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Saturday, 22 November 2025

The Ascendance of Türkiye, Iran, and Russia and the Shifting Regional Security Paradigm: A Geopolitical Realignment in the Middle East

 

Abstract

This essay examines the accelerating geopolitical realignment in the Middle East and Eurasia following the collapse of the Bashar al-Assad regime in December 2024, situating Türkiye, Iran, and Russia as three pivotal revisionist powers reshaping the region's security landscape. Using political, economic, and military data available through November 2025, the analysis argues that the simultaneous assertion of strategic autonomy by Ankara, Tehran, and Moscow—though driven by different ideological and geopolitical imperatives—reflects convergent patterns in the construction of defense-industrial self-sufficiency, the leveraging of economic and military instruments to consolidate influence in contested theaters, and the systematic challenge to Western-aligned security orders. The post-Assad environment in Syria, the Gaza conflict and its aftermath, the war in Ukraine, and regional energy and trade corridors collectively expose the depth of this trilateral reconfiguration. While each state faces substantial structural vulnerabilities, their combined assertiveness significantly narrows Israel's strategic freedom of action, complicates Western crisis management, and contributes to the emergence of a more competitive, fragmented regional order. The essay concludes that navigating this new landscape requires nuanced appreciation of the intersecting ambitions and constraints of Türkiye, Iran, and Russia as they redefine the balance of power across the broader Middle East.

I. Introduction: Post-Assad Realignment and Trilateral Assertiveness

The fall of Bashar al-Assad's regime in December 2024 marked a decisive rupture in the political geometry of the Middle East. The rapid offensive by Hayat Tahrir al-Sham and allied opposition forces, culminating in the capture of Damascus after just twelve days of intensive fighting, ended a thirteen-year stalemate and activated long-dormant rivalries among regional and global powers. Assad's collapse, facilitated by the weakening of his primary backers—Iranian proxies battered by Israeli operations and Russia distracted by its war in Ukraine—created a strategic vacuum that three actors immediately moved to fill: Türkiye, Iran, and Russia, each seeking to secure long-term influence over Syria's political transition, rebuild regional leverage, and assert strategic autonomy vis-à-vis the United States and its allies.

While Türkiye's regional ascent has attracted considerable attention due to its NATO membership, growing defense-industrial self-sufficiency, and dynamic diplomacy, Iran and Russia have pursued parallel strategies rooted in their own political economies and geopolitical aspirations. All three share a common objective that defines their contemporary strategic behavior: the ability to operate in contested theaters without deference to Western preferences, using combinations of military presence, paramilitary networks, economic penetration, and political brokerage. This convergence does not constitute a formal alliance in the traditional sense, but rather represents what might be characterized as a pattern of parallel assertiveness, wherein converging grievances against the Western-dominated international order and mutually reinforcing actions produce complementary outcomes that diminish Western influence and restrict Israeli strategic maneuverability.

The post-Assad transition therefore serves as a revealing lens for examining a broader shift in the region's power architecture. The emergence of this trilateral axis of assertiveness is reshaping the Middle East's conflict systems, energy alignments, and security architecture in ways that demand careful analytical attention. Each actor responds to its own strategic imperatives and faces distinct constraints, yet their behaviors increasingly intersect and amplify one another's impact on regional stability. Understanding these parallel trajectories and their points of convergence is essential for any realistic assessment of the Middle East's evolving strategic landscape and the challenges facing Western policymakers attempting to preserve influence and stability in an increasingly multipolar regional environment.

II. Economic Foundations of Strategic Power: Parallel Pathways of Türkiye, Iran, and Russia


II.i. Divergent Macroeconomic Profiles, Convergent Strategic Purposes

Ankara, Tehran, and Moscow demonstrate vastly different economic structures and levels of integration with global markets, yet each has leveraged its economy—despite considerable volatility and external pressure—to sustain assertive regional policies. The capacity of these three states to project power despite facing significant economic constraints reveals important insights about the relationship between economic resilience and strategic ambition in the contemporary international system.

Türkiye's economy remains comparatively diversified and dynamic despite persistent macroeconomic challenges. The World Bank projects GDP growth of approximately 3.5 percent for 2025, while the Turkish government's Medium-Term Economic Programme targets 3.3 percent growth. Economic data from the second quarter of 2025 showed quarter-on-quarter growth accelerating to 1.6 percent, driven primarily by investment and private consumption, even as tight monetary conditions moderately constrained private spending. The most significant macroeconomic narrative concerns inflation dynamics. Following the adoption of orthodox monetary policy under Finance Minister Mehmet Şimşek, who returned to his position in June 2023, Türkiye has pursued aggressive disinflation. Annual inflation, which peaked at approximately 75 percent in May 2024, has been driven downward, with the government's Medium-Term Economic Programme targeting year-end 2025 inflation of 28.5 percent. This disinflation trajectory, while slower than initially projected by policymakers and still elevated by international standards, has restored a degree of credibility to Turkish economic management among international financial institutions and preserved fiscal space for foreign policy initiatives. The government anticipates continued strength in tourism revenues and projects a narrowing current account deficit, factors that enhance economic capacity for regional engagement.

Iran's economy, by contrast, operates under long-standing international sanctions that have produced chronic inflation, currency depreciation, and structural inefficiencies across multiple sectors. Yet the Islamic Republic has repeatedly demonstrated adaptive resilience through pivoting toward barter arrangements, deepening trade relationships with China and Russia, and leveraging the Islamic Revolutionary Guard Corps as an integrated politico-economic actor that operates across conventional boundaries between state and market. Despite the Trump administration's reimposition of "maximum pressure" sanctions targeting Iran's energy sector throughout 2025, Iranian oil exports have proven remarkably resilient. According to TankerTrackers data, Iran shipped an estimated 66.8 million barrels in October 2025, averaging 2.15 million barrels per day, the highest monthly level of the year. China accounted for approximately 90.6 percent of these exports, with the United Arab Emirates serving as the second-largest buyer. These volumes, priced at substantial discounts of five to ten percent below Brent crude, likely generated between $3.9 billion and $4.2 billion in gross monthly revenue. The reimposition of UN Security Council sanctions through the "snapback" mechanism on September 27, 2025, triggered by France, Germany, and the United Kingdom, has not meaningfully reduced export volumes, as Iran has developed sophisticated evasion networks involving ship-to-ship transfers, disabled tracking systems, and alternative payment mechanisms that circumvent dollar-based international financial networks. This oil revenue, despite sanctions pressure, enables Tehran to sustain its regional proxy networks and invest in missile and drone programs despite persistent domestic economic pressures, including inflation that remains in double digits and widespread socioeconomic grievances that periodically erupt into civil unrest.

Russia's economy, operating under unprecedented Western sanctions following the February 2022 invasion of Ukraine, shifted to a war-mobilized footing that has produced both short-term resilience and mounting longer-term vulnerabilities. The GDP contraction widely expected early in the conflict was substantially mitigated by massive state spending, redirected energy exports to Asian markets, and accelerated import-substitution programs. However, by 2025, the Russian economy confronts increasingly severe constraints. Russia's GDP growth slowed dramatically to just 0.6 percent year-on-year in the third quarter of 2025, according to preliminary estimates from the state statistics agency Rosstat, significantly lower than the 1.1 percent growth recorded in the previous quarter and representing near-stagnation after two years of war-fueled expansion. Full-year GDP growth forecasts have been revised downward to approximately one percent for 2025, down from 4.1 percent in 2024 and 3.6 percent in 2023. This sharp deceleration reflects the exhaustion of manufacturing capacity and manpower reserves, combined with the peculiar nature of defense spending that functions as what analysts characterize as a "disposable-goods economy," wherein factories operate at full capacity and workers earn wages, but the output—weapons, ammunition, military equipment—is designed to be consumed or destroyed almost immediately on the battlefield, generating no lasting productive assets or productivity gains. The Russian Central Bank maintains its policy rate at 16.5 percent in an effort to control inflation that persists at approximately eight percent, well above the central bank's four percent target. Services and manufacturing purchasing managers' indices have declined sharply into contractionary territory, while household and corporate lending has moderated to near-standstill levels. The current account surplus declined by approximately 40 percent in the first half of 2025 according to Central Bank of Russia reports, reflecting deteriorating terms of trade partly induced by sanctions. Defense and security spending now exceeds eight percent of GDP and accounts for over 40 percent of total federal expenditure, levels not seen since the Soviet Union's Cold War era, creating severe opportunity costs and contributing to what economists characterize as a stagflationary environment combining minimal growth with persistent inflation.

Despite these profound differences in economic structure, performance, and external integration, all three states treat macroeconomic resilience not as an end in itself but as a strategic enabler, allowing them to sustain military operations, influence contested territories, and invest in indigenous defense industries that provide both military capability and diplomatic leverage. The capacity to maintain strategic initiatives despite economic headwinds represents a common pattern across all three actors, suggesting that conventional economic pressure, while imposing real costs, has not proven sufficient to fundamentally alter their strategic calculus or constrain their regional ambitions within the timeframes Western policymakers anticipated.

II.ii. Defense Industrial Development: Three Paths to Strategic Autonomy

Türkiye's transformation into a near-autonomous defense producer represents perhaps the clearest expression of economic policy meeting strategic autonomy. Turkish defense and aerospace exports reached approximately six billion dollars in 2023 and are reported to have grown to $7.154 billion in 2024, representing a 29 percent year-on-year increase. Industry reports suggest that exports in the first half of 2025 continued this growth trajectory, with the total project value now exceeding $100 billion, supported by research and development investment approaching three billion dollars annually and a domestic localization rate reportedly exceeding 75 percent. The sector's development has been driven substantially by periodic Western arms embargoes following Turkish military operations in Syria and the 2019 acquisition of Russian S-400 air defense systems, which triggered United States sanctions including Turkey's expulsion from the F-35 program. These restrictions, rather than constraining Turkish capabilities as intended, appear to have accelerated indigenous development programs across multiple capability areas. Turkish unmanned aerial vehicles have emerged as the sector's flagship products, with combat-proven effectiveness in conflicts including Libya, Nagorno-Karabakh, and Ukraine establishing Turkish systems as credible, affordable alternatives to American, Chinese, and Israeli platforms. Türkiye is simultaneously pursuing advanced capabilities including the National Combat Aircraft project known as KAAN, attempting to develop an indigenous fifth-generation fighter aircraft with optimistic timelines suggesting potential initial deliveries by 2028, alongside programs including the ANKA-3 stealth unmanned combat aerial vehicle, hypersonic missile development, and naval platforms such as the TCG Anadolu amphibious assault ship commissioned in 2023.

Iran's defense industrial trajectory, shaped by decades of international isolation, has followed a distinctly different path yet arrived at comparable strategic outcomes. Tehran has become what analysts characterize as a global leader in "asymmetric" defense manufacturing, specializing in inexpensive, robust missile and drone technologies that have been exported to Russia for use in Ukraine and to multiple non-state actors across the region. The Islamic Revolutionary Guard Corps maintains tight control over the defense sector, which has achieved near-complete localization in many categories precisely because decades of sanctions eliminated alternative procurement options. Iran's Shahed series of loitering munitions, designed with commercial off-the-shelf components to minimize production costs and maximize exportability, have reshaped warfare calculations from Yemen to Ukraine. Tehran's missile programs span short-range, medium-range, and increasingly long-range capabilities, with recent developments including hypersonic missile claims that, if substantiated, would represent significant technological advancement. This proliferation of Iranian drone and missile technology has provided Tehran with unprecedented leverage across multiple arenas, creating dependencies among recipient actors and establishing Iran as an indispensable military supplier for forces ranging from Houthi insurgents in Yemen to the Russian military prosecuting its war against Ukraine.

