Monday, September 7, 2015

Labor Day Thoughts – After Obama

In January 2017, 16 months from now, President Obama leaves office. What will his legacy be?

Who knows, it’s a long. long way from September 2015 to January 2017?

But here are a few educated guesses.

One, the U.S. will have a national debt of roughly $21 trillion, and from now until then, President Obama will be spending billions more on programs - free community colleges, across the board minimal wages, guaranteed sick and pregnancy leaves, solar and wind projects, EPA control of carbon emissions - to support his progressive agenda.

Two, the refugee crisis in Europe will continue to metastasize and spread. Germany will accept up to 2 million refugees (800,000 in 2015 alone) because its economy needs workers. Other European nations , Britain, and Sweden and the U.S. will partially fill the refugee gap by agreeing to take in a modicum of Middle Eastern and North Africans. But the rich Gulf Middle Eastern nations, such as Saudi Arabia and Qatar, will likely sit on their hands and accept no refugees.

Three, the dispute over the wisdom and consequences of the Iran deal will boil over, as two-thirds majorities in the U.S. House and Senate vote against the deal and 60% of the American people oppose it. Nevertheless, the deal will be implemented, largely unread by those in Congress who voted for it. President Obama and Secretary Kerry will argue no alternative to war exists , and opposing Middle Eastern states, Israel and others, will begin to prepare for war, or to build nuclear weapons, if they do not have them already, because of their belief the deal will expedite development in an Iran nuclear bomb.

There are no easy options here, as Richard Fontaine, 40, president of the Center for New American Security in Washington explained, “In Iraq we toppled the government and did an occupation and everything went to hell. In Libya, we didn’t topple the government and didn’t do an occupation and everything went to hell. In Syria, we didn’t topple the government and didn’t do an occupation and everything went to hell. This is the Middle East. Things go to hell.”

Four, a contentious U.S. Presidential campaign may result in a conservative Republican President, or left-wing Democrat. On the GOP side, victory will hinge on turn-out of the conservative base or of the “great silent majority,” a term coined by President Richard Nixon. Many in this majority have not voted before. But this time around they may. They say they are mad as hell, and they are not going to take it anymore. They are convinced straight talk, action, built-up of the military, and destruction of ISIS are needed. On the Democratic side, victory will depend on turn-out of the millenials, the minorities (black and Hispanics), and the literal elites in the media and academia. On both sides, the state of the economy will be decisive – if it booms, Democrats win; if it withers, Republicans triumph.

Five, the path to a more prosperous and productive economy may reside in the progress of data-driven innovators who believe algorithms and artificial intelligence will triumph over all and somehow the solutions lie in metrics and computer multi- angulation . Some believe there are limits to data-analysis of outcomes, and personal anecdotes and narrative storytelling are more humane and revealing.

Six, which brings me to health care. What lies beyond the Obama horizon? I believe ObamaCare will survive, but in a more limited form. The individual and employer mandates may go because of public and business opposition, but the provision prohibiting exclusion of people with chronic disease from health plans will survive. Republicans, if elected in overwhelming numbers, may repeal or replace ObamaCare but only if they provide coverage for those now subsidized by the ACA. Premiums and deductibles will rise significantly, and access to doctors and hospital networks and medical procedures and diagnostic tests, will shrink dramactically. More doctors will refuse to accept Medicare, Medicaid, and health exchange patients, and more doctors will enter concierge and direct –cash ambulatory practices, and will form doctor-owned and directed surgical, diagnostic, and urgent care centers focusing on convenience and patient satisfaction. The VA crisis, triggered by such news that 300,000 veterans have died while waiting, will intensify. A multi-headed fragmented health system, one private and governmental, one emphasizing guaranteed access the other choice, one stressing metric measurement of outcomes as the condition for entry the other confidentially and privacy as equally desirable, will emerge.

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