Should the Senate minority leader step down?

I’m Isaac Saul, and this is Tangle: an independent, nonpartisan, subscriber-supported politics newsletter that summarizes the best arguments from across the political spectrum on the news of the day — then “my take.”

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Today's read: 12 minutes.

Today, we're breaking down Mitch McConnell's health episodes. Plus, a question about Big Pharma, a correction, and a major milestone.

One million plays!

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Yesterday, we somehow referred to Bill Richardson as the former "governor of Mexico," rather than the former “governor of New Mexico." How the word "New" got deleted in our newsletter remains a mystery to our entire editorial team, and as much as we want to, we can't ignore the error.

This is the 91st correction in Tangle's 216-week history and our first since August 30th. We track corrections and place them at the top of the newsletter in an effort to maximize transparency with readers.

Quick hits.

  1. Former Proud Boys leader Enrique Tarrio was sentenced to 22 years in prison after being convicted of seditious conspiracy. It was the longest sentence yet for anyone charged in the January 6 Capitol riots. Four other Proud Boys members received sentences last week ranging from 10 to 18 years. (The sentence)
  2. A federal court struck down the latest congressional map from Alabama Republicans after it failed to comply with a Supreme Court order to increase the voting power of black residents. (The decision)
  3. President Biden announced former Treasury Secretary Jack Lew will serve as U.S. ambassador to Israel. (The nomination)
  4. A trial began yesterday for two organizers of last year's mass trucker protest in Canada who are being charged with mischief and obstructing police. (The trial)
  5. 61 people were indicted in Georgia on racketeering charges after their involvement in an effort to stop the construction of an Atlanta-area police training facility. (The indictment)

Today's topic.

Mitch McConnell. Senate Minority Leader Mitch McConnell (R-KY) froze last week for more than 30 seconds while fielding questions from reporters about potentially running for re-election, the second time he’s had such an episode this summer. In July, the 81-year-old McConnell froze in front of reporters for roughly 20 seconds before being escorted away by his staff. McConnell's aides have blamed the episodes on dehydration and lightheadedness, respectively.

During this past week’s press conference, an aide approached McConnell after he froze, asking if he heard the question, then asking reporters for a brief pause when McConnell remained unresponsive. Once McConnell re-engaged, he responded briefly to another question, which an aide needed to repeat to him moments later.

"Leader McConnell felt momentarily lightheaded and paused during his press conference today," a spokesperson said.

On Tuesday, after ordering diagnostic MRI brain imaging, the Capitol physician Brian Monahan released a statement saying there was "no evidence" of a "seizure disorder or stroke, TIA or movement disorder such as Parkinson's disease" as the cause of McConnell's episodes. There were "no changes recommended in treatment protocols," either, and no explanation of what may have caused the episodes. McConnell, a polio survivor, has been recovering from a concussion he sustained in a fall in March that caused him to miss work for several weeks.

"Occasional lightheadedness is not uncommon in concussion recovery and can also be expected as a result of dehydration," Monahan wrote.

McConnell, one of the most noteworthy senators in American history, is the latest high-profile politician to face questions about their health or age. We have previously covered Dianne Feinstein's (D-CA) cognitive issues and her bout with shingles, whether President Joe Biden is too old to run again, and the impact of John Fetterman's (D-PA) stroke and treatment for depression on his ability to serve.

Today, we're going to examine the questions about McConnell's health episodes and whether he should step down, with views from the right and left, then my take.

What the left is saying.

  • The left mostly thinks McConnell’s health incidents reveal he’s no longer fit to serve as a leader in the Senate. 
  • Some worry that if he steps down, the most radical faction of the GOP will seize control of the party and sow discord in the Senate.  
  • Others say the response to McConnell’s health incidents highlights the flaws in our discourse on aging. 

In New York Magazine, Ed Kilgore warned the Senate “could get very scary” if McConnell retires.