Russia, despite operating under severe Western sanctions that have disrupted access to advanced components and manufacturing equipment, remains one of the world's largest defense producers, though war attrition has strained industrial capacity and revealed significant quality control and production bottlenecks. Nevertheless, Moscow's missile systems, electronic warfare capabilities, and aerospace technologies continue to define significant dimensions of its geopolitical influence. The war in Ukraine has simultaneously accelerated military research and development, integrated Iranian drone and missile systems into Russian military operations through technology transfer arrangements, and spurred joint projects particularly in unmanned systems and munitions production. Russia's defense industrial base, while facing mounting challenges including component shortages, skilled labor depletion, and technological isolation from Western supply chains, continues to produce volumes of conventional weapons systems sufficient to sustain prolonged high-intensity conflict, albeit often with degraded quality and reliability compared to pre-war production standards.

Collectively, the defense-industrial ecosystems of Türkiye, Iran, and Russia—though operating at vastly different technological levels and with distinct specializations—reinforce a common strategic objective that defines their approach to the international system: minimizing dependence on Western arms transfers that carry political conditionality, maximizing export diplomacy that creates client relationships and dependencies, and enabling autonomous military interventions across multiple theaters without requirement for Western approval or logistical support. This parallel pursuit of defense-industrial autonomy, accelerated by Western sanctions and embargoes that were intended to constrain capabilities, has instead produced three increasingly self-sufficient military-industrial complexes that operate largely outside Western control mechanisms and provide these actors with enhanced freedom of action in regional conflicts.

III. Converting Economic and Military Capacity into Strategic Influence

All three actors—Ankara, Tehran, and Moscow—systematically convert economic resources and defense-industrial capabilities into geopolitical leverage across overlapping theaters. While their methods differ substantially, reflecting distinct political cultures, strategic traditions, and resource endowments, their behaviors show striking parallels in pursuit of influence, creation of client dependencies, and resistance to Western attempts at conflict management and resolution.

III.i. Syria: Competing Visions, Intersecting Strategies

The post-Assad transition represents the clearest arena of trilateral entanglement, wherein competing visions and objectives create a complex, fluid environment that constrains all actors while simultaneously preventing any single power from achieving dominance. The rapid collapse of the Assad regime exposed the limits of both Russian and Iranian backing, while creating unprecedented opportunities for Turkish influence that Ankara has moved aggressively to exploit.

Türkiye emerged from Assad's fall as the best-positioned external actor, having invested years in Syrian opposition groups, maintained substantial military presence in northern Syria particularly in Idlib province and areas of Aleppo, and provided reported intelligence cooperation with the rebel offensive that toppled the regime. Ankara's strategy for institutionalizing influence in the new Syrian order operates across multiple dimensions. Multiple reports indicate that Turkish military advisors are training elements of the new Syrian military under the transitional government led by Ahmed al-Sharaa, though Ankara has denied direct command-and-control relationships. Turkish security assistance appears focused on professionalizing Syrian security forces and establishing coherent command structures, activities that create dependencies favoring long-term Turkish influence. Economic statecraft represents Türkiye's most durable mechanism for establishing indispensability. Turkish goods are rapidly gaining market share in Syria, facilitated by geographic proximity, established trade networks from the civil war period, and preferential access negotiated with the new government. Most significantly, Türkiye is positioning itself as essential to Syrian reconstruction, estimated by various sources to require between $200 billion and $400 billion over the coming decade. Turkish involvement in Syrian energy infrastructure appears particularly strategic, with the proposed Kilis-Aleppo natural gas pipeline intended to channel Azerbaijani gas to Syria creating structural energy dependence on Turkish transit infrastructure. Ankara has reportedly been discussing a potential defense pact with Damascus that could station Turkish forces at bases in central Syria, including the strategic T-4 air base in Homs province, though as of late 2025 these negotiations remained ongoing with no finalized agreement publicly announced.

Iran, despite the fall of its long-standing ally representing what senior Islamic Revolutionary Guard Corps commanders have characterized as a "very bad defeat," has worked to preserve elements of its extensive militia infrastructure and maintain residual influence. Tehran's strategy appears focused on ensuring that no Syrian government can fully expel Iranian presence, maintaining support for complex networks of militias stretching from Deir ez-Zor in eastern Syria to southern regions, and keeping open potential arms transfer routes to Lebanon despite the disruption of the primary land corridor that previously connected Iran through Iraq and Syria to Hezbollah. Iranian influence has been substantially degraded by Assad's fall, which followed the severe weakening of Hezbollah through Israeli military operations in Lebanon that decimated the organization's leadership and substantially depleted its military capabilities. Nevertheless, Iran retains significant influence in Iraq through the Hashd al-Shaabi Popular Mobilization Forces and maintains relationships with various actors across Syria's fractured landscape, positioning Tehran to exploit future instability or governmental weakness even if unable to restore its previous dominance. Iranian media outlets close to the state have frequently depicted Türkiye as having worked with the United States and Israel to topple Assad as part of a grander plot aimed at empowering the West while weakening Iran, reflecting deep suspicion in Tehran regarding Turkish intentions and the broader regional realignment.

Russia, though its influence has diminished substantially relative to its position during the Assad era, retains a meaningful military footprint through its Hmeimim air base and Tartus naval facility, both of which represent strategically valuable assets for power projection capabilities in the Eastern Mediterranean and access routes to Africa where Russian mercenary forces operate extensively. Moscow has sought to position itself as a necessary mediator between Ankara and Tehran while simultaneously maintaining relationships with remnants of the old regime structures and preserving airpower capabilities that could prove valuable in future negotiations. Remarkably, despite backing the fallen Assad regime, Russia has managed what analysts characterize as a diplomatic recovery in its relationship with Syria's new transitional government. The new Syrian leadership has reportedly agreed to allow Russia to maintain access to its military bases, reflecting Damascus' recognition that Russian military presence serves multiple functions: as a potential deterrent against Israeli military operations that have intensified since Assad's fall, as a counterbalance to overwhelming Turkish influence, and as a signal of Syrian sovereignty and non-alignment with any single external power. Israel has expressed support for continued Russian presence in Syria, viewing Moscow as a buffer against expanding Turkish influence and recognizing Russia's historical role in managing de-confliction arrangements that have prevented Israeli-Russian confrontation despite hundreds of Israeli strikes on Syrian territory over the past decade.

This triangular competition fundamentally reshapes Israel's strategic environment in ways that impose meaningful new constraints. Unlike the era of Assad's weakness, wherein Israel maintained largely unchallenged air superiority over Syrian airspace and conducted hundreds of strikes against Iranian military infrastructure and weapons transfers to Hezbollah with minimal risk of entanglement with other major powers, Israel now confronts a more crowded, contested Syria. Turkish forces and advisors operate in the north, Russian air defense systems and aircraft remain deployed in the west, and Iranian proxies persist in embedded positions across the east and south. Any Israeli operation now carries increased risk of inadvertently striking Turkish personnel or equipment, potentially triggering a crisis involving a NATO member, or of entanglement with Russian assets that could force uncomfortable American mediation and impose political costs that might cause Israeli planners to exercise greater operational restraint. An Israeli government report from January 2025 concluded that the threat from Syria could evolve into something even more dangerous than the Iranian threat that previously dominated Israeli strategic calculations, pointing specifically to Türkiye's expanding role and warning that Israel may be on a collision course with Türkiye given Ankara's sponsorship of the forces now governing Damascus and its continued support for Hamas. Israel has launched over one thousand combined air and artillery strikes and ground operations in Syrian territory since December 2024 according to monitoring reports, targeting chemical weapons facilities, military infrastructure, and maintaining indefinite presence on Mount Hermon to ensure security for Israeli-held Golan Heights, but this freedom of action increasingly generates friction with multiple external actors rather than occurring in a permissive environment.

III.ii. Iraq, Libya, Ukraine, the South Caucasus, and the Eastern Mediterranean: A Multiplex of Overlapping Rivalries

Beyond Syria, Türkiye, Iran, and Russia pursue influence across multiple additional theaters in patterns that frequently overlap, compete, and occasionally reinforce one another, creating a complex regional environment wherein no single actor achieves dominance but Western influence faces systematic challenges across multiple fronts simultaneously.

In Iraq, all three actors maintain significant presence and pursue overlapping interests that increasingly transform northern Iraq into another arena of trilateral competition. Türkiye has worked to recalibrate its relationship with Baghdad from one characterized by military tensions over Kurdish insurgent operations to a more structured strategic partnership centered on trade, energy transit, and security cooperation. The two countries signed a defense industry cooperation agreement in May 2025, signaling improved bilateral relations despite ongoing disputes. Both governments continue to advance the Development Road Project, an ambitious initiative designed to create a transportation and trade corridor connecting the Persian Gulf to Europe via Iraq and Türkiye, potentially establishing Ankara as an indispensable regional logistics hub, though the project faces substantial implementation challenges including security concerns in southern Iraq, funding gaps, and competing regional corridor initiatives. However, the Kirkuk-Ceyhan oil pipeline, which carried Iraqi Kurdish oil exports through Türkiye until March 2023 when it was shut following an international arbitration ruling against Ankara, remained non-operational as of late 2025 despite various reports suggesting imminent restarts, representing substantial lost revenue for both Iraqi Kurdistan and Türkiye in transit fees. Iran maintains dominant influence in Iraq through the Hashd al-Shaabi Popular Mobilization Forces, extensive political alliances cultivated over two decades, and energy interdependence wherein Iraq relies on Iranian natural gas imports and electricity supplies for significant portions of its power generation. Russia engages economically and diplomatically in Iraq, seeking access to energy projects and extending its geopolitical reach into a country where American influence, while still substantial through security partnerships and diplomatic presence, faces systematic challenges from multiple competing actors. The overlapping goals of these three powers increasingly intersect in contested areas such as Sinjar, Kirkuk, and Mosul, transforming northern Iraq into a complex arena wherein Kurdish autonomy faces pressure from multiple directions, Sunni Arab populations navigate between various external patrons, and the central government in Baghdad attempts to balance competing relationships while preserving sovereignty.

Libya exemplifies the decentralized, proxy-rich environment in which all three powers pursue influence through support for competing factions in a fractured state. Türkiye supports the Tripoli-based Government of National Unity militarily and economically, having deployed military advisors, air defense systems, and armed drones that proved decisive in preventing the 2019-2020 offensive by eastern-based forces from capturing the capital. A defense cooperation agreement signed in July 2025 with the Tripoli government aims to rebuild Libyan military capabilities, positioning Turkish firms to supply equipment and training while establishing longer-term dependencies. Russia's Wagner Group successor formations back forces aligned with Khalifa Haftar in eastern Libya, providing military advisors, equipment, and air support through assets based in Syria and through mercenary networks that have expanded across the Sahel region. Iran maintains lower-profile outreach to both eastern and western Libyan factions, primarily focused on establishing intelligence networks and maintaining awareness of developments rather than pursuing the extensive military involvement characteristic of Turkish and Russian engagement. Türkiye's Libyan engagement serves multiple strategic purposes, but most significantly aims to solidify Ankara's expansive maritime jurisdiction claims in the Eastern Mediterranean through the controversial 2019 maritime boundary agreement with the Tripoli-based government, which claims overlapping exclusive economic zones that disregard the Greek islands of Crete and Rhodes and remain widely rejected by other Mediterranean states as lacking support in international law. The Eastern Mediterranean more broadly has become an arena of intensifying competition over natural gas resources, maritime boundaries, and naval access, wherein Türkiye confronts Greece and Cyprus with Russian energy interests, Israeli offshore gas development, and Egyptian claims creating a complex geometry of overlapping disputes that periodically escalate into military confrontations narrowly avoiding broader conflict.

