Have We Learned Our Lesson From Joe Biden?

A 25th Amendment for Congress.

Two weeks ago, Illinois Sen. Dick Durbin — Senate Minority Whip, top Democrat on the Judiciary Committee, mentor to Barack Obama — did something that many 80-year-olds do: he retired.

Here’s what he said, as cheery music played in the background:

The decision of whether to run for re-election has not been easy. I truly love the job of being United States Senator. But in my heart, I know it’s time to pass the torch. So, I am announcing today that I will not be seeking re-election at the end of my term.

The people of Illinois have honored me with this responsibility longer than anyone elected to the Senate in our state’s history. I’m truly grateful. Right now, the challenges facing our country are historic and unprecedented. The threats to our democracy and way of life are very real, and I can assure you I’ll do everything in my power to fight for Illinois and the future of our country every day of my remaining time in the Senate.

I’ve given over half of my life to House and Senate congressional service. I’ve always tried to stand up to power on behalf of the people of Illinois and our country… We’re also fortunate to have a strong Democratic bench ready to serve. We need them now more than ever… Now that I have this announcement behind me, I need to get back to work.

It’s hard not to wonder how the 2024 election might have gone if Joe Biden had delivered more or less that same message in 2022, gracefully passing the torch with enough time for a Democratic successor to put together a full campaign, instead of a slapdash 107-day effort.

Well, hard not for me to wonder, that is. Biden himself apparently has no such regrets. The ex-president resurfaced Wednesday for his first interview since leaving office — given, interestingly, to BBC, instead of an American news outlet. The interviewer asked him directly about whether he should have left the race sooner:

Q: Should you have withdrawn earlier, given someone else a bigger chance?

I don’t think it would have mattered. We left at a time when we were—we had a good candidate. She had fully funded. And what happened was, I had become—what we had set out to do, no one thought we could do. I’d become so successful in our agenda, it was hard to say, I’m going to stop now. I meant what I said when I started, that, I think it’s, “I’m prepared to hand this to the next generation. It’s a transition government.”

But things moved so quickly that it made it difficult to walk away. It was a hard decision.

Q: Regrets, though?

No, I think it was the right decision. I think that—well, it was just a difficult decision.

Q: But you shouldn’t have taken it earlier?

Well, I don’t think so. I mean, I don’t know how that would have made much difference.

Biden did not sound like someone who had learned a lot from his experience over the last year.

Has the rest of the political system?

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In recent months, some extraordinary stories have emerged about Biden and the extent to which top Democrats were concerned about his condition in the months leading up to his withdrawal. (See: his former chief of staff saying that Biden seemed “out of it” during debate preparations, including leaving a session halfway through to fall asleep by the pool. Or a rival for the 2020 Democratic nomination saying Biden didn’t recognize him at a 2023 event. Or foreign dignitaries reportedly worrying that Biden “appeared disoriented at events and at times gazed off into the distance.”)

Then, last week, two similarly extraordinary stories were published — though neither of them were about Biden, or even about aging politicians, in fact. One was about Sen. John Fetterman (D-PA), 55. The other was about former Rep. Yadira Caraveo (D-CO), 44, who lost her re-election bid last year and is now running to reclaim her seat, in what is expected to be one of the most competitive House races in the country.

According to New York Magazine, Fetterman’s then-chief of staff Adam Jentleson wrote the senator’s doctor in May 2024 that Fetterman — who suffered a stroke in 2022, and was hospitalized for depression in 2023 — is not always taking his medications and is prone to “conspiratorial thinking” and “megalomania.” Fetterman’s staff refuses to get in a car with him because he drives so recklessly, per Jentleson. (The senator later got into an accident, injuring his wife.)

Fetterman will sometimes just “shut down,” an aide said; advisers use words like “manic” to describe him. “He’s struggling in a way that shouldn’t be hidden from the public,” Jentleson said.

The Caraveo story came from the Colorado Sun. According to the newspaper, Caraveo — while a congresswoman — “twice appeared to attempt suicide in situations witnessed by staffers.” Aides also accused her of mistreating them; “some said they had to enter therapy to cope with what they experienced while working for Caraveo.”

These are sensitive stories about mental health struggles, and they should be treated as such. (Caraveo was also hospitalized for depression while in Congress.) They are, of course, different in kind than the stories about Biden.

But, taken together, the reports about all three offer a reminder that the American political system really hasn’t developed an effective way to deal with public officials who are unable to discharge the duties of their office.