“Let’s say McConnell gives up the gig in the current Congress. He would be succeeded as minority leader by one of the ‘three Johns’: Cornyn, Thune, or Barrasso,” Kilgore said. Although these three “are capable of keeping the money machine McConnell helped build for Republican Senate candidates humming through another election cycle… it’s unclear that any likely McConnell successor will have the influence and authority to keep Senate Republicans together if the 2024 presidential election devolves into another contested result surrounded by threats of violence.

“The one thing we know for sure is that the Republican Party that lifted Mitch McConnell to power is gone for good, and with it, more likely than not, the prospect of any Senate leader who can square so many circles and embody so many contradictions as this self-described heir to the great Kentucky schemer Henry Clay,” Kilgore said. “In his absence, the odds are high that the Senate GOP will become as fractious and irresponsible as its counterparts in the House. And no matter who holds the balance of power, that’s not good for democracy and stable governance.”

In MSNBC, Hayes Brown said McConnell is “not OK.”

Even though McConnell’s decision to not take time off after the latest freezing incident “was meant to be a sign of strength… his refusal to address the issue has brought attention to how difficult it is for Americans to talk openly about aging and the effects it can have.” American society “fears aging,” Brown said. “It is a culture that works overtime to stave off death, even while having one of the lowest life expectancies in the world compared to the amount spent on health care every year. It is considered taboo to bring up age in a variety of contexts, including whether or not someone is still hardy enough for the rigors of public service after more than eight decades on the planet.”

That said, “there is clearly something wrong with McConnell,” Brown added, “even if it’s lack of sleep or a reaction to a new medication or something else that’s easily treatable. But if he doesn’t disclose what a doctor finds, if a doctor finds something, then we’ll still be left in the dark about one of the country’s most powerful people.” It remains to be seen what the right course of action should be, but McConnell “needs to publicly confront what’s happening right now.”

In the Los Angeles Times, LZ Granderson argued that McConnell should only step away from his Senate role based on “his capacity to do the job” and not his age.

“A number of health issues can come with age, but aging in and of itself doesn’t have to come with health issues,” Granderson said. “Cognitive and physical decline is a natural progression of life, this much is true. It is also true that the pace of decline is not universal. It isn’t tied to a designated number like an exit off the 405.” The issue with dismissing someone like McConnell as too old “is that it sounds factual when really it’s quite subjective… Even in our families, age means different things. One elderly relative may not be able to drive anymore, but another can travel solo.

“If McConnell takes a break from the Senate or steps down, it won’t be because of age alone,” Granderson wrote. “The median age of U.S. senators, now at 65 years, is older than it was two years ago. The two White House front-runners — Biden and Donald Trump — are from the Silent Generation. That may be a lot of wrinkles. But it’s also a lot of wisdom and applicable lived experience — in theory, anyway. The casual ageism in our critique of elected officials also feels counterproductive in a society that is getting older as a whole.”

What the right is saying.

  • The right is mixed on the question of whether McConnell should retire from the Senate, though many say he should at least step down from his leadership role.
  • Some call out a double standard for how the media frames the health issues of politicians from different parties. 
  • Others say McConnell needs to be more transparent about his health. 

National Review’s editors said McConnell “needs to step aside.”

While McConnell is “truly a legend of the U.S. Senate” and “one of the most effective leaders in memory,” the time has come for him to “make the decision to step aside from leadership.” McConnell has “noticeably aged since his bad fall in March, when he sustained a concussion and broken rib, and he should want, for his own sake and that of his colleagues, to go out on his own terms. The details can be left to McConnell, who deserves a large measure of deference. A leadership transition doesn’t need to happen urgently, but the wheels should be turning.

“The time will come for a fuller appreciation of McConnell’s legacy,” the editors added. “But his strenuous opposition to campaign-finance reform, effective resistance to the Obama agenda, stalwart refusal to fill the Scalia seat prior to the 2016 election, fruitful cooperation with President Trump on judges, and, lately, strong support for American leadership abroad when the winds in the party are blowing the opposite way easily make him one of the most consequential politicians of our era. Prudence and realism have been hallmarks of his leadership and now are called for in considering his own future.”