The war in Ukraine and the Black Sea region represent the most kinetically active theater of Russian engagement, wherein Iran has emerged as an increasingly important military supplier while Türkiye maintains its complex position attempting to balance NATO membership with preservation of economic ties to Moscow. Iran provides drones and missiles to Russia that have substantially impacted the military balance, accelerating what analysts characterize as a quasi-alliance between Moscow and Tehran built on shared opposition to Western dominance, mutual military-technical cooperation, and converging interests in undermining American regional influence. Türkiye's approach to the Ukraine war epitomizes its pursuit of strategic autonomy within NATO structures, having mediated grain export agreements, maintained robust trade relationships with Russia including in energy imports and tourism flows, controlled the Turkish Straits in accordance with the Montreux Convention while limiting NATO naval access to the Black Sea, yet simultaneously supplying Ukraine with Bayraktar TB2 drones that proved highly effective in early phases of the conflict. This balancing act generates persistent tensions with both NATO allies who seek more robust Turkish support for Ukraine and with Russia which views Turkish military assistance to Kyiv as hostile even while maintaining overall functional relations with Ankara.

The South Caucasus region has emerged as another arena wherein this triangular dynamic destabilizes delicate post-conflict arrangements. Türkiye acts as Azerbaijan's principal military backer, having provided extensive training, equipment including advanced drones, and diplomatic support that proved decisive in Azerbaijan's military successes in the 2020 Nagorno-Karabakh war and subsequent 2023 operations that effectively ended Armenian control over the disputed territory. Russia, having served as peacekeeper and traditional security guarantor for Armenia, has seen its influence and credibility erode as Russian peacekeeping forces proved unable or unwilling to prevent Azerbaijani military operations, raising questions throughout the post-Soviet space about the reliability of Russian security commitments. Iran opposes any regional corridor arrangements that would enhance Turkish or Azerbaijani leverage, particularly the proposed Zangezur corridor that would provide direct land connection between Azerbaijan and its Nakhchivan exclave through Armenian territory, viewing such developments as potentially threatening given Iran's substantial Azerbaijani minority population and concerns about pan-Turkic integration projects that could undermine Iranian territorial integrity. The Syrian tilt in Türkiye's favor comes after Ankara gained substantial clout in the South Caucasus through the 2020 conflict, a development that has fueled major geopolitical and security concerns for Tehran and contributed to deteriorating Turkish-Iranian relations despite both countries' rhetorical emphasis on dialogue and conflict management.

IV. The Gaza War and Regional Diplomatic Realignment

The 2023-2024 Gaza conflict and its ongoing aftermath have served as a significant catalyst for Türkiye's diplomatic positioning and Israel's regional isolation, while exposing different dimensions of Iranian and Russian engagement with the Palestinian issue. The war's regional reverberations continue to reshape diplomatic alignments and strategic calculations across multiple theaters.

IV.i. Diplomatic Positioning and International Maneuvering

The Gaza conflict effectively ended the brief normalization in Turkish-Israeli relations that had commenced in 2022 following years of estrangement. While Türkiye has not formally severed all diplomatic ties, the relationship exists in a state of deep crisis characterized by hostile rhetoric and minimal functional cooperation. President Erdoğan's consistent, vocal support for Palestinian rights and his refusal to designate Hamas as a terrorist organization, combined with reported hosting of Hamas leaders in Türkiye for prolonged periods, have resonated powerfully across the Muslim world, enhancing Türkiye's soft power credentials in Arab and Islamic capitals that had previously distanced themselves from Ankara during its period of relative regional isolation following the Arab Spring. A fragile ceasefire between Israel and Hamas took effect on October 10, 2025, following implementation of the first phase of President Trump's 20-point Gaza peace plan. On November 17, 2025, the UN Security Council adopted Resolution 2803 by a vote of 13-0, with China and Russia abstaining, endorsing Trump's comprehensive plan and authorizing establishment of an International Stabilization Force for Gaza. Türkiye played a significant role in the diplomatic process leading to this resolution, joining Egypt, Qatar, Saudi Arabia, the United Arab Emirates, Indonesia, Pakistan, and Jordan in issuing a joint statement on November 14, 2025, calling for swift adoption of the U.S. resolution. This participation underscores Ankara's enhanced diplomatic standing as a regional actor whose engagement is considered essential for Middle Eastern peace processes. However, Israel has explicitly rejected Turkish participation in the International Stabilization Force itself, with Prime Minister Netanyahu and Foreign Minister Gideon Sa'ar stating in October 2025 that no Turkish troops would be permitted in Gaza due to President Erdoğan's hostile stance toward Israel. Despite this exclusion from the security force, Türkiye's central role in diplomatic negotiations and its position as a co-guarantor of the ceasefire agreement demonstrates its increased leverage in regional diplomacy, even when operating within constraints imposed by Israeli objections and American mediation. The ceasefire itself remains fragile, with ongoing violence resulting in approximately 280 Palestinian deaths according to Gaza's Health Ministry in the first month following its implementation, highlighting the substantial challenges facing any stabilization effort.

Iran doubled down on its support for Hamas, Palestinian Islamic Jihad, and other resistance factions throughout the conflict, treating Gaza as a central arena of its self-described "Axis of Resistance" against Israeli and Western influence. Tehran's approach combined rhetorical solidarity with material support, though the extent of Iranian weapons transfers and financial assistance during the conflict remained difficult to verify given the blockade on Gaza and Israeli interdiction efforts. Iran has engaged in direct military confrontation with Israel since April 2024, including the "12-Day War" in June 2025 that involved large-scale missile and drone exchanges, substantially escalating a conflict that had previously been prosecuted primarily through proxy forces. The severe weakening of Hezbollah through Israeli military operations, combined with the fall of Assad severing Iran's primary land corridor to Lebanon, has forced Tehran to contemplate alternative arms supply routes, with a February 2025 report revealing seizure of $2.5 million in cash transported through Türkiye to Hezbollah at Beirut's airport, raising questions about whether Turkish authorities were aware of or complicit in such transfers.

Russia, while officially supporting diplomatic solutions and hosting Hamas delegations in Moscow that provided the organization with political legitimacy and alternative diplomatic channels beyond regional mediation, used the Gaza conflict strategically to undermine United States regional credibility and position itself as an alternative mediator. Russia's abstention on UN Security Council Resolution 2803 rather than vetoing the American-backed resolution reflects Moscow's calculation that maintaining working relationships with both Israel and various Palestinian factions serves Russian interests better than adopting maximalist positions that would foreclose diplomatic flexibility. Russian engagement with the Palestinian issue operates primarily at the diplomatic level rather than involving significant material support, but serves to demonstrate Russia's continued relevance as a global power whose endorsement remains valuable in conflict resolution processes.

The parallel diplomatic behaviors of Türkiye, Iran, and Russia—each pursuing distinct objectives and employing different methods yet consistently positioning themselves as advocates for Palestinian rights and critics of Israeli military operations—collectively contributed to the erosion of Israel's regional standing and weakened momentum behind the Abraham Accords normalization framework that had appeared ascendant in 2020-2021. By adopting the strongest pro-Palestinian position of any major regional power, Türkiye differentiated itself from Arab states that signed the Abraham Accords and positioned itself as an authentic voice for Palestinian rights, generating diplomatic dividends across the Muslim world even as it deepened the rupture with Israel and created tensions with Arab governments that maintain relations with Israel or seek to do so.

IV.ii. Implications for Israeli Strategy

Israel now confronts what security analysts characterize as a trilateral challenge that substantially constrains operational freedom and complicates strategic planning across multiple theaters simultaneously. The convergence of Turkish military encroachment in Syria, Iranian proxy networks and ballistic missile capabilities, and Russian air defense systems and political obstruction in international forums creates what many Israeli analysts describe as the most restrictive regional environment for Israeli power projection since the 1970s, though this characterization should be qualified by recognition of Israel's substantial retained advantages in military technology, intelligence capabilities, and close American partnership.

The potential establishment of a Turkish-backed security architecture in Syria represents the most direct constraint on Israeli freedom of action. Israeli military planners have long relied on relative freedom to conduct airstrikes against Iranian and Hezbollah-related targets throughout Syria, having conducted hundreds of strikes over the past decade with minimal risk of confrontation with major powers. The introduction of significant Turkish military presence and potentially Turkish-supplied air defense systems complicates this calculus substantially. Israeli operations that risk Turkish casualties or that strike Turkish equipment would create a crisis involving a NATO member, potentially forcing American diplomatic intervention and imposing political costs that Israeli decision-makers must weigh against operational benefits. While Israel has demonstrated willingness to accept such costs when core security interests are at stake, the changed environment in Syria does impose meaningful constraints on operational freedom that did not exist during Assad's weakness.

Türkiye increasingly competes with Israel in defense export markets, particularly in the unmanned aerial vehicle sector and in emerging markets across Africa, Central Asia, and parts of Europe. This competition operates on multiple levels: economically, as Turkish systems gain market share previously held by Israeli exports; diplomatically, as defense relationships create incentives for political alignment with the supplier state; and strategically, as countries that rely on Turkish rather than Israeli defense technology become less dependent on maintaining good relations with Jerusalem. While Israel retains significant technological advantages in numerous defense sectors, particularly in sophisticated missile defense systems, intelligence platforms, and cyber capabilities, Turkish competition has intensified notably over the past five years and represents a genuine erosion of Israel's traditional dominance in certain market segments.

Iranian proxy networks, despite substantial degradation through Israeli military operations particularly against Hezbollah in Lebanon, continue to pose asymmetric threats across multiple theaters. Iranian ballistic and cruise missile capabilities, demonstrated through direct strikes against Israeli territory in April and June 2024 that penetrated air defenses despite intercept attempts, represent a strategic threat that Israeli planners must account for in any escalation scenario. Iran's entrenchment across Lebanon, Syria, Iraq, and Yemen through various militia and political relationships provides Tehran with multiple pressure points against Israeli interests even after suffering significant setbacks in Syria and Lebanon. The possibility of Iranian nuclear weapons development, which has accelerated substantially since the collapse of the Joint Comprehensive Plan of Action's restraints, represents an existential strategic challenge that dominates Israeli security planning.

Russian air defense systems in Syria, while not directly threatening Israel, complicate operational planning and create potential for inadvertent escalation if Israeli aircraft are engaged or Russian personnel are affected by Israeli strikes. Russia's consistent political support for positions opposing Israeli military operations in international forums, combined with Moscow's relationships with Iran and various regional actors, adds layers of diplomatic complexity to Israeli actions. Russia's de-confliction arrangements with Israel, which have historically prevented confrontation despite Israel's extensive strike campaign in Syria, depend on continued Russian willingness to maintain these mechanisms and could be disrupted by shifting Russian strategic priorities or by inadvertent incidents that neither side desires but that escalate beyond control.

Türkiye's expanding influence across multiple theaters—Syria, potential leverage in Gaza through diplomatic channels, Eastern Mediterranean maritime claims backed by naval power projection, and Red Sea presence through Somalia—creates what some Israeli analysts characterize as a form of strategic encirclement by an overtly hostile regional power. This characterization, while containing elements of strategic reality, also reflects a degree of Israeli threat perception that may exceed Türkiye's actual capacity to threaten core Israeli interests. Türkiye's ability to directly threaten Israel remains limited by geographic distance, the lack of common borders, Türkiye's continued NATO membership which constrains direct military confrontation, and Israel's substantial military-technological advantages. Nevertheless, the shift from Türkiye as a periodic Israeli partner—including extensive defense cooperation and intelligence sharing during the 1990s and 2000s—to Türkiye as a consistent adversary across multiple diplomatic and strategic domains represents a genuine degradation of Israel's regional position that imposes real costs in terms of diplomatic isolation, economic relationships, and strategic flexibility.

The combined effect of these three challenges—Turkish, Iranian, and Russian—is multiplicative rather than merely additive. Israeli planners must now account for scenarios wherein actions against Iranian targets in Syria could trigger Turkish responses, wherein Russian presence complicates strike planning, wherein Iranian missile capabilities threaten Israeli population centers, and wherein Turkish diplomatic mobilization in international forums amplifies criticism of Israeli military operations. This represents a fundamentally more constrained strategic environment than existed during the post-Cold War period when Israeli freedom of action faced fewer external constraints and regional power dynamics were more favorable to Israeli interests.