After all, one can — and should! — feel for Fetterman, Caraveo, and Biden (and their families) on a personal level. But, at the end of the day, the United States only has one president, Colorado’s 8th district only had one congresswoman, and Pennsylvania only has two senators. We pay them six-figure salaries to do important jobs representing us. If they can’t, we deserve to know about it — and to have a way to remedy it.

This issue is especially urgent at a time when Americans are living longer and experiencing more pronounced mental health issues, making it possible that growing numbers of lawmakers will struggle — for a variety of reasons — to perform their jobs.

Other examples abound. The late Sen. Dianne Feinstein (D-CA) would reportedly grow confused “about the basics of how the Senate functions” towards the end of her tenure, relying on staff to “remind her how and when she should vote” and what to say. Former Rep. Kay Granger (R-TX) allegedly lived in a memory care facility as her final term ended last year, missing months of votes.

In the Biden, Caraveo, and Granger cases, the most jarring details weren’t made available to the public until they had left office. Without much of a mechanism to oust her, Feinstein died in office. Fetterman is still serving; Democrats who are asked about him are giving answers mighty reminiscent of those they once gave about Joe Biden.

“John Fetterman is an excellent legislator and does a great job around here,” Senate Minority Leader Chuck Schumer (D-NY) said this week. Earlier today, a new story about Fetterman emerged, revealing that he began “slamming his hands on a desk” and shouting, “everybody is mad at me,” “why does everyone hate me, what did I ever do” at a recent meeting with representatives of a teachers union.

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At this point, now that I have spent some 1,200 words discussing the allegedly impaired conditions of Joe Biden and other contemporary politicians, I can already feel the responses destined for the comments section: What about Trump?

Fair question. In an effort to rigorously engage with that question, I’ve spent some time reading various op-eds (USA Today, The Hill) that make the case that our current president is also in the throes of mental decline.

To be honest, I was not very compelled by any of the examples listed: Trump claiming he built more border wall in his first term than he did, Trump claiming to have read an interview that he clearly didn’t read, Trump calling for tariffs on foreign films, Trump saying “I’m not a lawyer” when asked about due process.

Personally, these all sound very much to me like things Donald Trump would have done at many stages in his career, including as a much younger man. Then again, I also wasn’t always very compelled by claims about Biden’s decline in the 2021-23 period: there were some examples then that seemed notable, which I reported on, but others seemed fairly typical for a man who had been putting his foot in his mouth for decades. In retrospect, I’m not confident I struck the right balance.

It’s hard to assess Trump’s mental state for the same reason that it was hard to assess Biden’s: these are two men who have been imperfect communicators for as long as they’ve been in the public eye, both prone to gaffes and exaggerations. It’s just not easy for an outside observer to separate out what is par-for-the-course and what, now that they are in their late 70s and early 80s, might be more alarming.

Which is precisely why I don’t think I — or you, or any of the rest of us in our armchairs — ought to be the one making these diagnoses. But I’d also rather not, at either the presidential or congressional level, repeat the experience of only learning worrying details about the (physical or mental) health of public officials after the fact.

Instead, perhaps our recent experiences show us that it’s time to consider reforms of the 25th Amendment, which handles presidential disability — and that it’s time to start thinking about what a 25th Amendment might look like for members of Congress.

For the uninitiated, Section 3 of the 25th Amendment allows the president to temporarily hand over the duties of his office, a provision that has been invoked a handful of times during presidential surgeries. Section 4, which has never been invoked, allows the vice president and a majority of Cabinet members or “or of such other body as Congress may by law provide” to bench the president if they declare him unable to serve. (If the president says he is able, two-thirds votes of each chamber of Congress are required to strip him of his powers.)

During Trump’s first term, Rep. Jamie Raskin (D-MD) introduced a bill to create just such an “other body as Congress may by law provide,” which he called the “Commission on Presidential Capacity to Discharge the Powers and Duties of the Office.”

Raskin’s commission would have been made up of physicians, psychiatrists, and “former high-ranking executive branch officers” appointed by both parties. At any time, Congress would be able to approve a resolution directing the commission to “conduct an examination of the President” and determine whether he is “temporarily or permanently impaired” by “physical illness or disability,” “mental illness or deficiency,” “alcohol or drug use,” or another condition.

The commission would transmit a report to congressional leaders; if a majority of members (plus the vice president) rule the president unable to discharge his duties, the 25th Amendment would be invoked.

