To the President's Health

Your health, sir!

At Top Cottage, Hyde Park in 1941, with Fala and Ruthie Bie, granddaughter of one of the gardeners. Via. This was a press photo; he didn’t hide the wheelchair all the time.

In March 1944, not long after his 62nd birthday, President Franklin Roosevelt, who was taking too long to recover from a bout of flu the previous December, went to Bethesda Hospital for a battery of tests meant to find out why, and diagnosed with a pile of serious heart problems: hypertension, atherosclerosis, coronary artery disease, and congestive heart failure. The doctors' recommendations focused on rest—no business guests at lunch, and two hours' rest after lunch—not easy, as he was pretty busy prosecuting World War II and running for his fourth presidential term. They also prescribed some drugs, and thought he should cut down smoking, and try to lose some weight, which last turned out awkward: Roosevelt was anxious to hide his health problems from the public, as he always had been, going back to the paralysis he'd been concealing since contracting polio at Campobello in 1921, and the successful dieting ironically left him looking sick to the public, not his robust, jaunty, grinning self but gaunt and haggard, sparking exactly the rumors he was most anxious to avoid.

That was a kind of bad thing, as everybody understands nowadays, in the wake of Eisenhower's heart attacks, Kennedy's Addison's disease, Nixon's stress-related alcoholism, Reagan's incipient Alzheimer's, Trump's obesity, severe personality disorder, and possible psychoactive drug use (sniff, sniff!), and whatever was going on with President Joe Biden during the presidential campaign last year on June 27, during the presidential debate with Trump, when he spoke in an almost inaudibly hoarse whisper, and altogether lost the thread of what he was saying at at least one point early in the show. Just an hour or two later he seemed fine, as loud and as on message as ever, but the damage (thanks in part to a long campaign on the part of The New York Times and other organs, not to claim that Biden was suffering age-related infirmities but that the public thought he might be, based not on observation of the president but on a bunch of rather pushy Times-Siena public opinion polls) was done.

Presidents should ideally not be hiding anything from the American public, except, well, if they have to for some national security reason or other, maybe. We certainly don't want them hiding anything about their health, we think. We agree that presidenting is a really hard job, and a really crucial job, in the age of nuclear weapons and whatnot, and we really ought to be informed as to whether the occupant of the Oval Office is up to it or not, not that we could really do anything about it if he wasn't, that's up to "the Vice President and a majority of either the principal officers of the executive departments or of such other body as Congress may by law provide", according to the 25th Amendment, but it's the principle of the thing, right?

Or maybe, I'm just spitballing here, we should start recognizing how badly the whole thing has been working, from at least as far back as Grover Cleveland's concealed jaw cancer or Lincoln's certainly clinical depressions or who knows.

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What I want to say here about Roosevelt is that the situation in 1944-45 wasn't, in point of fact, all that bad, and didn't really need to be coped with by some means our Constitution didn't provide until 1965 and will never be used. I mean in the first place that the president himself, though definitely sick and physically disabled, was not actually all that incapacitated.

Although people noticed something not quite right about his speech, as recorded by his heart specialist Dr. H.G. Bruenn's "Clinical Notes on the Illness and Death of President Franklin D. Roosevelt", available from Ebsco, which were not published until 1970 (in Annals of internal medicine, LXXII/4) and are a big source for me here:

I'm sure we would have heard plenty about that, if Axios and Politico had been around, and it did in fact become a sort of issue, a couple of years after Roosevelt's death, when the rightwing isolationist John T. Flynn blamed Roosevelt's health for prolonging the war in his general denunciation of all things Roosevelt, The Roosevelt Myth, 1948, collecting all the signs of the president's incapacity that had been ignored before his death, though they were in fact reported, starting with Roosevelt's campaign launch in September 1944, delivered from his private car in San Diego, when he took to delivering his speeches from a chair, rather than carry the ten pounds of metal in the leg braces he had to wear in order to stand, as I learn from Herman E. Batemen ("Observations on President Roosevelt's Health during World War II", The Mississippi Valley Historical Review, XLIII/1, June 1956). The last time he stood for a speech, in early August, was on the deck of a ship when he was to tour Bremerton Naval Base, after which he was too tired to go on the tour. The response of the radio audience was worse:

But he won the election handily in November, and thereafter he did a lot in the four hours a day the doctors allowed him! He planned the Normandy invasion, appointing D.D. Eisenhower to command it, and maintained the leapfrogging strategy for breaking down the Japanese conquest of the Pacific; and negotiated with prickly de Gaulle and Chiang Kai-shek, to say nothing of mad Stalin. He managed the Manhattan Project, in its extraordinary secrecy. He introduced the concept of a "second bill of rights" (to "adequate medical care", "a good education", "a decent home", and a "useful and remunerative job") to the policy debate, and pushed through the G.I. Bill to fill it out legislatively, though the veterans of color were left out, thanks to the machinations of the Southern Democrats. A little over a month before he was killed by a massive cerebral hemorrhage, he traveled by ship to Crimea and oversaw the founding of the United Nations at the Yalta conference.

