The Meaning of President Trump
By Nayyer Ali MD
So what does Trump mean for the next four years? He is not elected dictator. He has a short attention span and famously does not like to read. I find it unlikely he will be a “hands-on” President, and will basically delegate most of the decision making to his cabinet and to Congress.
Trump, in terms of campaign platform, offered almost no specifics. He did suggest a massive tax cut for the wealthy, but he also railed against the national debt, so hard to see how he can try to reduce the latter while doing the former. The idea of a wall on the border is a joke that no one takes seriously, except perhaps a few of his more gullible supporters. He wants to “vet” immigrants, apparently Muslims, to keep out terror. The country already does that, so one is not sure what he means. The terror attacks of the last two years were not done by immigrants, but rather by their children. Vetting would not have helped.
One of the biggest items on the Republican agenda will be to repeal the ACA (Obamacare). The law has been very successful, coming in below cost, and cutting national uninsured rate to under 9%. A third of those are undocumented, so the real number is under 6%, and if the Republican states had expanded Medicaid as the law intended, that rate would be under 5%, or pretty close to universal health insurance.
Over 20 million people now have insurance because of the ACA, and its central provision, that insurance companies cannot deny coverage for pre-existing conditions, is very popular with the American people, even if the law as a whole is not. But to get rid of the pre-existing condition rule, the ACA needed to construct all of its other elements, including requiring people to jump in the pool and purchase insurance as long as they can afford it (with subsidies as needed).
To undo Obamacare, the Republicans could just repeal the whole thing, toss 20 million people back into uninsured status, and make the rest of America fearful that a job loss means the loss of health insurance. They may well do that, as most of the people who got insurance through the ACA were not Republican voters, in fact many of them don’t vote at all. Up to now, they have just said that they want to repeal Obamacare and replace it with something else, but have never put that something else on the table. They will soon have to. Already Trump has made statements that he wants to “amend” Obamacare, and that key provisions needed to be kept.
The Supreme Court will now stay conservative, as it has been for 40 years. The main consequences will be that voter suppression laws will be upheld around the country, and it is possible that the right to an abortion will be struck down. If that happens, abortion will not be illegal in the US, but it will be up to each state. What this means is that in Blue states not much will change, but in Red states, women who are too poor to travel to a nearby Blue state and pay for an abortion will be forced to carry the baby to term. Another action that we can expect from the Court is they will finally declare all forms of affirmative action to be illegal.
In terms of domestic policy, the two main outcomes of Trump is that there will be large tax cuts for the richest Americans, and sharp reductions in the safety net programs like Food Stamps, Welfare, student college aid, and Medicaid. Many poor people will lose health insurance, even more if Obamacare is severely curtailed. The critical question is how Trump is going to balance his desires to cut taxes and his history of criticizing Obama for running up the national debt, which will happen in spades if major tax cuts are put in place. During the campaign Trump also declared his support for a 500-billion dollar infrastructure investment. Will he just borrow the money for this? And how will he get Republicans to pass a proposal that looks awfully like the jobs plan Obama tried to get passed in 2011?
In terms of foreign policy, it’s hard to say. Trump spoke of getting our allies to “pay up” for the cost of protecting them. What will that mean in practice? Is NATO going to be a protection racket now, with Trump sending his son around Europe to collect fat envelopes of cash? Is he implying the US will withdraw from NATO if the Europeans don’t increase their defense spending? Hard to say what he means by these ideas. It may amount to a whole lot of nothing.
Trump made much of how stupid the Iraq War was, but also criticized Obama for leaving Iraq and thereby, in Trump’s view, allowed ISIS to grab control in Sunni parts of Iraq. It looks now like the Iraqis are slowly closing in on defeating ISIS in Iraq, with US help, but ISIS in Syria remains a potent force. What will Trump do about Syria? Will he intervene? Will his romance with Putin mean that he will accept an Assad victory as the price of defeating ISIS? And what will he do with the Turks and Saudis, who have pushed and supported the Syrian rebels for five years?
For Israel and the Palestinians, the situation will remain in stasis. Trump has no interest in the minutiae of the conflict, and for the Palestinians, their 50 years of occupation by Israel will go on without foreseeable end. With Iran, there is also the question of the nuclear deal. This deal keeps Iran from building a nuclear weapon for the next 10-15 years, when they were within 12 months of building a bomb. If Trump were to tear up the agreement, it is likely Iran would plunge full speed ahead with building a bomb, and create a crisis for the Trump administration. To tear up the deal, that was negotiated between Iran and the six major world powers, would mean the US would be going it alone. The other five countries will not re-impose sanctions on Iran, and without those the US will have no leverage to force Iran into making a better deal.