V. Structural Vulnerabilities of Türkiye, Iran, and Russia: Limits to Ambition

Despite their assertive regional postures and genuine achievements in expanding influence, each of these three states faces substantial internal constraints that shape the limits of their ambitions and create potential sources of volatility that could disrupt current trajectories. A rigorous analysis must acknowledge these vulnerabilities alongside assessments of capabilities, as the interplay between ambition and constraint will substantially determine the sustainability of current patterns.

Türkiye struggles with persistent high inflation that, despite progress in disinflation, continues to erode real wages and living standards for ordinary Turkish citizens. The government's target of 28.5 percent inflation for late 2025, while representing substantial improvement from the 75 percent peak in May 2024, remains severely elevated by international standards and imposes real socioeconomic costs. The Turkish lira remains structurally weak, having depreciated substantially over the past decade despite periodic interventions, creating ongoing pressure on import costs and foreign currency-denominated debt servicing. While foreign currency reserves have recovered somewhat under orthodox monetary policy, they remain insufficient relative to external financing needs and vulnerable to capital flow reversals that could be triggered by geopolitical shocks or loss of investor confidence. This economic fragility means that any major foreign policy miscalculation or the imposition of sustained economic sanctions—particularly sanctions targeting the Turkish financial sector or major economic relationships—could rapidly undermine domestic economic stability, potentially forcing policy retrenchment or creating domestic political pressures that constrain foreign policy adventurism.

Moreover, Türkiye's increasingly assertive foreign policy has become deeply personalized under President Erdoğan, now 71 years old and having ruled for over two decades through various constitutional arrangements. The highly centralized nature of Turkish foreign policy decision-making, wherein major initiatives frequently reflect presidential priorities and personal relationships rather than institutionalized bureaucratic processes, creates succession uncertainty that could destabilize carefully constructed relationships and commitments should political transition occur. Domestic political opposition has demonstrated renewed strength, evidenced by the AK Party's losses in major municipal elections in March 2024, including defeats in Istanbul, Ankara, and other major urban centers. While Erdoğan retains substantial political control through command of state institutions, dominance over media landscapes, and continued support from conservative and nationalist constituencies, the emergence of credible opposition alternatives creates an axis of internal vulnerability. This opposition could either constrain foreign policy adventurism as domestic economic concerns take priority, or conversely could incentivize nationalist posturing and foreign policy activism as means of maintaining political support through appeals to Turkish national pride and regional influence.

Most fundamentally, Türkiye's foreign policy trajectory exists in profound tension with its NATO membership, creating what Western analysts increasingly characterize as an unsustainable contradiction. The acquisition of Russian S-400 air defense systems in explicit defiance of alliance concerns, open hostility toward Israel which is a key American regional partner, periodic tensions with Greece over Aegean and Mediterranean disputes that have brought two NATO allies to the brink of military confrontation, obstruction of Swedish and Finnish NATO accession for extended periods despite strong American and European support for expansion, and maintenance of complex relationships with Russia even during Moscow's war against Ukraine all create persistent friction within the alliance. The United States maintains a strong interest in preserving Turkish NATO membership given Türkiye's strategic location controlling the Turkish Straits and Black Sea access, its substantial military capabilities including the alliance's second-largest standing military, and its role in containing Russian and Iranian influence. However, this imperative creates a pattern wherein Washington continuously manages symptoms of Turkish assertiveness—mediating Greek-Turkish disputes, attempting to prevent Turkish-Israeli escalation, negotiating compromises on various sanctions regimes, tolerating Turkish actions that would trigger severe responses if undertaken by other allies—rather than addressing the fundamental driver, which is Türkiye's pursuit of strategic autonomy that frequently conflicts with alliance priorities and partner security interests.

Iran grapples with an even more severe constellation of economic, demographic, and political vulnerabilities despite its demonstrated capacity for resilience under pressure. International sanctions, while imperfectly enforced and subject to extensive evasion, impose cumulative costs on the Iranian economy that manifest in persistent double-digit inflation, currency depreciation that has seen the rial lose approximately 90 percent of its value against the dollar over the past decade, and structural inefficiencies that limit productivity growth and economic diversification. Youth unemployment remains persistently high despite occasional statistical improvements, contributing to widespread socioeconomic grievances that periodically erupt into civil unrest, most notably in the 2022-2023 protests following Mahsa Amini's death that represented the most sustained challenge to the Islamic Republic since its founding. The regime's capacity to suppress these protests through violent means demonstrates its coercive capabilities but also reveals the brittleness of its legitimacy among significant portions of the population, particularly urban youth and educated professionals.

Iran faces severe water scarcity challenges driven by climate change, unsustainable agricultural practices, and decades of mismanagement, with major rivers drying up, aquifers depleting at alarming rates, and water-related protests becoming increasingly common in provinces across the country. This environmental crisis intersects with demographic pressures including an aging population as birth rates have declined dramatically below replacement levels, creating long-term economic challenges as the ratio of working-age population to dependents deteriorates. The Islamic Revolutionary Guard Corps, while serving as an effective instrument for regional power projection and internal control, also represents a source of economic distortion and inefficiency, controlling vast portions of the economy through front companies and import monopolies that crowd out private sector development and contribute to widespread corruption that undermines regime legitimacy.

Succession dynamics within Iran's gerontocratic leadership structure create additional uncertainty, with Supreme Leader Ali Khamenei now 86 years old and no clear succession mechanism that commands broad consensus among regime factions. The potential for internal power struggles following Khamenei's eventual death or incapacitation creates significant risk of domestic instability that could either produce foreign policy retrenchment as competing factions focus on internal consolidation, or could generate foreign policy adventurism as various actors attempt to demonstrate nationalist credentials and rally support through external confrontation.

Russia confronts what many economists characterize as the most severe structural constraints among the three actors, despite its continued capacity to project military power and maintain geopolitical influence. The sharp economic deceleration to near-stagnation in 2025, with GDP growth of approximately one percent compared to over four percent in 2024, reflects the exhaustion of war-mobilized growth and the mounting costs of sustained high-intensity conflict. Defense and security spending now consuming over eight percent of GDP and exceeding 40 percent of federal expenditure creates enormous opportunity costs, starving civilian sectors of investment and contributing to degradation of infrastructure, education, and healthcare systems. The Russian Central Bank's maintenance of a 16.5 percent policy rate to combat persistent inflation substantially constrains private sector borrowing and investment, while record-low unemployment conceals underlying labor market distortions driven by military mobilization that has withdrawn hundreds of thousands of working-age men from productive employment.

Russia's demographic crisis represents perhaps its most intractable long-term challenge, with population decline driven by low birth rates, high mortality particularly among working-age men, emigration of educated professionals seeking opportunities abroad, and war casualties that, while subject to disputed figures, likely number in the hundreds of thousands killed and wounded. The combination of population decline and an aging population creates severe constraints on military manpower, economic productivity, and fiscal sustainability of pension and healthcare systems. Western sanctions, while failing to produce the rapid economic collapse some predicted in 2022, are gradually imposing cumulative technological isolation that will erode Russia's capacity to maintain sophisticated defense systems, modernize industrial capacity, and compete in advanced technology sectors. The redirection of energy exports from European markets to Asian markets, while mitigating immediate revenue losses, occurs at substantial price discounts and through infrastructure that provides less flexibility than the pipeline networks to Europe, creating longer-term vulnerabilities should Asian demand moderate or alternative suppliers emerge.

Russia's political system, even more personalized than Türkiye's and more opaque than Iran's clerical structures, centers overwhelmingly on President Putin, now 73 years old and having dominated Russian politics for a quarter century. The lack of transparent succession mechanisms, the systematic elimination or marginalization of potential alternative power centers, and the construction of a political system wherein legitimacy derives substantially from Putin's personal authority create profound succession uncertainty. The combination of mounting economic strains, military casualties that affect families across Russia's regions, and potential leadership transition creates scenarios wherein current foreign policy assertiveness could prove unsustainable, though predicting the timing or nature of such transitions remains highly speculative.

These vulnerabilities do not negate the regional assertiveness of Türkiye, Iran, and Russia or invalidate assessments of their expanding influence, but they do shape the limits of their ambitions and create potential pressure points that Western policymakers might leverage. However, history suggests that states facing domestic vulnerabilities may attempt foreign policy activism precisely to offset domestic pressures—rallying nationalist sentiment, demonstrating strength to internal audiences, creating external enemies that justify domestic repression, and generating economic opportunities through resource extraction or reconstruction contracts in zones of influence. This dynamic raises risks of miscalculation and escalation, as leaders facing domestic constraints may feel compelled to demonstrate resolve in international disputes, may misread adversary intentions or capabilities, or may undertake commitments that prove difficult to sustain but equally difficult to abandon without loss of face.

VI. The Western Policy Dilemma: Managing Revisionist Powers Within and Outside Alliance Structures

The simultaneous assertion of strategic autonomy by Türkiye, Iran, and Russia presents Western policymakers, particularly in Washington, with an acute dilemma that has thus far resisted satisfactory resolution. The challenge lies not merely in managing individual relationships with each actor, but in addressing the systemic implications of their convergent behaviors and the mutual reinforcement of their challenges to Western influence.

Türkiye's position as a NATO ally pursuing policies that frequently conflict with alliance priorities creates the most immediate policy contradiction. Accommodation of Turkish interests to preserve alliance cohesion risks undermining other regional partnerships, particularly with Israel and Greece, establishing precedents that embolden other allies to pursue autonomous policies without consequence, and ultimately hollowing out alliance solidarity through tolerance of systematic deviation from collective commitments. However, punitive approaches toward Türkiye risk pushing Ankara into closer alignment with Russia or China, potentially leading to eventual NATO exit or transformation into a hostile neutral that would represent a catastrophic strategic loss given Türkiye's control of the Turkish Straits, its location bordering Russia and the Middle East, its substantial military capabilities, and its influence across multiple contested regions. American policymakers have consistently prioritized alliance preservation over punishment for Turkish deviations, accepting significant costs in terms of strained relationships with other partners and tolerance of Turkish actions that undermine stated American objectives, yet this approach has not arrested the trajectory toward greater Turkish strategic autonomy and has arguably encouraged continued deviation by demonstrating that such behavior carries minimal cost.

The optimal policy approach likely involves sustained diplomatic engagement that acknowledges legitimate Turkish interests and grievances—including security concerns regarding Kurdish insurgency, aspirations for regional influence commensurate with Türkiye's size and capabilities, and desires for more equitable treatment within alliance structures—while firmly defending core alliance principles and partner security commitments. This balance has proven extremely difficult to maintain in practice, as Turkish and American definitions of legitimate interests diverge substantially and Turkish actions frequently create zero-sum tradeoffs with other American commitments. The question of whether Turkish strategic autonomy represents a temporary phenomenon driven by specific leadership personalities and circumstances, or instead reflects a fundamental reorientation that will persist regardless of political changes within Türkiye, substantially shapes appropriate policy responses but remains unresolved.

Iran presents a different constellation of policy challenges, operating entirely outside Western alliance structures and explicitly defining itself in opposition to American regional presence and influence. The collapse of the Joint Comprehensive Plan of Action following American withdrawal in 2018 and subsequent Iranian nuclear advances have created an increasingly acute proliferation challenge, with Iran now possessing sufficient highly enriched uranium and technical knowledge to potentially produce nuclear weapons within a relatively short timeframe if a decision were made to weaponize the program. Diplomacy aimed at constraining Iranian nuclear ambitions has thus far failed to produce lasting agreements, while sanctions-based pressure has imposed real costs but has not compelled fundamental changes in Iranian regional behavior or nuclear policy. Military options targeting Iranian nuclear facilities, while technically feasible for either the United States or Israel, carry enormous risks of regional escalation, uncertain prospects for permanent destruction of capabilities that could be reconstituted or moved, and potential for triggering Iranian retaliation across multiple theaters simultaneously. The lack of viable pathways to either accommodating Iranian regional role or compelling Iranian behavior change creates a persistent source of instability and crisis potential.