I especially like to note how he worked with his presidential rival Wendell Willkie to take down the ideological structure of the US party system, purging the conservative Southern Democrats, in the hope of building a more partisan system, liberal vs. conservative, something more or less like what was achieved in the later 20th century.

Robert Hugh Ferrell argued in his 1998 The Dying President that Roosevelt's illness had made him unfit to serve, with a host of undesirable consequences:

including a lack of study of the need for the use of the atomic bomb against Japan, a nonchalance regarding the evidence of the Holocaust crime, an inattention to China and Chinese Communism, a casual support of French involvement in Vietnam with all of the attendant consequences of that fatal mistake for American foreign policy in the postwar period, an inadvertent backing of the ridiculous Morgenthau Plan, and an unconscionable isolation of Truman.

I don't know to what extent Roosevelt should be considered guilty of all these things or, where he is, why they should be ascribed to his poor health. On the bomb, the scientists themselves were just coming to understand what it would do to a target; at the urging of Albert Einstein and Eleanor Roosevelt, he had a meeting scheduled with Leo Szilard on the subject, but died before the meeting took place. The support of France in Indochina, and Algeria too, was of a piece with helping the British and Dutch in Burma and Malaya and Indonesia recover their empires after the Japanese departed and the natives turned, to the Europeans' surprise, to fighting for independence, negotiated not just with de Gaulle but also Churchill, a figure of enormous respect to those Americans (not sure I'll ever understand why)—not a special fixation on Vietnam.

Roosevelt may not have been much of a hero in regard to the Holocaust, but recent research shows he was more committed to the rescue of European Jews than he publicly showed, influenced by treasury secretary Henry Morgenthau and, again, Eleanor. Morgenthau's plan for postwar Germany, to permanently destroy the country's industrial capacity, on the other hand, was indeed ridiculous, but it was Churchill, again, and Anthony Eden who signed on to it—Roosevelt didn't actually say anything when they discussed it in Quebec, just left the impression he wasn't opposed, and after he died Hull and Stimson had no trouble persuading Truman to drop the idea and back the Marshall Plan instead.

I don't think, in general, Roosevelt did bad things, when he did them, because of hypertension or atherosclerosis. I think he did them because he was a person of his time, and couldn't always rise above the conventional wisdom. Would Roosevelt have challenged Churchill and decided to introduce the bomb with a demonstration explosion instead of targeting Japan if he'd been healthier? I really don't think so. Maybe if he'd lived to have that meeting with Szilard (Truman did convene a study group in May 1944, the so-called Interim Committee of politicians, scientists, and industrialists, which recommended going ahead with the real bombing).

Roosevelt's neglect of Vice President Truman—he learned of the existence of the Manhattan Project the day after the president died—was a real error, and one you might want to blame on his illness, or his effort to cover it up, or his inability to face it: he clearly didn't want to prepare Truman for the presidency. He didn't think much of his third vice president, and resented how the party had foisted him on him after forcing him to dump the very progressive Henry Wallace. But it wasn't an irreparable error, like Abraham Lincoln's choice of the Union Democrat Andrew Johnson in 1864; Truman had great gifts of his own, and h eventually became a pretty effective president.

That's something, the vice president's situation, that's really changed in our unspoken constitution, by the way, for better (Walter Mondale) or worse (Dick Cheney), but I think on the whole positive—they are no longer the nonentities they once were.

FDR believed, I think, that he was indispensable; that the war literally couldn't be won without him. Not without cause! Nevertheless, he was wrong, in part precisely because he had been such a good president: his administration, his cabinet (even with Hull and Morgenthau fighting like cats and dogs) was strong enough to survive his loss.

The broader point I wanted to make has to do with that: it would obviously be a good thing if all politicians would be entirely truthful about their physical condition, and we should cherish those who are, but in the meantime there's something else we could aim at that might be more realistic: making a government survivable, so that it's not derailed if the big guy gets sick or dies.

Joe Biden was a truly excellent president in exactly this way, in my opinion, facing challenges not unlike those the Roosevelt administration faced (largely brought on by the ineptness and viciousness of the first Trump administration, too)—the Covid pandemic and its attendant economic collapse, the breakdown of the international order with the savage wars in Europe and North Africa and the Middle East, the rise of a new fascism abroad and at home—crammed into a much shorter time frame, in a particularly institutional way, so that if he had died in office the government would have been able to soldier on the way it did in 1945. In a way that's what happened on June 27, politically, and that's why it was so inevitable that the vice president would succeed him in the presidential campaign; because it was her job.

Which didn't work out, of course, and that's too bad, but we don't need to talk about that right now, with the news that Biden really is sick now, with a hopefully treatable but aggressive prostate cancer. A better time for also expressing the hope that his administration's achievements in the American Rescue Plan Act, Infrastructure Investment and Jobs Act, CHIPS and Science Act, and Inflation Reduction Act, and other areas are also robust enough to make it through to the other side of the current horror—I really think it's possible, and if there's any justice, they will.