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OPINION | PHILLIP M. MCMATH AND PHAM LIEM: Questioning the president's cognition

by PHILLIP M. MCMATH AND PHAM LIEM | Today at 2:18 a.m.

On Jan. 12, 1950, Dean Acheson, Secretary of State in the administration of President Truman, gave a speech to the National Press Club. In it he outlined the "defensive perimeter" of the United States and her Asian allies as running through Japan, the Philippines, and the Ryukyu Islands.

This excluded the Republic of South Korea, where the reaction was one of shock and panic. Six months later, marching through Acheson's "green light," Communist North Korea crossed the 38th parallel and attacked the South.

When in October Communist China, supported by the Soviet Union, entered the war, the world barely averted a nuclear catastrophe. In July 1953 the conflict staggered to a stalemate, but nearly 40,000 Americans died, while over a million Korean and Chinese soldiers perished along with at least two million civilians.

As expected, Acheson and his defenders insisted he was misunderstood. Perhaps so, but that misunderstanding had grave consequences.

On Oct. 21, 2021, at a CNN-sponsored town hall, President Biden was asked by Anderson Cooper whether the U.S. would come to Taiwan's defense if attacked by Communist China. He responded, "Yes, we have a commitment to do that."

That was not--nor ever has been--American policy. Had Biden just announced a more forceful commitment to defend Taiwan? An alarmed White House immediately executed a walk-back. What was meant, you understand, is that while the Taiwan Relations Act (enacted in 1979) obligates the U.S. to assist Taiwan in case of an attack, it does not mandate a NATO-type commitment to go to war with China.

Instead, our long-standing policy has been and remains one of "strategic ambiguity." But ambiguities are treacherous and can become more so when one tampers with their vagueness. So the hurried walk-back inadvertently created even greater uncertainty by implying that the U.S. might not defend Taiwan at all. Thus, with a few careless words, the Biden fumble had morphed our Taiwan/China policy into a dangerous muddle.

Equally alarming was the obvious fact that on such a critical point of peace and war the U.S. president did not know his country's defense policy. Had he not mastered an understanding of the Taiwan Relations Act during his eight years as vice president?

Biden has had a four-decade involvement with China. He has traveled there multiple times. He has known President Xi for over a decade and met with him on several occasions. Did he not grasp how the U.S. defense posture regarding Taiwan was distinguishable from the NATO assurance that an attack on thee is an attack on me? Had he not been refreshed about this distinction as our new president? Was it not anticipated that he would have to articulate this sensitive matter clearly and cogently while the world hung upon his every word?

Wasn't foreign policy advertised as one of his strong points and his primary responsibility as commander-in-chief of America and leader of the free world?

Everyone agrees that the China threat requires a new and sophisticated strategy. The pressing question: Can this strategy be constructed successfully with this president conjoined as he is with a defense establishment that engineered the Afghanistan disaster?

Concerning Afghanistan, George Stephanopoulos of ABC News on Aug. 18 asked Biden:

Stephanopoulos: "So no one told ... your military advisers did not tell you, 'No, we should just keep 2,500 troops. It's been a stable situation for the last several years. We can do that. We can continue to do that'?"

Biden: "No. No one said that to me that I can recall."

However, as all the world knows, his military advisers contradicted him. The Joint Chiefs' recommendation would not have been offered in a casual chat over lunch. A formal and detailed plan devised by the Pentagon in coordination with the National Security Council would have been prepared for the president's approval. Anything less would be inconceivable.

President Biden will be 79 this month, the oldest president in our history. If he finishes his term, he'll be 82. In gerontology, people are classified by age groups: 65-75 is Young Old, mostly functional, but 75-85 is Old Old, and up to half in this latter group will have serious functional and mental impairment, frequently in the form of increasing dementia.

In 1988, Biden suffered intracerebral bleeding that required surgery for two aneurysms, the first in February and the second in May. He has since developed a heart rhythm abnormality known as atrial fibrillation that increases his risk of stroke and may be a precursor to further cardiac failure. For this reason he may be taking blood thinner medication, which puts him in a double bind because it would predispose him to another cerebral hemorrhage.

Moreover, patients with dementia can sometimes develop a sudden and dramatic mental incompetence amounting to a break with reality. Biden at times seems to appear disoriented. Recently in an interview with a friendly CNN reporter he went into a bizarre 15-second trance in which he was unable to function.

He seemed paralyzed. No explanation has been forthcoming. But it is clear to everyone that Biden has frequent memory lapses and an inability to complete simple sentences or communicate thoughts in a logical or coherent manner.

His mental lapses are almost too numerous to catalog. Here are a few examples that are hard to dismiss as being merely ill-informed:

During the campaign he said, "I think we can win back the House," when the Democrats already controlled it.

In a televised interview he was disoriented by a question and lamented, "What am I doing here?"

Trying to make a speech, he couldn't remember the words to the Declaration of Independence, which he had intended to quote. "You know the thing," he said by way of lame extrication.
He once announced he was running for the Senate when he was running for president, frequently could not remember people's names or their offices in prepared speeches, even when he had notes, couldn't remember the name of his secretary of defense, and said that when he was in Walter Reed Hospital the nurses "would breathe in my nostrils to make me move."

Previously he declared that President Franklin Roosevelt went on television in 1929 to assure Americans about the stock market crash. Roosevelt was not president then, and there was no television.

He couldn't remember if the U.S. had informed the French about the abrogation of their nuclear submarine contract with Australia. The outraged French withdrew their ambassador. Biden later confessed he was confused and "clumsy."

In another CNN interview he stumbled out:

"Um, you know there's a, uh, during World War II, uh you know, where Roosevelt came up with a thing, that uh, you know, was totally different, than a, than the, he called it, you know, the World War II, he had the War Production Board."

Churchillian this is not. Such befuddlement in the nation's chief executive can create a crisis where none need exist. Events in Taiwan may yet prove the point.

The American people deserve to know if the president of the United States is mentally competent. He should be administered CognICA, the FDA-approved five-minute screening test designed to provide an accurate measure of cognitive function. His medical records should be released in full. If the results are satisfactory, he should be re-evaluated until he leaves office. The day may come when this aging president might have to resign.

When Biden said he did not recall what was recommended about Afghanistan, it may be he was telling the truth. And when he misstated U.S. policy on Taiwan, he knew it once, but could no longer remember.

Phillip H. McMath is a lawyer, Vietnam veteran, and writer who lives in Little Rock. Pham Liem, M.D, is retired as Jackson T. Stephens Professor of Geriatrics at UAMS and Associate Chief of Staff for Geriatrics and Extended Care at the Central Arkansas Veteran Health System in Little Rock.