Russia's invasion of Ukraine transformed Western policy from management of a difficult relationship to explicit confrontation through comprehensive sanctions and extensive military assistance to Ukraine. The war has substantially weakened Russia's conventional military capabilities through equipment losses and personnel casualties, has triggered expansion of NATO through Finnish and Swedish accession, and has demonstrated the viability of Western defense industrial cooperation and intelligence sharing. However, the war has not produced the Russian strategic defeat that some Western policymakers anticipated, with Russia having absorbed initial setbacks and established defensive lines that have proven difficult for Ukrainian forces to breach despite substantial Western military assistance. The question of whether sustained Western support can enable Ukrainian military success sufficient to compel acceptable negotiated settlement terms, or whether the conflict settles into prolonged stalemate requiring eventual negotiation from positions of mutual exhaustion, substantially shapes calculations about resource allocation, alliance burden-sharing, and broader strategy toward Russia. The intersection of the Ukraine war with Middle Eastern dynamics, particularly through Iranian military supplies to Russia and Turkish mediation efforts, demonstrates the increasingly interconnected nature of these regional challenges.

The convergent behaviors of Türkiye, Iran, and Russia—pursuing strategic autonomy, building defense-industrial self-sufficiency, leveraging economic and military instruments to expand influence in contested spaces, and challenging Western-aligned security orders—collectively create a more complex international environment than Western powers have faced since the Cold War's end. Unlike the Cold War's relatively clear bipolar structure or the post-Cold War unipolar moment, the contemporary environment features multiple centers of power pursuing distinct objectives through varied means, creating a multipolar regional landscape wherein Western influence faces systematic challenges across multiple theaters simultaneously. The traditional policy tools of alliance management, economic pressure, military deterrence, and diplomatic engagement remain relevant but require adaptation to this more complex environment wherein adversaries learn from each other's successes, coordinate actions without formal alliance structures, and exploit divisions among Western partners.

VII. Conclusion: Navigating an Unsettled Regional Transition

The contemporary Middle East and broader Eurasian landscape is being reshaped by the convergent assertiveness of three revisionist powers—Türkiye, Iran, and Russia—whose strategic behaviors, while driven by distinct ideological commitments and geopolitical imperatives, increasingly overlap, reinforce, and amplify one another's challenges to the Western-dominated post-Cold War order. The fall of the Assad regime in December 2024, rather than simplifying the regional landscape by removing a source of instability, has instead activated new competitions and exposed the depth of this trilateral reconfiguration.

The balance of available evidence supports several conclusions about the emerging regional order. First, each of these three actors has developed genuine capabilities—economic resilience despite external pressure, defense-industrial autonomy that reduces dependence on Western suppliers, and military forces capable of sustained operations in contested environments—that enable regional power projection and create meaningful constraints on adversaries. These capabilities are not merely rhetorical posturing but reflect real investments, institutional development, and demonstrated performance in multiple conflict zones. The assertion that any of these actors can be easily pressured into compliance with Western preferences through conventional diplomatic or economic means has been repeatedly disproven by events.

Second, the convergence of Turkish, Iranian, and Russian behaviors creates challenges that exceed the sum of their individual effects. Israel confronts not merely one adversary but a complex environment wherein actions against Iranian targets in Syria risk entanglement with Turkish forces, wherein Russian air defense systems complicate operational planning, wherein Iranian ballistic missiles threaten population centers, and wherein Turkish diplomatic mobilization amplifies international criticism. Western policymakers face not a single manageable challenge but overlapping crises in Ukraine, Syria, Iraq, Libya, the South Caucasus, and the Eastern Mediterranean that strain resources, test alliance cohesion, and create tradeoffs between competing objectives. This multiplicative effect represents a fundamental shift from the post-Cold War environment wherein the United States and its allies could address regional challenges sequentially with relative confidence in escalation dominance.

Third, however, projections of irreversible hegemonic ascent by any of these actors require significant qualification. Türkiye faces persistent inflation, currency fragility, political polarization, succession uncertainty, and the fundamental contradiction between NATO membership and increasingly autonomous foreign policy. Iran grapples with sanctions, demographic decline, water scarcity, recurring domestic unrest, and the fragility of gerontocratic succession. Russia confronts near-economic stagnation, technological isolation, demographic crisis, and the mounting costs of sustained military mobilization. These vulnerabilities create limits to ambition and potential sources of reversal that must be weighed against assessments of expanding influence. The sustainability of current trajectories depends substantially on whether these actors can manage internal constraints while maintaining external assertiveness, a balance that history suggests often proves difficult.

The most probable trajectory for the coming years involves continued escalating friction across multiple domains rather than either stable accommodation or decisive confrontation. Türkiye can be expected to leverage its economic capabilities and defense exports to consolidate positions in Syria and pursue influence in Iraq, Libya, and beyond, while maintaining hostile diplomatic stance toward Israel and asserting claims in the Eastern Mediterranean. Iran will likely continue supporting proxy networks despite setbacks, advancing missile and potentially nuclear capabilities, and seeking to preserve influence in Iraq and remnants of presence in Syria. Russia will remain militarily engaged in Syria while prosecuting its war in Ukraine, seeking to preserve great power status through military presence in contested regions despite mounting economic constraints. None of these actors is likely to achieve complete dominance in any theater, but neither are they likely to be expelled or contained through current Western approaches.

The scenario that demands most urgent attention from policymakers involves inadvertent escalation, particularly risks of Israeli military operations in Syria striking Turkish personnel or assets, or of confrontations in the Eastern Mediterranean between Turkish and Greek forces drawing in NATO, or of Iranian escalation producing direct Israeli or American military responses that spiral beyond initial intentions. Each of these scenarios could rapidly escalate into crises that force uncomfortable American choices between competing commitments and risk broader regional conflagration. The current diplomatic infrastructure for managing such crises appears insufficient, with de-confliction mechanisms that worked in earlier periods showing signs of strain under the weight of expanded military presences and deteriorating political relationships.

For Western policymakers, particularly in Washington, the central strategic challenge involves managing the contradiction of maintaining alliance relationships and partnerships with actors pursuing increasingly divergent regional visions while simultaneously confronting revisionist powers that exploit these divisions and coordinate their challenges to Western influence. The era of unchallenged Western dominance in the Middle East and broader Eurasian space has concluded, replaced by a more complex, multipolar environment in which Türkiye, Iran, and Russia function as increasingly autonomous actors capable of meaningful resistance to Western preferences. Whether this transition produces eventual stable equilibrium, wherein spheres of influence are tacitly recognized and crisis management mechanisms prevent escalation, or instead generates sustained confrontation with periodic explosions of violence, depends substantially on diplomatic skill, strategic wisdom, and willingness to accept complexity that recent regional history suggests may be in limited supply among all parties. The test of effective statecraft will lie in the capacity to preserve core interests and commitments while avoiding catastrophic confrontations in an environment of structural competition and constrained resources, a challenge that requires both firmness in defending vital interests and flexibility in acknowledging the limits of available power.

The Affordability Altar: How Mamdani Reminds Trump of His Economic Roots


In a political landscape defined by noise, polarization, and relentless cultural warfare, the victory of New York City Mayor-elect Zohran Mamdani—a self-described democratic socialist—and his remarkably cordial meeting with President Donald Trump this week stand as two of the most significant political events of November 2025. The conventional wisdom surrounding this unlikely détente—and Mamdani’s success—is simple: affordability trumps ideology.

The data is clear. Mamdani's victory was anchored by a laser focus on the pocketbook issues that define the modern struggle for the working and middle class: affordable housing, free universal childcare, reduced transit costs, and aggressive actions to lower grocery prices. His platform was a direct response to the crippling inflation and cost-of-living crisis gripping the nation, and it delivered a decisive victory in America’s most symbolically important city.

The stunning 180-degree turn by President Trump—who weeks earlier had branded Mamdani a "communist lunatic," only to praise him as a "rational person" and a man he would be “cheering for” following their Oval Office meeting—is not mere political spectacle. It reflects a pragmatic, and perhaps desperate, recognition of a fundamental truth: the economic anxiety that propelled Trump to victory over Kamala Harris in 2024 is the same force that just elected Mamdani in New York.

The Core of “America First”

The original, successful iteration of the “America First” movement in 2024 was less about ideological purity and far more about economic relief. Voters who felt left behind by globalization, stagnant wages, and escalating costs of daily life found a champion in Trump’s promise to “Bring Back the American Dream and Make It Affordable Again.” His campaign was overtly populist, targeting housing scarcity, healthcare costs, and everyday expenses.

Yet since his re-election, the administration’s focus has drifted. A growing emphasis on foreign policy assertiveness—threatening military engagement with Iran, Venezuela, and Nigeria—has begun to consume the bandwidth of the White House. This shift, influenced in part by pro-interventionist voices at odds with the original America First ethos, risks pulling the nation into costly and potentially protracted conflicts.

These foreign policy moves not only alienate the non-interventionist segment of Trump’s base but are also severe distractions from what remains the primary concern of American voters: economic security at home.

The Inflationary Trap: Tariffs and Labor Shortages

This strategic drift has been compounded by economic policy decisions that have intensified, rather than eased, the affordability crisis.

Tariff Inflation

President Trump's sweeping tariffs—while intended to protect domestic industry—have operated as a direct tax on American consumers and businesses. The Commerce Department’s recent data, though showing a reduced trade deficit, confirms that tariffs depressed imports and contributed to inflation remaining stubbornly above the Federal Reserve’s target.

The President’s tactical decision to lift tariffs on certain consumer goods, including coffee and fruit juice, reflects an implicit admission of their inflationary toll.

Labor Market Squeeze

The administration’s immigration crackdown, including mass deportations, has further restricted labor supply in key sectors such as agriculture, food processing, construction, and healthcare. As economists predicted, the shrinking labor pool has driven up wages in ways not matched by productivity, forcing businesses to pass those costs to consumers.

Together, higher import costs and a constrained labor market have created a recipe for sustained inflation just as the President heads into a challenging 2026 midterm cycle.

The Mamdani–Trump Nexus: Pragmatism Over Principle

The surprising warmth displayed during the Mamdani–Trump meeting, despite their ideological divide, reflects a savvy political calculus. Mamdani’s entire campaign was a textbook demonstration of how to politically weaponize the affordability crisis. He didn’t merely narrate economic suffering; he proposed material, immediate solutions—rent freezes, free transit, city-owned grocery stores.

Trump, whose political instincts remain formidable, recognized in Mamdani’s success a mirror of his own 2024 message: address affordability or lose the electorate.

The President understands that aligning himself—even symbolically—with Mamdani’s affordability agenda could serve as a pressure-release valve for his own political vulnerabilities. If Mamdani’s aggressive supply-side interventions begin to reduce prices in New York, Trump can claim credit for fostering cooperation with a popular mayor.

Yet this convergence is not merely political. It is structural: the same affordability crisis that elected Trump in 2024 is now accelerating at the municipal level.

The Strategic Alliance: How Trump’s Billionaire Network Could Rescue Mamdani’s Housing Mandate

There is a deeper political-economic logic underlying the Mamdani–Trump détente—one that has been almost entirely overlooked. Mamdani’s signature promise, the construction of 200,000 new permanently affordable units, is prohibitively expensive as currently designed. Without external intervention, the plan is likely to collapse under its own fiscal weight.

This is precisely where Trump—the only sitting President with half a century of personal ties to New York’s billionaire class—could become indispensable.

Why Mamdani Cannot Finance His Housing Plan Alone

The projected cost of the housing initiative approaches $100 billion, a sum that requires:

  • raising the city’s statutory debt cap

  • navigating a turbulent insurance environment

  • absorbing cost increases from all-union labor mandates

  • shielding financially strained rent-stabilized buildings from collapse

Even in a high-tax, high-capacity city like New York, this combination of barriers is insurmountable without external capital.

