To hear it told by political hacks, amateur flacks, campaign operatives, and media professionals, the concerns that have been raised around Pennsylvania Senate candidate John Fetterman’s cognitive faculties are simultaneously gross and irrelevant.

Even discussing Fetterman’s post-stroke auditory processing issues is “appalling”—akin to expressing hateful prejudice against the disabled. The notion that being unable to speak and process information—two items high on the list of senatorial duties—is prohibitive is like attacking “Tammy Duckworth or Madison Cawthorn” for “needing a wheelchair.” It’s an “intentional distraction” from the issues that really matter in this election cycle. And anyway, the Senate “has not actually been a deliberative body for decades.”

For the sin of landing an interview with Fetterman and relating her observations about the candidate’s impairments, NBC News reporter Dasha Burns has been the target of intense criticism from her own industry. In an interview, Fetterman’s wife even said the reporter should face “consequences” for her “ableism.” It’s unclear yet whether this dangerous assault on journalistic autonomy represents an attack on the very engine of American democracy.

The candidate’s condition, we’re told, may even be a net plus. “Fetterman has become even more familiar to voters,” Rebecca Traister’s New York Magazine profile of him read, “not because of his Everyman toughness but because of his struggles.” After all, swing voters “haven’t always listened to their doctors,” either.

In an age before the ever-present threat posed by mean tweets, all this frenetic activity would serve as an indication that Fetterman’s health issues aren’t a distraction at all. Indeed, the number of gaskets blowing simultaneously gives you some idea of the degree to which this issue has consumed Fetterman’s campaign at the worst possible moment. Panic is setting in, and the candidate’s campaign seems just as anxious.

In late September, Democrats began convening focus groups to assess just how relevant Fetterman’s faculties are to persuadable voters. According to the rosy picture Democrats painted for reporters, the candidate’s cognitive impairments are a sideshow. Not only do “persuadable voters believe Fetterman is fit to serve,” NBC News reported, they think he’s “getting sharper.” But not two weeks later, the Fetterman campaign produced a 30-second spot—short enough to suggest it will be backed by a significant ad buy—that addresses the issue head-on.

“After my stroke,” Fetterman opens, “I was just grateful to see Giselle and my kids.” In the soft-focus spot, Fetterman denounces “politicians” who “spend so much time fighting about the things that don’t matter.” What does matter, says Fetterman, is having the economic security to be able to spend time with loved ones because we never know how much time we have.

It’s a touching message, but it hardly allays concerns about Fetterman’s ailments. The point of an ad like this is to “hang a lantern” on the candidate’s negatives, thereby reframing the issue in more favorable terms. That’s a workable strategy, but it comes at the cost of conceding that the negative in question is a real and pressing concern for voters.

More ominously, from the perspective of Pennsylvania’s Democratic voters, is the prospect of President Joe Biden’s imminent return to the state.

As the midterm election season heads into the home stretch, the president will host a fundraiser in Pennsylvania alongside Fetterman. Biden hasn’t been seen with Fetterman in any capacity since September 5; indeed, the president hasn’t campaigned much at all of late. “Biden doesn’t appear eager to land Air Force One in states where he’s underwater in the polls, and incumbent Democratic senators are fighting to hang on,” Axios reported on Friday. “And he’s yet to headline any campaign rallies this month where he is in front of big audiences to make his closing argument.” Pennsylvania is just such a state where Biden’s presence could do more to harm than good for Democratic prospects.

September’s Franklin & Marshall Poll of the Keystone State showed that only 28 percent of Pennsylvania’s registered voters say the president is doing a “good” or “excellent” job. Seventy percent describe his performance in office as “fair” or “poor.” While that poll showed the race for Senate tightening significantly from August, Fetterman maintains a narrow lead over his Republican opponent. Moreover, the Fetterman campaign has outraised and continues to outspend Mehmet Oz, who has pumped at least $17 million of his own wealth into his campaign. The wisdom of the Fetterman camp’s decision to tether itself to the Democratic Party’s unpopular figurehead is questionable unless we assume that Democratic wallets are starting to tighten up as enthusiasm for the candidate wanes.

In head-to-head polling, Fetterman retains the lead he has consistently maintained since he secured the Democratic nomination. Oz has benefited recently from pollsters’ efforts to screen out unlikely voters and the Republican base “coming home” to their party’s flawed nominee. And yet, the Fetterman camp and its supporters are making a lot of sudden movements. These convulsions betray the fear that the new focus on the candidate’s impairments could overwhelm his campaign’s advantages. They’re right to worry.

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