The Wall Street Journal editorial board defended McConnell and called out the “Beltway double standard on the health of public officials.”

“You can tell who’s loved and hated in Washington by the way they’re treated when they have a health issue,” the board said. “President Biden stumbles through his first term, and is tripping toward another, with nary a notice from the Democratic-media complex about his obvious physical and mental decline.” But McConnell “freezes up twice in five weeks before the cameras and he’s supposed to resign forthwith… Washington’s double standard on the health of politicians is also something to behold.”

Even as Biden “stumbles repeatedly, blurts out inanities and non sequiturs, and sometimes doesn’t seem to know where he is on stage,” Democrats argue “everyone is supposed to ignore [his] infirmities.” It’s true that “too many people cling to power for too long in Washington. But Senate leaders are chosen by their party colleagues, who are in the best position to judge Mr. McConnell’s continuing abilities,” the board added. “If they think Mr. McConnell can still be an effective leader of an increasingly fractious GOP Senate conference, then he should stay in the job.”

In the Washington Post, Jim Geraghty said McConnell “needs to tell the whole truth about his health” and “choose a policy of maximum disclosure.”

“While it would be preferable to believe that this episode was just a matter of dehydration or some minor issue that will go away quickly, it would be easier to believe that assessment if it came from a medical professional whose way of making a living did not depend on McConnell staying in office,” Geraghty wrote. When Ronald Reagan was president in his 70s, his administration recognized that his age “would generate legitimate concerns about his health and ability to perform the duties of his office.” They concluded “the right response was to give voters an excruciating amount of information about his health..”

Today, the contrast is “is stark and unflattering.” Political leaders can “spin a lot of things, but the state of a politician’s health can be hidden from the public only for so long. I realize no politician wants to leave office because of health problems. But they’re not in those jobs to make themselves feel good and important in old age; they’re in those jobs to serve the public.” As such, “the absolute minimum they can do is provide the public with full and unvarnished information — no minimizing, no begrudging the legitimacy of these questions — about their health.”

My take.

  • We need to do something about the rapidly aging Congress, because too many members seem unfit to serve.
  • I have no idea what McConnell’s condition is — which is a problem.
  • Ultimately, term limits are looking more appealing than ever. 

Well, I wasn't expecting to cover this in the newsletter, since I've already let a lot of my emotions out on our YouTube channel. But the recent statements from McConnell's office, the Capitol physician, and a slew of commentary from the right and left have forced my hand.

First: Whatever this is, it isn't "dehydration" and "lightheadedness." I was out at a bar last night with a few friends when the topic of McConnell "freezing" came up, and it was funny hearing all the normies who loosely pay attention to politics talk about it. When I was asked (and shared) the explanation from McConnell's team, there was a literal outburst of laughter — scoffing at the absurdity of the explanation. It was like a good punchline. Which, to me, is the right response. To anyone not mired in this stuff, the idea that this is just an older man who forgot to drink enough water is absurd on its face.

But you know what is so frustrating here? We don't know. And maybe McConnell doesn't, either. I texted a family member who is both a political junkie and a neurologist about the episodes, and he speculated that if McConnell is experiencing TIA (effectively "mini strokes"), his doctors would be a lot more cautious with him and he probably wouldn't be working. He suggested maybe the fall McConnell took earlier this year initiated some kind of epilepsy. That’s pure speculation, of course, and neither of us have an informed idea. But in his letter, the Capitol physician explicitly went out of his way to exclude TIA and epilepsy, so my cousin was at least above the target.

Speaking of the Capitol physician, there are few doctors who are as vulnerable to conflict of interest as those who serve in that position. As Jim Geraghty said (under “What the right is saying”), it would be easier to believe the assessment "if it came from a medical professional whose way of making a living did not depend on McConnell staying in office." I don't put much stock in the Capitol physician's public letter, which reads more like a public relations bit than a diagnosis. So, like everyone else, I'm left with pure conjecture.

