In one of the most dramatic moments in the Senate in years, 80-year-old John McCain rallied from surgery and a diagnosis of brain cancer to cast a 1 am vote that torpedoed Republican efforts to repeal Obamacare — for now. The vote had been put on hold once already, to give him time to recuperate.
For all the drama, we shouldn’t be surprised that a medical emergency interfered with Senate business. The highest levels of American politics bear an uncomfortable resemblance to a gerontocracy. From the Senate to the presidency to — perhaps most strikingly — the Supreme Court, top positions are held more and more by people in their 70s or above.
Disruptive medical tragedies are an unavoidable statistical consequence of this trend, as is the risk that key political actors will develop cognitive impairment. There's no easy solution to the problem, but it demands a frank conversation.
Reforms such as term appointments for justices could help with the problem, but it’s just as important to try to shift societal norms to take more seriously some elemental realities of human aging.
Tact and, perhaps, anxiety surrounding our own mortality too often short-circuit these conversations.
McCain's diagnosis was hardly the first time senatorial health played a key role in the partisan battles over health reform. The Affordable Care Act passed in the first place because 92-year-old Sen. Robert Byrd was wheeled out onto the Senate floor for three vital votes in 2009. And Byrd’s votes were especially critical as a result of Sen. Edward Kennedy’s poignant struggle with the brain cancer that killed him, at 77, in August 2009.
Kennedy was replaced by Republican Scott Brown, depriving Democrats of a filibuster-proof majority and therefore almost destroying the centerpiece achievement of the Obama presidency.
Blanket judgments about older politicians are of course indefensible. Many of our older leaders have more skill and intellectual firepower than most of us will ever have. Feel free to debate Mitch McConnell on legislative tactics or Hillary Clinton on health policy if you doubt me. Countless examples, down to @JohnDingell’s hilarious Twitter feed, remind us that gifted people contribute to our common life well after the conventional retirement age.
Still, people who do not watch Congress regularly can be taken aback by just how advanced in age — and sometimes evidently slowed — people at the pinnacle of power can be. Viewing the confirmation hearings of Christopher Wray, the new FBI director, the magazine writer Jason Fagone tweeted:
Grassley is 83. Feinstein is 84. Hatch is 83. Leahy is 77. Combined age of the first four questioners is 327.— Jason Fagone (@jfagone) July 12, 2017
In the body as a whole, 23 senators are at least 70. Seven are 80 or older.
The geriatric Supreme Court has long inspired hand-wringing but no action. Rumors abound that Supreme Court Justice Anthony Kennedy, now 81, may retire. Five of the nine justices are older than 67, three are 78 or older, and several have serious age-related health problems. Out of fear of letting President Trump choose their successor, Justices Stephen Breyer and Ruth Bader Ginsberg surely feel obliged to hang on until at least 2020, if they can.
Worries about decline on the bench aren’t theoretical: After William O. Douglas suffered a stroke in 1974, it took 11 months for his colleagues to convince him to retire. Chief Justice William Rehnquist fended off suggestions that he might be too weak to work as he underwent chemotherapy and an emergency hospitalization, before his death in 2004.
Obviously, the more elderly our judges and politicians become, the higher the probability of illness or death within their ranks. By my count, 29 senators and House members have died in office since 1999. More than half were 72 or older when they died.
Twenty-nine deaths may seem like a lot, but it’s actually less than what one would predict, given the statistics for the entire US population. Below, I used the most recent government age-specific mortality data to calculate the probability of dying within six years for a randomly selected American man or woman of a given age.
A randomly selected 70-year-old American woman would have an 18 percent mortality risk. By age 80, this mortality risk doubles to 36 percent.
Sen. Dianne Feinstein (D-CA), who is 84, has not ruled out running for reelection. At her age, the randomly selected man or woman would have a less than 50 percent statistical chance of serving a full term.
Senators like Feinstein, of course, are hardly a random draw from the US population. People that successful tend to be vigorous and healthy, and to have access to excellent medical care and other supports. But the statistics remain daunting, especially when one adds rising age-related incidence of mild cognitive impairment to the mix. Over age 70, almost one-fifth of American adults experience some mild cognitive impairment.
I find much to admire in Sen. Feinstein’s pioneering career. She is smart and tough. She works well with Republicans. But I do not believe she should run again. She’s been in office since 1992, and she would almost certainly be replaced by another Democrat who shares her overall values. It’s time to give someone else a chance in this major position of influence and power.
That doesn’t mean that Feinstein should withdraw from public life. Consider President Jimmy Carter’s glorious post-presidential career. At 92, he continues to work to improve public health around the world — and to wield a hammer for Habitat for Humanity.