A Win–Win–Win Political Economy

If Trump steps in to orchestrate a financing compact, the political and material benefits align powerfully:

1. Trump gets a legacy-defining victory
For decades, Trump has chafed at the idea that New York’s political and financial class dismissed him. Facilitating the largest affordable housing expansion in modern U.S. history allows him to recast himself as the president who restored livability in the city he once helped build.

It would also reinforce his original “make life affordable” message heading into the midterms.

2. Mamdani gets the capital needed to deliver on his mandate
The mayor-elect’s agenda is structurally sound but financially impossible under current conditions. Federal leverage and private capital are the missing ingredients.

3. New York’s billionaire class gets a more stable workforce
This element is crucial. Major New York employers are struggling to retain lower- and mid-level employees who cannot afford to live within commuting distance. Affordable workforce housing directly benefits them.

The Billionaires Who Could Make It Happen

Trump is uniquely positioned to convene the exact group of New York–based financial titans who would benefit from—and could help fund—such a housing initiative:

  • Jamie Dimon (JPMorgan Chase) — influential banker, deeply tied to the city’s economic health.

  • Stephen Schwarzman (Blackstone) — head of the world’s largest real-estate private equity firm; long-standing personal relationship with Trump.

  • Stephen Ross (Related Companies) — major developer with deep political reach and direct interest in urban housing.

  • Howard Lutnick (Cantor Fitzgerald) — politically flexible financier with a vested interest in downtown workforce stability.

  • Barry Sternlicht (Starwood Capital) — major national real-estate figure outspoken about urban affordability.

  • Ronald Lauder (Estée Lauder) — billionaire philanthropist and long-time Trump ally.

  • Larry Fink (BlackRock) — more distant from Trump personally, but BlackRock controls enormous municipal and housing-related funds and cannot ignore federally backed financing structures.

With Trump convening these actors, a New York Workforce Housing Investment Compact—blending federal credit guarantees, institutional lending, and city land contributions—becomes plausible.

This reframes the Mamdani–Trump relationship not as ideological oddity but as a deeply rational convergence rooted in shared economic imperatives.

Domestic Pressures: Tariffs, Inflation, and Midterm Vulnerability

The broader political environment intensifies the stakes. Two intertwined domestic pressures threaten the President ahead of the 2026 midterms: sustained inflation and credibility erosion around the affordability agenda.

A thorough analysis of both reveals a dangerous drift between the administration’s policies and voter priorities.

Tariffs as a Political Liability

Tariffs, though reducing the trade deficit, have pushed inflation upward. Voters in key swing regions are already experiencing higher prices for food, household goods, and heating fuel—costs that Democrats will eagerly tie to Trump’s policies.

Immigration and Labor Market Constraints

Similarly, the administration’s restrictive immigration approach has tightened labor markets in critical, immigrant-dependent sectors, adding fuel to inflation. This “labor-squeeze inflation” is becoming a potent political liability.

If affordability remains the top voter concern—as all polling suggests—the White House risks a midterm backlash unless it dramatically refocuses its domestic agenda.

The Foreign Policy Shadow: Permanent War vs. Populist Economics

This economic vulnerability is magnified by an increasingly assertive foreign policy stance. Threats of confrontation with Iran, Venezuela, or Nigeria run counter to the non-interventionist ethos that animated many of Trump’s 2024 supporters.

Any military miscalculation could:

  • spike global oil prices

  • destabilize key regions

  • drain resources from domestic spending priorities

  • fracture Trump’s populist coalition

Foreign adventurism is politically combustible when voters are already squeezed by inflation.

The Mamdani Mandate: Ambition, Obstacles, and the Tightrope Ahead

Mamdani’s victory represents a clear public mandate: solve the affordability crisis. His agenda has two main pillars:

1. Supply Expansion: The 200,000-Unit Housing Plan

This is the economically rational long-term strategy but faces major constraints:

  • need for state approval to raise the debt cap

  • soaring costs due to all-union labor mandates

  • extremely high per-unit construction costs

  • insurance market instability

  • the sheer scale of required financing

Without outside partnership—possibly at the federal level—the plan is vulnerable.

2. Rent Regulation: Immediate Relief, Long-Term Risks

Mamdani’s proposed four-year rent freeze is politically attractive but carries risk:

  • disincentivizing maintenance

  • accelerating building deterioration

  • risking widespread landlord default

  • forcing the city to acquire distressed buildings unexpectedly

In a worst-case scenario, the freeze could precipitate a housing crisis within a housing crisis.

Conclusion: A Strategic Convergence Shaped by Affordability

The election of Zohran Mamdani is more than a municipal event—it is a resounding referendum on the national economic condition. President Trump’s unexpected embrace of Mamdani reflects a deeper realization: the political foundation of his 2024 victory—affordability—is eroding under the weight of tariff-driven inflation and foreign policy distractions.

But the Mamdani–Trump relationship has evolved into something more consequential. It represents a potential strategic alliance grounded in the shared interests of:

  • a president seeking to reclaim his affordability message,

  • a mayor requiring unprecedented capital to execute his mandate, and

  • a billionaire class eager for workforce stability.

If Trump leverages his New York network—Jamie Dimon, Stephen Schwarzman, Stephen Ross, Howard Lutnick, Barry Sternlicht, Ronald Lauder, Larry Fink, and others—to support the Mamdani housing initiative, it could become a historic, tri-partite partnership that reshapes the city’s housing landscape and revitalizes Trump’s political fortunes.

If he does not, the affordability crisis that elected both men may become the force that unseats Trump’s congressional allies in 2026—and perhaps Trump himself in 2028.

At the end of the day, the message remains unchanged: the road to political survival in America still runs through the household budget.

The Alberta Healthcare Debate: A Critical Examination of the 'Dual Practice' Reform


Introduction: The Legislative Reality Takes Shape

On November 19, 2025, Alberta Premier Danielle Smith confirmed what had been circulating in confidential draft legislation: the provincial government plans to allow physicians to operate simultaneously within both the public and private health-care systems through what is being called a “Dual Practice Surgery Model.”  This announcement—following a November 18 Globe and Mail report on proposed amendments to the Alberta Health Care Insurance Act—marks a potentially watershed moment for Canada’s publicly funded Medicare system.

Under the proposed framework, surgeons (and possibly other clinicians) would be classified as “flexibly-participating physicians.” These practitioners could decide, on a case-by-case basis, whether to deliver a given surgery under the public system or in a private-pay environment—without necessarily notifying government in advance of which services they will perform publicly versus privately. 

Premier Smith emphasized that participation would come with strings: surgeons wanting to take part in the dual-practice model would need to commit to a minimum ratio of publicly funded surgeries per year in order to qualify.The targeted areas are highly salient: knee, hip, eye, and shoulder surgeries—precisely the elective procedures for which wait-lists are among the longest in Alberta. Smith justified the reform by pointing to the systemic strains: patients are waiting too long, operating room capacity is underutilized, and some frustrated specialists are leaving the province—or even the country—for more lucrative opportunities elsewhere. 

Smith framed the reform as a win-win: by permitting private-pay (or insurer-funded) surgeries in the “off-hours,” such as weekends, public wait-lists would shorten because more surgical volume would become available overall, and surgeons would be incentivized to stay in Alberta’s health system. She also stressed that all medically necessary care covered by Alberta Health Insurance will still be “everything your Alberta Health Insurance covers remains covered.” Importantly, Smith insists that life-threatening conditions, such as cancer surgeries or emergencies, would remain entirely within the publicly funded system, with no private-pay “line-jumping” for those cases. 

Behind much of the policy advocacy for this reform are influential think tanks—such as the Fraser Institute and the Montreal Economic Institute—arguing that introducing market-based competition and financial incentives will spur efficiency and innovation. These groups portray the plan as the most significant health-care reform in decades. But while their narrative is compelling to some, a more critical analysis rooted in empirical evidence, macroeconomic logic, and comparative health policy suggests that the reform also carries profound risks.

Risks, Trade-offs, and Hidden Assumptions

1. Unproven Efficiency Gains and Allocation Risks

Smith’s government is not merely proposing dual pay structures, but a broader re-funding of surgical services via a shift to activity-based funding. According to Smith, hospitals will compete for funding based on how many and what types of surgeries they deliver.  But critics warn that such a model could incentivize “cream-skimming”: private or private-adjacent providers might prioritize low-complexity, high-margin elective surgeries (like knees or hips), leaving public hospitals to handle more resource-intensive, complex cases without adequate funding.  The Health Sciences Association of Alberta has expressed concern that under such a regime, major surgeries could decline in public hospitals as staff and capacity are diverted to better-funded, profit-oriented clinics. 

2. Equity and Two-Tier System Concerns

The Canadian Medical Association (CMA) has strongly criticized the dual-practice plan, warning that it may worsen access disparities and degrade outcomes.  Their argument is informed by global evidence: where parallel private systems operate, outcomes and access for publicly funded patients often suffer.  Indeed, the CMA suggests this could lead to some Albertans paying twice—once via taxes to support the public system, and again out-of-pocket (or through insurance) to access the “faster” private track. 

Opposition voices have echoed these concerns: the NDP argues the reform amounts to two-tier, “American-style” medicine, undermining the universality principle of Medicare. On the other side, the United Conservative government retorts that this is not “American-style” but more akin to European mixed models, pointing to research from the Montreal Economic Institute about the benefits of mixed public-private systems. 

3. Workforce Planning & Retention Uncertainty

Smith frequently invokes physician retention as a rationale: the dual-practice model, she argues, will keep surgeons in Alberta rather than losing them to other jurisdictions.  But critics contest whether this guarantee holds. There is uncertainty around safeguards: while the government mentions that “safeguards” like mandatory public service hours might be enforced, such provisions are not yet concretely detailed.  Without well-designed and enforceable guardrails, there is a risk that the public system could hollow out, losing not only volume but also talent.

4. Structural Overhaul Risks

The dual-practice reform is taking place against the backdrop of wider restructuring in Alberta’s health system. Notably, the government is dismantling Alberta Health Services (AHS) and replacing it with specialized provincial agencies—including Acute Care Alberta, which now oversees chartered surgical facilities. Alberta Health Services This fragmentation raises questions about coordination, accountability, and the long-term governance of a hybrid system.

Health-care unions and workers have voiced alarm: according to the Alberta Union of Provincial Employees (AUPE), Bill 55 (the Health Statutes Amendment Act, 2025) could enable a privatization agenda that “undermines public health care” and gives the government sweeping authority to shift institutions into private provision. AUPE Some warn of layoffs, reduced standards, and instability for health workers if profit-driven models take priority over patient outcomes.

5. Transparency, Accountability & Cost Controls

Smith has pledged that cost-per-surgery data will be publicly available, and that more complex procedures will be compensated at higher rates. But transparency alone does not guarantee equitable access or fiscal prudence. Without robust regulatory oversight, there is a risk that private-pay corridors may grow unchecked, leading to escalating costs or shifting public money toward profit-driven entities. Observers note that such payment models, if not properly bounded, could exacerbate inequities rather than alleviate them.

Why This Matters: A Broader Stakes Perspective

  • For Patients: The reform promises faster access for some, but not without creating potential stratification in care. Albertans who can pay (or have supplemental insurance) may receive faster treatment, while others remain constrained by public wait-lists.

  • For Public Medicare: The model tests the resilience of Canada’s single-payer promise. If dual practice becomes entrenched without strong safeguards, it could erode public trust and undermine the very foundations of universal coverage.

  • For Health-Economics: The plan is being sold as a cost-saving, efficiency-boosting measure, but history suggests that introducing market-like incentives into health care often brings unintended consequences—especially when poorly regulated.

  • For Governance: The timing of the reform, alongside the restructuring of Alberta’s health institutions, raises critical governance questions: who will regulate, oversee, and enforce equity in this new mixed system? How will public accountability be maintained when profit motives are introduced?

The announcement of Alberta’s Dual Practice Surgery Model represents more than a policy tweak—it is a paradigm shift. By explicitly allowing doctors to straddle public and private spheres, the provincial government is challenging long-standing principles of universal, publicly insured care. While the proposed reform is framed in terms of flexibility, wait-time reduction, and physician retention, the evidence—both global and local—raises serious red flags about equity, cost, and the future integrity of Alberta’s (and Canada's) Medicare.