Here's what isn't conjecture, though: This is uncharted territory. Before the year 2000, the average age of the Senate was never over 60, but it has been ever since. Today, the average age is 64 years old. More noticeably, the percentage of Senators over 70 has risen from just over 5% in the year 2000, to 15% in 2010, to nearly 25% this year. Only 10% of the Senate is under the age of 50, and only two — J.D. Vance (R-OH) and Jon Ossoff (D-GA) — are under 40. As I've said over and over again, age is not the issue here. Fitness is. But the higher the percentage of our senators who are elderly, the higher the likelihood that some won't be fit to serve anymore. And we are seeing that play out in real time, right before our eyes.

Perhaps a little bit of this increased average age can be attributed to life expectancy going up, but that impact should be marginal. Life expectancy in the U.S. in 2000 was 76 years old; today it is 79. The real reason for the increased average age is that being a member of Congress has become a lifelong career, rather than a momentary chapter in one’s life. Politicians are increasingly working in Congress until retirement (or until health and age issues force them out). For their part, maybe this is rational. McConnell makes $193,400 per year and has great health care. He and his wife Elaine Chao own three homes and have a combined net worth of $30 million. He's a conservative hero and now the longest serving leader in party history. The job is cushy, the money is good, and the accolades are real. Things have worked out for him.

But this cannot go on.

We can't have people who are in charge of solving our immigration crisis or exorbitantly expensive health care or the runaway debt who can't even answer questions from reporters. We can't have questions of war and peace — literal life and death — being solved by 81-year-olds with mysterious, unexplainable health conditions that randomly cause them to be unable to speak, hear, or move. Or, in the case of people like Feinstein, we can't have members of Congress voting on bills when they don't know they're there for a vote. None of this is acceptable.

The obvious answer supported by 83% of Americans (including 80% of Democrats and 86% of Republicans) is term limits. There are great arguments for term limits, but I've personally been torn on the idea. I don't like removing choice from voters — if they have a representative they love and want to keep putting them into office, they should be able to do that. And I don't like the idea of a constant cycle of rookie politicians in Congress — they need time to learn the ropes and the system. 

But over the last few years, my position has evolved and become more ardently pro-term limits. I no longer see these potential threats or even the very real harms outweighing what we have now. Gerrymandering and closed primaries already remove so much choice from voters, making the power of incumbency way too strong to rely solely on voting to remove members of Congress who are unfit — especially when they have six-year terms. And while rookie politicians bring inexperience, they can also inject fresh energy into our aging Congress and create a younger, more representative body.

Of course, the best case scenario would be if members of Congress stepped down on their own — if the culture of Congress were one where people served a few terms admirably and then left. But Congress doesn't have that culture, and we don't have those members, so it's time to do something new. As long as he refuses to step down, Americans are right to view McConnell as the latest in a long list of reasons why we need reform — and term limits are as good an option as any.

Your questions, answered.

Q: Recognizing that PBMs [Pharmacy Benefit Managers] have a big influence on our drug prices...that aside, do you think the U.S. is paying the biggest portion of pharmaceutical R&D through our exorbitant drug prices, compared to other countries?

— Art from Cedar Park, Texas

Tangle: In response to our edition on Medicare drug price negotiations, a reader wrote in with their take on this very question. “[Asthma medication] costs $375 - $750 depending on the insurance company in the US. That same asthma medicine by the same manufacturer costs $100 in Canada and $25 in Indonesia. American consumers are subsidizing the healthcare of the world,” they wrote.

After I read this, I did two things. First, I looked into these claims, and found that they were generally true. Back in 2015, the Seattle Times published a Q&A where one of their readers asked why the asthma medication Advair that cost them $857 was available for $134 in Canada. What was their answer? Unlike in Canada, our government is unable to negotiate drug prices. This made me a little more convinced that Medicare negotiation is a step in the right direction, and that maybe we are subsidizing R&D — and by extension the world’s medication — with the exorbitant drug prices we pay here.