Rumors regularly hit Washington about the cognitive function of various senators. Strom Thurmond served to age 100, and was visibly infirm and unable to perform his senatorial duties toward the end of his service. McCain’s confused questioning of former FBI Director James Comey led to much commentary, before his diagnosis, as did Sen. Orrin Hatch’s parroting of a young aide’s talking points in a colloquy with Sen. Claire McCaskill.
80-year-old senators tend to be healthier than the average octogenarian. They also might be too driven to step aside.
The potential presence of mild impairments should not disqualify people from public office. At 75, Edward Kennedy remained one of the most effective senators in American history — whatever his capacity for rapid memory recall. Still, health and mental acuity is a relevant concern when we expect senators to spot likely problems in eleventh-hour amendments to health legislation.
The prevalence of real dementia is far lower than the risks of mild cognitive impairment, but annual risks among the healthy roughly double every five years after age 70. By age 85, almost one-third of adults experience some form of dementia.
On the one hand, competitive and successful senior politicians are surely less likely to suffer these difficulties. On the other, driven people are less likely to be self-reflective about when it’s time to move on.
Then there’s the presidency. Ronald Reagan’s age at inauguration, 69, caused some concern — at the time he was the oldest to take the job — but Donald Trump is 70. Vox’s Matt Yglesias has argued that Sen. Bernie Sanders is now the Democratic frontrunner for 2020. The three leading Democratic contenders — Elizabeth Warren, Joe Biden, and Sanders — would be 71, 78, and 79, respectively, on Inauguration Day 2021.
Some medical experts have expressed concern that President Trump may be experiencing mild cognitive impairment: They say it’s reflected in declining verbal complexity in his responses to media interviews. Yes, there is more than a whiff of politicking in some of this discussion. But this remains a legitimate issue, especially in light of similar assessments made regarding President Reagan, who later succumbed to Alzheimer’s.
There are reforms that could help, but we need to change norms too
One useful reform would be to subject all candidates for major office to a proper medical review from nonpartisan authorities. Presidential candidates might be examined by the staff of Bethesda Naval Hospital. They should be entitled to privacy regarding matters that don’t affect their capacities to hold public office, but qualified and nonpartisan medical authorities should have an opportunity to examine them and to review their records.
In this, as in so many other areas, President Trump made a mockery of the process by submitting a gonzo health report from his Manhattan physician. ("If elected, Mr. Trump … will be the healthiest individual ever elected to the presidency.") That seemed funny when the smart money assumed a Clinton presidency. It’s less funny now, as we depend upon Trump’s health and mental acuity as he negotiates with North Korea.
We should also scrap lifetime appointments to the Supreme Court in favor of fixed 18-year terms. Under such a system, each presidential administration could appoint one Supreme Court justice every two years on a predictable schedule. (It’s noteworthy that these changes would increase the prospects for older jurists to be appointed in the first place. Today, a president would be foolish to nominate a 65-year-old to the high court, but the calculus changes if terms are limited.)
Aware of the challenges facing elderly judges, the Ninth Circuit Court of Appeals has several sensible programs. It “offers a battery of mental health assessments, hosts discussions with neurological experts and has created a hotline where staff may report signs of cognitive decline in their colleagues,” notes the law professor and biographer David J. Garrow, who has long expressed concern about cognitive decline on the bench. The Supreme Court could take a cue.
Justices should take personal responsibility too. Justices should not serve 30 or 40 years, particularly when they can be replaced by someone from their own party. In 2011, Randall Kennedy called upon Justices Ginsburg and Breyer to immediately retire. They should have done so.
Is Sanders “too old” to run in 2020?
Let’s also work to establish sensible norms for people running for high office. Senators over the age of 75 should not ordinarily run for reelection, in my view. Candidates well over 70 should not ordinarily run for president either. Yes, I would say that to Joe Biden and Bernie Sanders, although I would proudly support either man against Mike Pence or Trump.
I’m confident that Biden and Sanders could run effective and compelling presidential campaigns. I’m much more worried about their capacity to continue to perform at a high level over the full course of their presidencies. For that reason, I also want presidential candidates of every age to openly discuss how they plan to manage their health issues as they assume the weightiest job in the world. It’s not dirty pool for reporters and political opponents to press them on such questions.
We should address these matters without rancor or cruelty, but also without euphemism or undue reticence.
These matters are hard to talk about in American politics because they are hard to talk about in our own lives. I see my mortality etched on my father’s face, as my daughters see it in mine. Mortality and bodily fragility are two great constants of human life. How we handle those constraints provides a small but important test of American democracy.
Harold Pollack is the Helen Ross professor of social service administration at the University of Chicago.
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