In the next sections, a deeper dive into the comparative evidence, economic incentives, and the risk of systemic stratification will show why this so-called “reform” may be far more perilous than proponents acknowledge.

The Siren Song of Market Efficiency: Cost and Crowding-Out

The fiscal case for Alberta’s dual-practice reform is rooted in a familiar macroeconomic narrative: the current single-payer model is allegedly unsustainable, draining provincial coffers and crowding out other public priorities. Healthcare’s share of government expenditure has grown dramatically, constraining spending on education, infrastructure, and social services. Proponents argue that by allowing surgeons to moonlight in the private sector—after meeting a floor of publicly funded work—overall surgical capacity will rise, wait times will shrink, and physician retention will improve. In theory, this injects market discipline, aligns incentives, and unlocks latent capacity.

Yet this diagnosis, while superficially compelling, obscures profound risks. The free-market remedy is, in many respects, ill-suited to the realities of health care and physician behavior—and the evidence suggests it may backfire, undercutting both equity and public capacity.

The Zero-Sum Reality of Physician Time

At the heart of the reform is the assumption that physician time is essentially elastic—that doctors can seamlessly expand their hours, or shift work, to accommodate both public and private practice without degrading the public system. Empirical and experiential realities strongly challenge that assumption.

Conflict of Incentives and Allocation Risks

Dr. Brian Wirzba, president of the Alberta Medical Association, has warned that dual practice without rigorous guardrails risks destabilizing the public system. He argues that conflict-of-interest rules, safeguards against subsidization of private services by public resources, and robust workforce-planning mechanisms are needed to prevent crowding-out.

International studies back him up. A systematic review of dual practice globally found that when physicians are allowed to split time between public and private work, they may engage in predatory behavior—prioritizing higher-paying private services, steering patients toward their private practices, or shifting their best effort to the private sphere. Moreover, the same review raises concerns that dual practice can undermine public services, leading to backlogs, underused equipment, delayed treatment, and a deterioration of quality in the public sector.

Because private care often pays more, physicians have a strong financial incentive to allocate their time where it yields the greatest return. This undermines the idea that the public system remains insulated simply because of minimum public-service quotas.

Empirical Evidence from Alberta’s Own System

Recent provincial experience suggests that these risks are not abstract. A November 2025 investigation by The Tyee, drawing on internal Alberta Health Services (AHS) data and expert research (including work by the Parkland Institute), found that while private surgical facilities (chartered surgical facilities, or CSFs) have accommodated more low-acuity, elective procedures, wait times for complex, high-priority surgeries in the public system have actually increased.

This phenomenon aligns with the “cream-skimming” critique: private or private-like providers focus on volume, high-margin procedures (e.g., hips, knees, cataracts), leaving public hospitals to handle the more complex, less profitable cases—often at a higher cost per case, but without the same financial incentives. As The Tyee report warns, this may produce inequities in access, as well as resource strain on public acute-care centers.

The Illusion of Risk Mitigation

Supporters of the reform, such as think tanks like the Montreal Economic Institute, argue that requiring a minimum threshold of publicly funded work will prevent physician “abandonment” of the system. But even with such a model, the dual-practice system removes the protective barrier that currently discourages doctors from going fully private—a barrier that some medical academic leaders, like former University of Calgary medical school dean Jon Meddings, describe as central to preserving public-sector supply. In his view, since very few physicians currently opt out of Medicare (because it would threaten their income), the public system has had a de facto shield. By contrast, the hybrid model empowers physicians to “test the private waters” without risking full exclusion from public payments.

Macroeconomic and Policy Trade-offs

Viewed through the lens of macroeconomics and public policy, the dual-practice reform may represent a short-term fix with long-term costs:

  1. Budgetary Reallocation vs. Structural Strengthening
    While the reform seeks to optimize fiscal efficiency by aligning payment to productivity (via activity-based funding), critics warn that this may reallocate rather than add capacity. The new funding model announced by Smith ties grants to surgical volume and type, creating direct competition between public hospitals and private-leaning surgical centers. But as unions and health workers have cautioned, this could lead public hospitals to lose key staff or even rent out OR time to external entities—potentially weakening the public core.

  2. Equity Risks
    Dual practice inherently raises equity concerns. Canadian Doctors for Medicare, among other voices, argue that if doctors can be paid more by patients in the private sector than by the government for the same procedures, they will almost certainly spend more time privately, to the detriment of those who rely solely on the public system. As this happens, a two-tier structure may emerge: privately paying or insured patients get quicker access, while public-system patients face stagnating or even worsening wait times.

  3. Sustainability vs. Fragmentation
    The proposed reform does not occur in isolation. It coincides with a major restructuring: the dismantling of Alberta Health Services and its replacement with specialized agencies (e.g., Acute Care Alberta) that oversee surgical volume under the new activity-based model. This institutional fragmentation may erode accountability and continuity, making it harder to ensure equitable distribution of resources. Dr. Wirzba, among others, has warned that instead of fixing “old silos,” the reform risks building new ones.

In sum, the fiscal logic of dual practice—more efficiency, more supply, shorter waits—is alluring, especially in a constrained budgetary environment. But it rests on a dangerously optimistic assumption: that physician labor and time can simply be dialed up like any other market good. The evidence, both from Alberta’s own unfolding reforms and decades of international study, suggests otherwise. Without strong conflict-of-interest regulation, transparent allocation, and protections for the public core, dual practice risks undermining the system it purports to strengthen.

Far from being the panacea for wait-time woes, this reform could precipitate a crowding-out of public care, exacerbate inequities, and shift scarce resources from complex, publicly funded cases to easier, more profitable ones. If Alberta is serious about sustainability, the answer lies not in privatizing care, but in strengthening public infrastructure, workforce planning, and systemic coordination—not diluting it.


The Empirical Record: Lessons from Dual Practice Internationally

The international evidence on physician dual practice offers a far more cautionary tale than the optimistic projections put forward by Alberta’s reformers. While the concept of doctors working in both private and public settings can seem like a pragmatic compromise, real-world data suggest serious trade-offs—and systemic risks.

Historical and International Evidence on Dual Practice


Canadian and North American Experience

  • In Manitoba, research from the 1990s revealed that public-stream patients of surgeons who also maintained private practices waited significantly longer than patients of surgeons who worked exclusively in the public system. These waits were not trivial: the Canadian Medical Association Journal recounts that the differential could be as much as 13 additional weeks

  • In Alberta itself, dual-practice in cataract surgery has historical precedent: surgeons operating in both public hospitals and private clinics (charging facility fees in the private setting) have been scrutinized.  A report from the Consumers’ Association of Canada noted long public wait times and higher fees in private clinics.

These Canadian cases underscore an enduring pattern: dual practice may create perverse incentives that disadvantage publicly insured patients.

Broader Global Evidence

  • A systematic literature review by Karolina Socha and Mickael Bech (University of Southern Denmark) found that while dual practitioners may benefit financially, there is a structural risk of them shifting effort toward private practice, favoring more lucrative patients, and under-serving their public-sector obligations.  The review also warns of “cream-skimming” (selecting the most profitable patients) and of public resource misuse, including self-referrals from public patients to private practices. 

  • According to a World Health Organization (WHO) governance report, dual practice is very widespread globally, but its negative impacts—especially for universal health-care coverage—are poorly quantified because evidence remains largely descriptive. 

Structural and Behavioral Dynamics: Why Dual Practice Undermines Public Provision

Much of the problem lies in economic incentives, not necessarily the morality of individual doctors. Dual practice embeds what economists call principal–agent problems: physicians (agents) may be strongly motivated by profit, which can diverge from public-system goals (the principals).

  • The incentive structures inherent in dual practice can lead physicians to prefer private patients, especially when public waiting lists are long. The longer public wait times become, the stronger the incentive to channel patients into their private practices. This is not simply a matter of greed but of rational economic decision-making under an unbalanced system.

  • The WHO report also highlights how weak governance or regulatory frameworks fail to correct these misaligned incentives. 

The Cost Arithmetic of Private Delivery

Critics of dual practice often argue that private-provision efficiency gains outweigh the costs. But the empirical record suggests otherwise.

  • In Canada, case studies show that privatized procedures can be materially more expensive. For instance, a study in Quebec found that certain procedures at private clinics cost up to 150% more than the same procedures in public hospitals. Another source reported that private colonoscopies cost $739 vs. $290 in public settings. 

  • More recently in Alberta, a Parkland Institute analysis found that for-profit surgical facilities (chartered surgical facilities, or CSFs) are billing the government more than twice the cost of equivalent public-hospital procedures for hip, knee, and shoulder surgeries. The same report shows that public spending on these for-profit centers has ballooned, while surgical capacity in public hospitals has actually declined. 

  • Additional cost-inflation concerns arise from contract negotiations: according to internal documents, some CSFs have raised their rates sharply, with increases that far outpace general healthcare inflation.

These fiscal dynamics directly challenge the reformers’ argument that a mixed public-private model will save money or relieve pressure on the public system. In practice, profit motives and administrative burdens may actually increase net cost to taxpayers.

Why This Matters for Alberta’s Reform

Putting Alberta’s dual-practice proposal in light of this evidence raises several red flags:

  1. Behavioral Risks Are Not Theoretical
    The empirical record—from Manitoba’s cataract backlog to global dual-practice studies—shows that unless tightly regulated, dual-practice systems create strong incentives for physicians to prioritize private over public patients.

  2. Governance Deficits
    The WHO and other reviews stress that governance mechanisms (regulation, oversight, conflict-of-interest rules) are often weak or underdeveloped. Without robust oversight, the negative externalities of dual practice can erode public-system integrity.

  3. Cost Overrun Potential
    The assumption that private delivery will reduce public costs is challenged by real-world data: in multiple jurisdictions, private delivery has proven more expensive, and the administrative costs of managing two parallel systems can consume or even outweigh the projected savings.

  4. Equity Implications
    Because private services are often accessible to wealthier patients (or insured ones), a dual-practice model can reinforce or worsen health inequities. Public patients may end up disadvantaged—not just by longer waits, but also by being systematically routed into lower-capacity or under-resourced public segments.

Alberta’s proposed dual-practice reform may be sold as a pragmatic, win-win solution—but the empirical record warns that such models are fraught with structural risk. Historical Canadian cases, global reviews, and recent cost-overrun evidence all suggest that dual practice, if not carefully constrained, tends to siphon capacity, degrade equity, and drive up public expenditures.

If Alberta proceeds along this path, policymakers must pay close attention to governance, regulation, and rigorous cost-benefit assessment—not just ideological appeals to market efficiency. Without strong checks, the “solution” risks becoming a backdoor privatization that undermines the public system’s long-term sustainability..

The Scandinavian Fallacy vs. The American Spectre

The invocation of Scandinavian mixed-delivery models—often deployed by advocates of Alberta’s reforms—is a powerful rhetorical device but a profoundly misleading one. Premier Smith referenced countries such as Sweden, Germany, and Australia as successful examples of dual-model systems, and Nadeem Esmail of the Fraser Institute argued that the proposed reforms would align Alberta more closely with global norms. This logic trades on the prestige of high-performing European health systems while obscuring the very conditions that make those systems function.

Scandinavian Models Operate Under Vastly Different Structural Conditions

Countries like Sweden and Norway do indeed maintain mixed public–private delivery arrangements. However, these systems are embedded within—and dependent upon—structural conditions that bear little resemblance to Alberta’s fiscal, regulatory, and political context. Scandinavian systems combine strict regulatory controls, robust public financing, centralized health workforce planning, and unusually high levels of social spending. Private-sector participation remains supplemental, tightly circumscribed, and designed explicitly to avoid the siphoning of personnel, resources, or political support away from the public system.