Second, I thought of Trump.

Military and healthcare are the two biggest expenses in the federal budget. And much as Trump won support for pushing allies to foot the bill for military commitments, Biden could take the position that the United States is subsidizing the world's health care. Not by funding innovation, but by subsidizing profits for Big Pharma. After all, it’s Americans who also pay the price for the research and development that leads to so many successful, globally used drugs.

A lot of critics of the Medicare drug negotiation have argued that decreasing profits for Big Pharma will hurt innovation, but I just don’t buy it. I’ll ask — in what other industry does the country that’s home to innovation centers get hit with the highest costs in that industry? I liked the argument we quoted from Howard Gleckman in Forbes, that Big Pharma doesn’t do that much cutting-edge research, but instead acquires smaller research companies and markets and manufactures their drugs. 

You mentioned PBMs (pharmacy benefit managers) are a big reason for our high costs, because they’re unnecessary and expensive middlemen. And you know what else sound like middlemen? Companies that market and manufacture work done elsewhere. And when you tell the middleman to charge you less, they won’t cut off their revenue source — they’ll just charge other people more.

Want to have a question answered in the newsletter? You can reply to this email (it goes straight to my inbox) or fill out this form.

Under the radar.

Two solutions to our situation on the border appear to be failing. First, tensions between the Biden administration and local Democrats are coming to a head as shelters around the country overflow with thousands of migrants being bussed into major cities. In New York, Boston, and Chicago, a humanitarian crisis is unfolding as migrants are being bussed in without enough resources to handle them. At the same time, the $1 million "floating border wall" Texas officials placed in the Rio Grande has not slowed down migrants crossing the river. Instead, migrants have simply circumvented the 1,000-foot-long barrier to wade into the U.S. Axios has the story on the blue state migrant crisis, and The Wall Street Journal has the story on the floating border wall


  • 8.5. The average years of service for representatives elected to the 118th House.
  • 11.2. The average years of service for senators elected to the 118th Senate.
  • 2.5. The average years of service for incoming representatives in the 1800s.
  • 4.8. The average years of service for incoming senators in the 1800s.
  • 22. The number of terms served in the House by Reps. Hal Rogers (R-KY), Steny Hoyer (D-MD), and Christopher Smith (R-NJ).
  • 1937. The year Rogers was born.
  • 90. The age of Dianne Feinstein (D-CA), the oldest member of Congress.

The extras.

  • One year ago today we were still on break, so our most recent newsletter was still our edition on nuclear energy.
  • The most clicked link in yesterday's newsletter was America's most polarizing foods.
  • Strong labor: 437 Tangle readers answered our poll asking about the state of labor in the United States right now, with 45% saying it is 'relatively strong.' 7% answered 'very strong,' 21% said 'neither strong nor weak,' 19% said 'relatively weak,' and 4% said 'weak.' "Strong for the already privileged. Weak for those who need it the most," one respondent added.
  • Nothing to do with politics: A Delta airlines flight was grounded because of a passenger's diarrhea.  
  • Take the poll. Do you think our aging Congress is a problem? If so, what's the solution? Let us know!

Have a nice day.

After returning from a family vacation on the Big Island of Hawaii, Ami Juel and her husband were watching the devastation of the Lahaina fires on television when their five-year-old son, Edison, asked them to turn it off because it was too sad. After they explained what happened and why Maui was on the news, Edison wanted to help and suggested setting up a lemonade stand, which the Juels supported. The lemonade stand opened last Saturday on a busy Seattle street, where the response was far beyond what they imagined. “Most people were like, ‘this is so cool. What a great idea. We’ve been looking for ways to help. We felt so helpless and didn’t know where to donate,'” Ami said. After a week’s worth of sales, Ami and Edison had $17,000 to send to Lahaina. Good News Network has the story.

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Isaac Saul
I'm a politics reporter who grew up in Bucks County, PA — one of the most politically divided counties in America. I'm trying to fix the way we consume political news.