Tellingly, Raskin pushed the bill while Trump was in office, but never during Biden’s presidency, despite lingering questions that might have been satisfied by a physician’s examination. Perhaps that suggests that Raskin’s proposal didn’t go far enough: maybe his commission should be even more empowered, placed out of the reach of partisan politics and allowed to convene and request a presidential examination whenever a majority of its member chooses (not just when Congress asks them to).

Even short of handing such a commission the power to remove the president from office, the idea of appointing an independent, bipartisan panel of doctors to regularly assess his health isn’t such a bad one.

The mental states of both Trump and Biden have also been difficult to track because they were so close to the only doctor who was monitoring them: Trump’s doctor, Ronny Jackson, is now a Republican member of Congress; Biden’s, Kevin O’Connor, grew to become a close family friend. In those circumstances, it was difficult to trust the vague reports those doctors would put out; annual check-ups from the bipartisan panel, complete with a full public report, would be more trustworthy. That might sound excessively nanny-ish, but after our recent experiences, some level of independent reporting on the president’s health seems necessary. (This is the person we are trusting to immediately mobilize to protect our country from urgent attacks, after all.)

And why stop there? After the stories about Fetterman, and Feinstein, and Granger, perhaps a similar commission should also be impaneled to have regular check-ups with members of Congress, and to alert their constituents if anything seems awry.

An Office of the Attending Physician already exists on Capitol Hill, but it appears to suffer from the same problem as the White House analogue: excessive closeness with the patient, potentially clouding their judgment. In 2023, when congressional physician Brian Monahan said that Sen. Mitch McConnell’s (R-KY) freezing episodes were the result of dehydration, even some of Monahan’s other patients were unconvinced.

Sen. Rand Paul (R-KY), an ophthalmologist, said that Monahan’s assertion amounted to “misinformation” that was “clearly not accurate” and not a “valid medical diagnosis.” (McConnell’s biographer also shared evidence with me in an interview that the cause of the freeze-ups was not dehydration, as the doctor had claimed.)

Congress already has an independent Office of Congressional Conduct to assess ethics complaints. But for health allegations, the only layer of accountability currently comes from journalists (a harder task as local news outlets die out, missing stories like Granger’s). Maybe an Office of Congressional Capacity is needed as well, to jump in if there are credible claims of a lawmaker unable to perform their duties. Unlike the Office of the Attending Physician, who reports to the members of Congress; the Office of Congressional Capacity could report directly to us, their bosses.

If they issue a worrisome enough report, it would also be wise to have a process like the 25th Amendment to remove an impaired member of Congress. Or, at the very least, we could remove some of the barriers that might currently hold lawmakers back from giving up their seats: the fear that they will go empty, or flip to the other party. Last year, then-Rep. Derek Kilmer (D-WA) introduced a constitutional amendment that would require each House member to devise a list of five individuals who could take their seat if they die. Within 10 days of the vacancy, their state’s governor would have to pick one of the five.

That same proposal could be extended to cases where a panel of doctors declare a lawmaker unable to serve. Nationalizing the process for calling special elections and appointing interim senators — some states require them quickly, others don’t; some states require same-party appointees, others don’t — would also help relieve the pressure on parties, in an era of slim majorities, to grip every seat so tightly, fearing a vacancy more than an incapacitated member.

These proposals may sound far-fetched, but the idea of deputizing unbiased physicians to help decide questions of fitness has already been implemented on the state level. In Delaware, the Lieutenant Governor becomes Acting Governor if the state Chief Justice, the president of the state’s Medical Society, and the director of the state’s Division of Substance Abuse and Mental Health unanimously say that the governor is unable to serve.

In Iowa, the Lieutenant Governor can call a conference of the state Chief Justice, the state Director of Mental Health, and the dean of medicine at the University of Iowa, who can examine the Governor and unanimously vote to temporarily discharge him from office.

Oregon has a similar provision, involving another group of judges and physicians; countries like Nigeria and Guyana also include doctors in their 25th Amendment equivalents.

It should worry every American that we’ve lived through two stretches in the last five years when the president’s own aides have wondered about their fitness, and when the 25th Amendment could credibly have been invoked: against Trump, after January 6th, and against Biden, after the spring of 2024.

And yet, neither time did the process come close to being triggered, nor did we even receive a comprehensive report on the president’s status, just like we’ve received little information when concerns have been raised about members of Congress like Kay Granger, Dianne Feinstein, and John Fetterman.

How many of these stories do we have to live through before we start asking whether a new process must be put in place?