America’s Gerontocracy Needs a Public Physician - The Atlantic

Aside from some brief written statements, the public has not heard directly from 84-year-old Senator Mitch McConnell since he fell at his home in Washington, D.C., and was taken away by an ambulance two months ago. Why he fell, what has happened since, and how he’s doing now remain unclear. His absence has inspired conspiracy theories, memes, and morbid speculation that a couple of awkwardly staged proof-of-life photos have done little to assuage.

If Americans are doubtful that McConnell will ever return to the Senate floor, it’s understandable: This is not the country’s first encounter with a frail or ailing representative. Six elderly members of Congress have died just this term, and others have demonstrated mental decline. Younger members have also had episodes of incapacity, as when Representative Tom Kean of New Jersey missed months of work this past spring while hospitalized for depression. Our previous president suffered obvious but under-disclosed deterioration while in office; our current leader, who will leave office the oldest president we’ve ever had, is under constant scrutiny for signs of impairment.

Historically, our elected leaders have argued, for plenty of good reasons, that they are entitled to privacy regarding their health and discretion about when they leave. Congressional norms tie power to seniority, which discourages early retirement; airing the health status of our leaders risks creating national-security concerns. But letting politicians judge their own capacity to serve has simply not worked in the public’s interest. I’m a physician—a geriatrician, in fact—and I know from countless encounters with frail, aging patients that many have difficulty admitting when their capacity has started to slip. Many people struggle to recognize, too, when a new impairment means a permanent change in conditions, not just a temporary setback.

The United States needs a system to oversee its leaders’ fitness to serve. Currently, no independent entity assesses and publicly reports on the health of the president or members of Congress. Congress should make one. Let’s call it the Office of the Medical Adviser: an office of medical personnel designated to routinely evaluate whether our highest-ranking public servants can reliably fulfill their duties.<br>The OMA would serve a distinct function from the Office of the Attending Physician, which responds to emergencies at the Capitol, handles occupational-health concerns for Congress and the Supreme Court, and provides many members with primary care. Brian Monahan has held the role of attending physician of the U.S. Congress since 2009. On occasion, Dr. Monahan has provided information to the public about a representative’s health; in McConnell’s case, for instance, he has twice recently provided letters that offered few details about the senator’s condition, other than to imply that McConnell’s health was not as bad as the speculation surrounding it. (The OAP did not respond to a request for comment.)

This is the dilemma of both the OAP and the president’s physician: Their charge is to provide clinical services, not to represent the interests of the public. Their loyalty, correctly, is primarily to their patients. I would never lie if one of my patients asked me to offer documentation of their health, but I might agree to downplay areas of uncertainty or to keep some things private. My obligation to disclose would be secondary to my patient’s wishes and privacy.

The OMA, crucially, would not provide elected officials with care or medical advice. Rather, the office would periodically—say, once every two years—evaluate officials’ health and cognitive well-being. Congressionally appointed physicians would be empowered to request medical records, refer officials to specialists for additional input, and arrange additional testing. Their charge would be to determine whether an individual is cognitively and physically capable of carrying out the responsibilities of their office until their next evaluation, two years down the line.

The OMA would then publicly release brief, structured documentation attesting to a congressional member’s functional capacity. These letters would provide insight into a member’s health status without revealing details immaterial to their ability to meet the demands of their position. The public doesn’t need to know about every blood-pressure medicine someone is prescribed or every mole they have removed. Many members can and do ably perform their role while living with a disability, a chronic disease, or a treated mental illness; the OMA would enumerate only issues relevant to someone’s ability to meet the terms of their job, and would summarize all else as “additional health issues reviewed.”

But were a member to show signs of decline, whether from age or illness progression, the OMA would assess whether that person’s ability to fulfill their responsibilities was in...