Bill Bumgarner is a retired former health care executive from northwest Iowa who worked
in hospital management for 41 years, predominantly in the state of Iowa.

The American people have decided to entrust Donald Trump with their present and their future for the next four years.

That’s how elections work. That’s democracy.

Voters have empowered the president-elect to seek whatever policy objectives he chooses to pursue. Americans should support Trump when his policies make sense. We should oppose him vigorously when his intent is not consistent with our values.

That’s democracy, too.

It’s fair to expect that Trump, along with Republican governors and legislatures in red states, may perceive the recent election outcome as a permission structure to advance new extreme policy positions.   

If Republicans follow through on their campaign rhetoric, Americans may be confronted with the real-life implications of their choice.

Our country could experience a hard day’s night.

Will inflation—currently at low historical levels—spike if the incoming president chooses to impose crushing tariffs on certain foreign nations as promised? It’s simple economics that broad based tariffs increase prices paid by consumers for many everyday products. As a result, the disposable income of Americans would decline.

If Trump pursues the Republicans’ long-time objective of repealing the Affordable Care Act, will millions of citizens feel the uncertainty caused by the loss of health care access? Reflect just for a moment. How would you feel if you, or your loved ones, did not have health insurance coverage?

The increase in extreme abortion restrictions in many states have already impacted the health and lives of women. Will states like Iowa, with harsh or ill-defined limitations, also struggle to recruit needed doctors to their communities, particularly in rural areas?

Should Trump appoint someone like Robert F. Kennedy, Jr. to a health administration leadership position, will children and adults suffer if proven and long-accepted public health practices are marginalized? That could include a wide range of vaccinations and fluoridation of the water. It all makes no sense, but would be consistent with the anti-science world view of MAGA true believers.    

Will our air, water and climate further deteriorate if regulations that protect the environment are weakened to satisfy the interests—and increase the campaign contributions—of the business community? Such actions would be consistent with the Republican Party’s indifference towards policy that considers the foundational needs of future generations.

If Trump follows through on his pledge to hastily conduct the mass deportation of undocumented immigrants, will America’s economy suffer? Foreign workers currently represent a key segment within the country’s labor force. That’s true in Iowa as well. A deportation plan would likely result in worker shortages and a disruption of production and services across many industries. 

Will the quality of Iowa’s public schools decline due to a hastily conceived and costly school voucher program? There are already early signs that this is happening as costs rise above budget targets. In Nebraska, where Republicans dominate state government, citizens just voted to repeal a similar plan, knowing the inevitable threat it presents to public education.

If Trump alienates global allies as he did in his first term, to include appeasing the vile objectives of Russian President Vladimir Putin, will the U.S. be less safe? Will he allow Ukraine to fall to Putin, stand back if western Europe nations are similarly threatened, or allow diplomatic missteps in the Middle East to result in a perilous regional war?

Will the chaos, recklessness, and division that has been the Trump brand harm our country’s standing in the world? Might allies no longer coordinate to share critical international security information—cooperation that helps combat terrorism and other risks—because they no longer trust the U.S. government?   

It can be thrilling when your chosen candidate wins a long, hard fought election campaign. Yet, campaign promises transformed to policy impacts people in real ways, in ways many Trump voters may not fully recognize.

The safety and security offered by programs we depend on can fade away quickly by passing a bill in Congress or walking away from an international military alliance. It’s more challenging to put the broken pieces back together, especially given the fractured politics practiced in the United States today. 

Perhaps it will take a run of bad policy to hit home with voters to fully understand that we live in a real, sometimes unforgiving, world. That the laugh lines repeated at campaign rallies time and again can turn out to be not so funny in the end. 

Since early Wednesday morning, when the direction of the presidential election became clear, I haven’t been able to stop thinking about three things.

The enduring anxiety of women living in red states, including Iowa, who cannot be assured that the health services they need, and should expect, will be there if a planned pregnancy goes tragically wrong.

The real fear of deportation being experienced by honest, hard-working immigrant families who entered the U.S.—and Iowa—due to an outdated and poorly managed immigration policy. Both political parties, over many years, are culpable.

And the grave uncertainty of the brave people of Ukraine, not knowing if the United States will continue to help them defend their freedom.

I wish I could tell them all it’s going to be OK. But I can’t.

It may well be that first, America and its allies must live through a hard day’s night. 

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Top image of night sky with stars and strong clouds as seen from above is by Zacarias da Mata, available via Shutterstock.