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The news that former President Joe Biden has been diagnosed with an aggressive form of prostate cancer was a stunning disclosure. First, because of its obvious tragedy—the Bidens have achieved much but suffered more, and their patriarch’s having such a serious illness is devastating. But second, because of its timing: The diagnosis comes just as Biden is being hammered in the press thanks to several new books on his presidency and his disastrous (and aborted) 2024 campaign. In different ways, these books make a similar case, arguing that Biden was not as cognitively sharp as his staffers led the public to believe, and that by running for reelection despite his obvious frailty and advanced age, he cost Democrats the election and the public’s trust. Now the cancer announcement raises new questions, chief among them When was this diagnosis actually made?

The splashiest of the Biden books is Original Sin: President Biden’s Decline, Its Cover-Up, and His Disastrous Choice to Run Again, by Jake Tapper and Alex Thompson. Despite its ubiquity, it is not the only one: Also making headlines are 2024: How Trump Retook the White House and the Democrats Lost America, by reporters Josh Dawsey, Tyler Pager, and Isaac Arnsdorf; Fight: Inside the Wildest Battle for the White House, by Jonathan Allen and Amie Parnes; and Uncharted: How Trump Beat Biden, Harris, and the Odds in the Wildest Campaign in History, by Chris Whipple. The Tapper and Thompson volume, though, particularly indicts Biden’s aides and family members for engaging in an intentional cover-up of the former president’s waning cognitive skills.

It also relays a brief—but compelling—tale about Beau Biden’s cancer battle. Doctors discovered a brain tumor after Beau collapsed during a family vacation in summer 2013, and he was diagnosed with Stage 4 glioblastoma. Beau, then the attorney general of Delaware, was secretly flown across the country for various treatments. But the public was told only that he had had a “small lesion” removed from his brain. Beau himself told a reporter in November 2013 that he had a “clean bill of health”—even though his diagnosis was terminal. A doctor said the same to the press in February 2014. During this time, Joe Biden would fly to be with Beau, fudging the truth of his whereabouts to reporters. Beau died in May 2015.

Health care is usually a private matter. But when the person whose health is at issue is a sitting public official—and especially when they’re the president of the United States—it’s more complicated than that. What the public does with the information doesn’t help: Predictably, internet doctors who got their degrees from the University of Google’s acclaimed WebMD School of Medicine are opining on the improbability of Joe Biden’s diagnostic timeline. The last known time Biden was screened for prostate cancer was in 2014. Why, many are asking, was he not screened again? Or was he screened again but the results were concealed? With cancer this advanced, mustn’t he have had it while in office? What does that then say about either the quality of his health care or what might have been hidden from the public?

Biden spokesman Chris Meagher says there was no cover-up—that the former president’s diagnosis came last week.

The problem for Biden’s team is that the conversation around Biden’s diagnosis goes beyond the standard palace intrigue that characterizes so much political gossip. A cover-up feels plausible because we already know that the Bidens and those around them did act deceitfully, even if they did so with the best intentions. Biden really was a good president. He still is the only Democrat to beat Trump. The 2024 election really was a crucial one, and the stakes really were high, and those around the then president really did seem to believe that he was the only person who could save America from our current descent into authoritarianism. By all accounts, Biden was lucid much of the time and was largely capable of doing the job of the president—though occasionally he needed the help of aides. And he was periodically confused. And he had bad days and bad times of day. This debate—how impaired is too impaired?—is familiar to anyone who has ever had to talk to an aging relative about continuing to drive, or moving into supported living, or accepting more help at home. But this was fundamentally different. Biden’s aides weren’t debating taking away his keys. They were trying to put him back in the White House to lead the country for four more years.

That those internal debates were kept from the public and even from many of the higher-ups in the Democratic Party really has caused the public to lose trust in Democrats. Ambitious Democratic politicians seem to have clocked this, and they’re on a national mea culpa tour. Or, really, a they-a culpa tour: Even those who defended Biden’s health during the election are now telling the press that the party screwed up and should apologize.

They’re right about the screwup. But they’re missing the bigger picture. As the when-did-he-know theorizing about Biden’s diagnosis shows, Americans simply don’t trust that they’re getting the truth from Democrats. But here’s the thing: They also aren’t getting the truth from Republicans. And so what we need in this moment is less an intra-Democratic navel-gazing than a systemwide update.

Luke Winkie Read More

Early on in the Tapper and Thompson book, they tell the story of Rep. Kay Granger, the first Republican woman elected to the House from Texas, who in July 2024 “cast her last vote in Congress at 81-years-old and was then secretly placed in an assisted-living facility for patients with dementia,” the authors write. “She (or her family) continued to collect her congressional paycheck; her constituents were not officially informed, and members of Congress who knew about it kept quiet.” Sens. Strom Thurmond and Dianne Feinstein experienced cognitive decline toward the end of their tenures (Thurmond for roughly a decade). Various presidents have hidden illnesses while in office. “As the Cuban Missile Crisis unfolded, Kennedy was taking many drugs to manage his various ailments,” Tapper and Thompson write. “We still don’t know when Ronald Reagan’s Alzheimer’s truly began.”

We can interpret this in one of two ways: This is either a norm in Washington that will continue or a pervasive and bipartisan problem that needs fixing. Democrats should go with Option B—especially now that we have a notoriously dishonest man in office who is pushing 80, already displays what appears to be his own physical and cognitive decline, and is surrounded by diehard lackeys willing to shamelessly lie for him (not to mention his long history of exaggerating his own claims to health).

Of course Democrats need to reckon with what happened in 2024. But one of the lessons should be that presidents—all presidents, not just Democratic ones—must be open with the American people about their health. Given where we’ve landed, the only way to do that is by mandating transparency. That means health examinations by highly qualified and apolitical doctors or, as oncologist Ezekiel Emanuel recently suggested in the New York Times, a panel of doctors, not personal physicians who make unbelievable claims or, in Trump’s case, allow the patient to dictate the letter about their own health. Remember when Trump’s personal physician wrote in 2015, “If elected, Mr. Trump, I can state unequivocally, will be the healthiest individual ever elected to the presidency”? Or when Ronny Jackson, then Trump’s doctor and now a MAGA member of Congress, said he had “incredible genes” and not only was fit for his first term but could carry out a second? This is the kind of thing we expect from ridiculous dictators. We shouldn’t accept them from the American president.

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Our political institutions are in crisis. A big part of that crisis is because Trump is dismantling so many of them. But the crisis in trust can be laid at Democrats’ feet too. The solution isn’t simply for Democrats to agonize and apologize. It’s to make a series of real, permanent changes that apply across the board, to all presidents (and perhaps some rules that apply to members of Congress as well), regardless of party affiliation or personal preference.

Biden’s diagnosis is heartbreaking. The skeptical response to it is also—and is itself a diagnosis of the public’s cynicism. MAGA Republicans are invested in fueling that cynicism. Democrats must meet the moment by being the party to advocate that safeguards be put in place so that similar mistakes won’t happen in the future—and to emphasize that, for all the conservative criticism of Biden’s caginess about his health, Republicans are allowing Trump to engage in the same behavior and, again, to potentially deceive an American public that deserves, at a bare minimum, the most basic of health information about the world’s most powerful men.

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