As for Pakistan and Afghanistan, expect little change. Trump blamed Obama’s premature complete withdrawal from Iraq in 2011 for allowing the rise of ISIS in Iraq. As such, I doubt he will pull out of Afghanistan; instead, he will keep a significant US presence, guaranteeing that the Taliban will not be able to seize power for the next four years. Pakistan should finally come to terms with the reality that supporting the Afghan Taliban is a dead end.
Finally, we come to the trade policy. In Trump’s world view the decline of US manufacturing jobs was due to bad trade deals that allowed jobs to be moved to China and Mexico in particular (he doesn’t complain about jobs being shipped to Germany or Canada for example). In reality, most of the decline in manufacturing jobs was due to automation, factories now need 300 workers instead of 3000. Will he impose import quotas and tariffs on China and Mexico? His supporters are expecting some kind of drastic action. A trade war with China and Mexico, where those countries respond with tariffs on US goods, will beggar both sides, and end up costing jobs. But for him to do nothing on this issue is not likely, given how much he spoke about it.
On global warming, Trump will try to undo much of what Obama has committed us to. In particular, the Paris Climate Accord, which was critical because it brought China and India into a deal to cut emissions. However, intense international and domestic pressure could possibly push Trump into “renegotiating” the Paris Accords to somewhat laxer standards, but keep the US on board. In addition, there are several secular trends that will create progress. US gas mileage standards are locked in to rise to 54 mpg by 2025. The rollout of more and more electric cars appears to be a given, and solar and wind power is getting close to the point of being cheaper than fossil fuels. The issues of how to run a grid with renewables that don’t generate power when the wind is minimal or the solar panels that do nothing at night is still a complex problem. But a Trump presidency is just a 4 or maybe 8-year delay in aggressive action on global warming, and the problem itself is going to be solved over 40-60 years. So, the issue is not final based on the next four years.
I’ve lived through 12 Presidential elections, and this was the only one where I thought one of the candidates was just unhinged. But this country has been around for 240 years, and it has survived some pretty awful Presidents. This election was not in the backdrop of the Civil War like 1860, or the Great Depression like 1932, or civil rights upheaval of 1964. The country is reasonably prosperous and peaceful. The stakes in this election were not that high. There is no domestic issue that is of burning importance and very divisive, except for perhaps what to do with 11 million undocumented that live here. The country will get through the next four years. It may do some pretty dumb things, but for people who are prosperous, educated, and live in Blue states, life will not change much, if at all. Those that will be hurt by the Republicans and Trump are the weakest in society. And despite his bluster and lack of basic knowledge, he will hopefully not get the country into another full-scale war.
In the long run, every action creates its reaction, and Trump is a reaction to the cultural, economic, and political changes that have buffeted America in the last 30 years. But there will be a reaction to Trump. As he fails to keep his promises, and as poor Whites who voted for him see that he is not making their lives better, the Republicans will pay a price in a future election. The pendulum will swing.
What keeps me deeply optimistic is that also in the long run, the liberals always win. If you go back through American history, as far as 200 years, you can see the country has been divided between liberals and conservatives. The Republican Party originally was a deeply liberal party organized to oppose slavery. In the 1830’s liberals opposed slavery while conservatives were fine with it, in the end slavery was gone and even conservatives agreed that was the right thing. In the early 20th century, Progressives wanted an end to child labor, a national income tax, break up the monopolies of industry that had been created, create an FDA to protect people from fake medicines, give women the right to vote, etc. These were all opposed by conservatives at the time, they eventually came to accept them. In the 1930’s we got the New Deal and Social Security, a program that liberals wanted and that present-day conservatives accept. In the 1960’s came civil rights, women’s rights, immigration reform, student loan aid, and Medicare. The environmental movement created the Endangered Species Act and the EPA. All were opposed by conservatives, and now they are accepted by conservatives.
Liberals always want to fix society’s problems, and think big and want big changes. Conservatives always resist, but in the end the liberals win, and the conservatives accept, and the next generation repeats the pattern but with a new set of issues.
Obama made the country a much better place. Trump and the Republicans can reverse some of what he did, but not all, and there will be another time with a Democratic President and Congress to move the ball forward again.