What does America do about a sitting president’s gradual loss of cognition, or fitness of mind? Biden is not the first president to present this question, but he is the oldest, perhaps most exposed – with domestic and international tensions high, country divided. The answer, unfortunately, is not much. We may have to hold our breath for two years.

The President just got a medical report notable for the gap: no mental fitness attestation for the 80 year old. This is unnerving and says more than a mental acuity test would. Biden is visibly failing, and everyone sees it.  

This health report, and the mental health component missing, seems like a final straw, but may not be. Ironically, aside from no comment on Biden’s mental health – at an age when many fail and doctors commonly test cognitive function – the report is not great.

Biden apparently contends with “atrial fibrillation,” “hyperlipidemia,” “gastroesophageal reflux,” “degenerative … spine,” “loss of feeling in his feet,” had a “lesion” removed, and mobility issues – so heart, blood (too many lipids), upper gastrointestinal, esophagus, spine, nerves, possible cancer, and mobility.

Other than that, he is a veritable hotrod, reflection of cobranding with aviator glasses and a corvette. Yeah, well, that is not giving other doctors much comfort. Obama’s personal physician Dr. David Scheiner notes: “You’re not going to learn anything, They sugarcoat these things. It worries me that he is aging… If I look at him, he’s not a young 80.” Indeed.

Former Obama and Trump doctor Ron Jackson, now a Congressman, says the report is “alarming,” offers “no transparency,” and no mention of cognitive testing despite Biden’s “deteriorating mental health.” He calls it what it seems, a “cover up.”

All this is deeply concerning as we live in an era of uncommon, unforgiving digital intimacy, when everyone from China’s Xi and Russia’s Putin to school children can see the cognitive decay. While many fear Vice President Harris’ lack of seasoning, competence, and seriousness, if not leftists leanings and temperament, the reality is that China, Russia, Iran, North Korea, and others see what we do. More to the point, they see an opportunity – to seize greater power globally.

The best two historical comparisons, while inapt, are Woodrow Wilson and FDR in final years. In October 1919, one year before 1920 elections, Wilson suffered a massive stroke. The incapacitating nature of the stroke fundamentally affected his decision-making ability, but was hidden.

As one scholar notes: Wilson’s doctor “had tremendous … loyalty to Wilson,” so “kept the severity of the stroke hidden from Congress, the American people, and even the president himself.” Like Biden’s doctor refusing any questions on capacity, Wilson’s “formally refused to sign a document of disability and was reluctant to address the subject of presidential succession.”

Still, “Wilson was essentially incapacitated and hemiplegic …messages relayed directly through his wife…”  Notably, a dangerous precedent was set. “Patient-physician confidentiality superseded national security amid the backdrop of friendship and political power on the eve of a pivotal juncture in the history of American foreign policy.”

Gosh, that sounds frighteningly similar, although the camera is on Biden, and he has yet to have a stroke, unlike Wilson and the recently seated Democrat Senator from Pennsylvania who is suddenly far sicker than reported during the campaign, now the Senate’s deciding vote.

FDRs’ fading health was no less compelling, hidden just as purposefully. He died in office six months after being reelected in 1944. Prior to that, many historians note, and Winston Churchill lamented, FDR’s weak mind likely allowing Stalin to prevail at Yalta with Eastern Europe in the balance.

All this leads us back to now – history before our eyes. The constitutional process only allows removal by impeachment, majority vote in the House, and two-thirds in the Senate. Barring a massive change compelling Democrats to admit Biden’s incapacity, impeachment is out.

Separately, the 25^th Amendment requires a process equally unlikely to produce removal. If removal occurs, the vice president becomes president and nominates a vice president. But do not count on this any time soon.

Section 4 reads: “Whenever 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, transmit to the President pro tempore of the Senate and the Speaker of the House of Representatives their written declaration that the President is unable to discharge the powers and duties of his office, the Vice President shall immediately assume the powers and duties of the office as Acting President.”

Since neither impeachment nor the 25^th Amendment are likely to kick in without a major change forcing Democrats’ hands, resignation is the only other option – with as much risk as now felt.

In the moment, the best answer may be to hope Biden continues, pray for the country, imagine China understands our president is not The Nation, then – hold our breath for the next two years.

Robert Charles is a former Assistant Secretary of State under Colin Powell, former Reagan and Bush 41 White House staffer, attorney, and naval intelligence officer (USNR). He wrote “Narcotics and Terrorism” (2003), “Eagles and Evergreens” (2018), and is National Spokesman for AMAC.

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