There were lapses that officials and allies wrote off, even earlier this year, that they’re now willing to discuss, at least on background with reporters.

— The debate also may have been Biden at his sustained worst. For all the gaffes that we collected, no one was willing to share a story, even on background, that compared to his extended, shaky performance on TV.

— There’s a deliberate effort by the White House to make accommodations for this president. As Axios first reported, events are scheduled midday when Biden is thought to be at his best. Meetings are also kept deliberately small to avoid overwhelming the president.

— Joe Biden, the famous retail politician who loved to work a big room and couldn’t stop talking, is largely gone.⁶ The President Biden who remains is far more quiet and cocooned.

Responding to some reader questions

Based on unhappy emails and angry responses on social media, it’s clear that these stories make some readers uncomfortable.

Just speaking for myself, I wanted to take a stab at some of the most frequent questions I’ve received.

What about Trump?

I find this an underwhelming question. There has been ample coverage of Trump’s policies, of his remarks, of his own cognitive health, going back years and continuing in 2024.

Concerns about Trump’s mental state were so ever-present during his administration that it ended up pressuring the president into undergoing a cognitive test.

Why are reporters so focused on Biden’s age now?

This is also a surprising question to me. When the U.S. president’s gaffes become this noticeable, and prominent allies are urging him to rethink his campaign or withdraw, that’s a major story.

Why should we trust the media, when so many of these stories draw on anonymous sources?

I can only speak for me, but the people I’ve talked to for these stories are serious individuals — and in many cases, real fans of Biden.

They include administration officials with firsthand exposure to Biden, former White House medical personnel who have treated him in the past, and influential Democrats who have interacted with the president in private settings in recent months.

These sources may not stay anonymous forever. If worries over Biden persist, it wouldn’t surprise me if more Democrats go on record about their concerns.

Counterpoint: Why didn’t reporters pick up on Biden’s struggles earlier?

This is a trickier question, and I’d defer to a full-time White House reporter. But from my vantage point, as a reporter who sometimes covers the White House, I’ve noticed a few factors.

First, sources’ willingness to speak on Biden’s aging; some of the same people who recently downplayed questions about Biden’s health and gaffes are now openly sharing critical stories with reporters.

Second, the White House’s persistent efforts to knock down questions, sometimes by deploying Biden allies who publicly swore that the president, behind closed doors, was always at the top of his game. That claim got a lot harder to defend after the debate.

Third, as president, Biden really has gotten a lot done — the Inflation Reduction Act contains major changes to the cost of prescription drugs in America, for instance — and that’s helped keep focus on his policies. But as a candidate running for re-election, and struggling to convince voters to back him again, his speaking and campaigning limitations have become more obvious.

I also think blanket critiques of “the media” miss that we’re not a monolith. There were good reporters — Alex Thompson at Axios comes to mind — who did dig into Biden’s aging, despite persistent opposition from Democrats and even many readers.

Aren’t there more important stories than Biden’s age, like the candidates’ policies?

I agree that the stakes of the 2024 election are extremely important — which is why we’ve written about the possible effects on Medicare, the Affordable Care Act, abortion, abortion, abortion, and much much more.

It takes time to do these pieces; I can’t write on every issue and new development, as much as I want to! But I’m confident that we’ll continue our close coverage of the next president’s policies, even as we probe the questions raised about the current one.

1. Biden’s gaffe was compounded by Trump’s quick response. “He’s right,” Trump said. “He did beat Medicaid. He beat it to death. And he’s destroying Medicare.”

2. Biden has repeatedly invoked his administration’s drug-price reforms, like finally requiring Medicare to negotiate directly with pharma companies on the cost of their drugs, in speeches that I’ve watched in person or on TV.

“We finally beat Big Pharma” is such a go-to line for Biden that I’m still surprised he flubbed it at the debate.

3. Biden’s struggles weren’t the only story out of the debate. Trump repeatedly misspoke or misrepresented numerous issues. You can see our live debate coverage that tried to make sense of both candidates’ remarks.

4. As physician to the president, O’Connor is chiefly responsible for ensuring Biden’s health and steering his care. O’Connor’s role has gone well beyond the president; the longtime Biden confidant helped navigate Biden’s family through Beau Biden’s brain cancer and his tragic 2015 death, the passing of Biden’s own mother, and other health concerns.

5. Our story didn’t draw on any interviews with Ronny Jackson, Trump’s former White House physician and a current GOP congressman. (Jackson is no fan of The Post, after we scooped that he had been quietly demoted.)

Jackson has been arguing for months that Biden should get a cognitive test — a demand that’s been hard to separate from his staunch advocacy for Trump — so we didn’t include it in our piece.

6. I found this 2012 TIME Magazine story by my current colleague Michael Scherer to be really fascinating. It’s a well-written, evocative portrait of Vice President Biden at the peak of his campaigning powers.