The balance of probabilities suggests that selectively borrowing the form of Scandinavian dual practice—while refusing the substance that sustains it—amounts to an attempt to produce high-equity outcomes under incompatible institutional conditions. Fiscal conservatives in Canada frequently argue that public services are already overburdened, yet the very Scandinavian systems they invoke rely on higher taxation, more generous social insurance, and deeply coordinated governance mechanisms to achieve the outcomes used to justify reform. It stands to reason to expect that importing only the “private option” component effectively amputates the institutional foundations that prevent dual practice from widening inequities or distorting incentives.

The Evidence on Parallel Systems: Access and Equity Concerns

Canadian medical organizations have consistently warned that dual practice risks transforming health care into a two-tier system, with preferential access for those able to pay. The Canadian Medical Association and Canadian Doctors for Medicare emphasize that queue-jumping is not merely a theoretical concern but an unavoidable feature of systems where private pay creates differential access pathways. The British Columbia Supreme Court’s 2020 ruling against Cambie Surgeries Corporation made this point with exceptional clarity. The court concluded that introducing parallel private care would:
• increase public-sector demand,
• reduce public capacity,
• raise system-wide costs,
• incentivize physicians to prioritize private over public practice,
• increase risks of ethical conflicts,
• undermine political support for public funding, and
• exacerbate inequities in access to medically necessary care.

This comprehensive judicial assessment underscores that dual practice does not simply coexist with public access—it fundamentally reshapes the allocation of time, talent, and resources in ways that disadvantage public patients.

International evidence reinforces these findings. Countries such as Australia and the United Kingdom, which maintain sizeable private-pay sectors operating parallel to public systems, have not seen reductions in public wait times. In many cases, public wait times have remained static or worsened, despite significant private-sector expansion. The balance of probabilities indicates that private practice redistributes rather than creates system capacity. Those with financial means benefit from faster access, while public-system patients face longer queues as physicians shift time and attention toward higher-revenue private work.

Alberta's Current Wait Time Crisis: Context and Causes

Understanding the magnitude and drivers of Alberta’s wait time crisis is essential for evaluating the merits and limitations of proposed reforms. Alberta currently faces some of the longest specialist wait times in Canada. Orthopedic surgery patients wait an average of 46.1 weeks from referral to treatment—nearly double the national average—and recent estimates place the median wait to consult an orthopedic surgeon at approximately 64 weeks. Premier Smith has noted that more than 80,000 Albertans are waiting for elective surgeries such as hip and knee replacements. These figures are not abstract metrics but indicators of profound physical suffering, reduced mobility, and diminished quality of life for tens of thousands of residents.

However, it stands to reason to expect that the roots of these delays extend far beyond payment models. Analyses consistently show that surgical wait times are driven by structural bottlenecks—particularly shortages of operating room capacity and nursing staff—while physician compensation models rank low among explanatory factors. The COVID-19 pandemic further strained an already overstretched system, but Alberta’s targeted measures—including the expansion of accredited private surgical centres, the addition of operating rooms in public hospitals, and the implementation of centralized intake pathways—demonstrate that incremental, system-focused reforms can produce measurable improvements without fundamentally restructuring physician payment arrangements. The balance of probabilities suggests that Alberta’s comparatively strong pandemic-era surgical performance, maintaining higher completion rates than Ontario, reflects the effectiveness of these targeted interventions rather than any need for sweeping dual-practice reforms.

The Naïveté of Supply-Side Simplification

Proponents of dual practice often assert that allowing physicians to work privately after meeting minimum public commitments will “eliminate the gap between supply and demand for doctors.” This represents a significant oversimplification of the structural realities that drive workforce shortages. Alberta’s health-care capacity challenges stem from intertwined labour, training, and institutional dynamics that dual practice does nothing to resolve.

Workforce Planning and Training Pipeline Constraints

One of the most binding constraints on physician supply is the limited number of medical school placements and residency positions—both tightly rationed across Canada. Alberta also faces protracted delays in integrating internationally trained physicians, due to credentialing barriers and regulatory fragmentation. The balance of probabilities suggests that these pipeline constraints—rather than physician payment models—set the upper limit on provincial health-care capacity. Introducing dual practice does not expand medical school enrolment, increase residency training slots, or streamline assessment for international graduates; it simply redistributes how existing physicians allocate finite time.

Retention and Burnout in the Post-Pandemic Environment

Retention challenges compound these structural shortages. Burnout, worsened during the COVID-19 pandemic, has driven many physicians and nurses toward early retirement, reduced clinical hours, or alternative career paths. It may be argued with considerable confidence that dual practice risks worsening this trend. By creating a more lucrative and flexible private alternative, it incentivizes practitioners to reduce their public commitments in favour of environments offering greater control over scheduling, workload, and remuneration. Far from stabilizing the workforce, the policy may accelerate the shift of experienced clinicians out of the public system, deepening capacity shortfalls rather than alleviating them.

Geographic Imbalances and Rural Health-Care Deserts

Critical shortages in rural and remote regions remain one of Alberta’s most persistent and politically sensitive health-care challenges. The balance of probabilities strongly suggests that dual-practice policies will overwhelmingly incentivize physicians to concentrate in high-demand, high-income urban centres where private surgical markets are most financially viable. Surgical wait times already vary sharply across regions, mirroring longstanding disparities in health-care access, staffing capacity, and facility availability. Market-based reforms, by their very nature, systematically favour areas capable of sustaining profitable private-pay practices—precisely the opposite distribution required to support under-resourced rural communities.

It stands to reason to expect that Alberta cannot close the structural “gap” between supply and demand by enabling physicians to gravitate toward lucrative private-market opportunities while failing to address chronic underfunding, recruitment challenges, and inefficiencies in public workforce management. This represents a form of trickle-down health policy that assumes expanded access for wealthier, private-pay patients will somehow produce downstream benefits for the public system—a proposition lacking empirical support in comparable jurisdictions.

The Canada Health Act: Compliance Questions and Federal Response

The proposed reforms raise serious questions regarding Alberta’s compliance with the Canada Health Act (CHA), which prohibits extra-billing or charging for medically necessary services already insured under provincial plans. Several medical leaders have warned that the dual-practice proposal could put Alberta in direct conflict with federal legislation. Dr. Paul Parks, past president of the Alberta Medical Association, warned the reforms could constitute a “death blow” to the Act—an assessment that reflects the unprecedented nature of the proposed flexibility for physicians to toggle between public and private billing streams.

Guillaume Bertrand, director of communications for federal Health Minister Marjorie Michel, stated that Ottawa “will always protect” Canada’s universal health-care system, confirming that Health Canada officials are actively engaging with Alberta counterparts to analyze the reforms and their potential implications. This signals early-stage federal scrutiny and suggests the federal government is preparing for a more assertive posture should Alberta proceed.

Ottawa possesses well-established enforcement mechanisms for provincial non-compliance. The CHA requires mandatory dollar-for-dollar deductions from federal health transfers in cases of extra-billing or user fees. Historically, these penalties have been substantial: between 1984 and 1987, $244,732,000 in deductions was refunded to provinces—including Alberta—after non-compliant charges were eliminated. More recently, in March 2023, more than $76.4 million in Canada Health Transfer deductions were levied against British Columbia, Alberta, Saskatchewan, Manitoba, Quebec, New Brunswick, and Nova Scotia for medically necessary diagnostic services that had been improperly billed to patients.

Legal experts caution that Alberta’s dual-practice model—unprecedented in Canada for allowing physicians to actively operate in both systems simultaneously—would almost certainly trigger legal challenges and potential clawbacks. The balance of probabilities suggests the reforms will face significant federal scrutiny, and Alberta risks material fiscal penalties should components of the proposal be deemed inconsistent with the CHA.

Institutional Perspectives: Professional and Advocacy Responses

The response from the medical community reflects deep divisions and significant concern regarding the reform’s design and potential consequences. The Alberta Medical Association (AMA) insists that any health-care reform must be evidence-based, transparent, and developed through meaningful engagement with physicians, patients, and frontline providers. The AMA has articulated specific conditions for any dual-practice framework, including:

  • clear conflict-of-interest policies to prevent physicians from steering patients toward private options;

  • safeguards to prevent public resources from subsidizing private services;

  • mechanisms to ensure adequate public-system workforce allocation, particularly for highly complex and emergent care;

  • rigorous prioritization of medically necessary services in resource planning;

  • and maintenance of access based primarily on need, not ability to pay.

Advocacy groups have expressed even sharper concerns. Friends of Medicare argues that the reform would make Alberta the only jurisdiction in Canada to allow doctors to work freely in both systems—an arrangement they characterize as “an unprecedented attack on Albertans’ public health care” that would “unequivocally bulldoze a path for American-style health care in Alberta.” Chris Gallaway, the organization’s executive director, questioned how the proposal could remain compliant with federal law and asserted that the UCP government has persistently sought mechanisms to redirect public dollars toward private profits, allegedly contributing to higher costs, longer waits, and chronic understaffing.

It may be argued with substantial confidence that these critiques reflect not ideological alarmism but well-documented empirical patterns in countries operating dual-practice systems. The concerns raised by medical professionals and advocacy groups map closely onto known outcomes—crowding out of public-sector care, widening equity gaps, and destabilization of public capacity—observed internationally when financial incentives are allowed to pull physicians toward private practice at the expense of public commitments.

Alternative Reform Pathways: Evidence-Based System Improvements

The severity of Alberta’s current health-care crisis requires urgent, pragmatic intervention. However, the balance of probabilities strongly suggests that robust, evidence-based alternatives to dual practice offer far more credible pathways for improving system performance without undermining the equity principles at the core of Medicare. These alternatives are grounded in international best practices, empirical evaluation, and structural reforms that actually expand system capacity rather than simply reshuffling existing providers.

Activity-Based Funding and Improved Resource Allocation

Alberta has announced plans to implement activity-based funding (ABF) beginning in 2026. Under this model, health-care providers are compensated for each patient treated, with payments calibrated to the patient’s diagnosis, acuity, and complexity. Nearly every advanced universal health-care system—from Scandinavia to Western Europe to Australia—relies on variants of ABF. The empirical record indicates that such models consistently increase the volume of services delivered using existing infrastructure, reduce wait times, improve quality, enhance access to cutting-edge medical technologies, and decrease wasteful spending.

It stands to reason to expect that activity-based funding directly addresses one of the central inefficiencies in Canada’s current model: the perverse incentive structure of global (lump-sum) hospital budgets, which can lead institutions to view additional patients as cost burdens rather than service imperatives. ABF changes this calculus by tying funding to outputs rather than fixed annual envelopes. Unlike dual practice, it does so entirely within the public system and without creating financial incentives for physicians to divert time away from publicly insured patients. The result is a structurally aligned, equity-preserving mechanism that enhances efficiency while upholding the universality provisions of the Canada Health Act.

Expanded Roles and Team-Based Care

International evidence overwhelmingly shows that expanding the scope of practice for non-physician professionals can yield substantial improvements in wait times and care quality. Nurses and nurse practitioners performing pre-admission assessments, biopsies, hysteroscopies, endoscopic procedures, chronic disease management, and other delegated tasks have enabled specialists to focus on complex surgical and diagnostic cases. Jurisdictions such as the United Kingdom, the Netherlands, and New Zealand have demonstrated that these task-shifting strategies materially expand effective system capacity.

The balance of probabilities suggests that optimizing health-care team utilization constitutes a true supply-side reform—one that increases the total volume of care delivered rather than merely redistributing a finite pool of physician labour between public and private settings. Unlike dual practice, which structurally incentivizes physicians to prioritize higher-paying private work, team-based care reforms expand the range of providers capable of delivering timely, high-quality care within the public system.

Digital Health Infrastructure and Process Improvements

Investments in digital health infrastructure—such as interoperable electronic health records, national patient-tracking platforms, shared diagnostic imaging systems, and province-wide referral management tools—have demonstrated significant improvements in efficiency across numerous international health systems. When combined with process improvement methodologies (Lean, Six Sigma, clinical pathway redesign, centralized booking, and queue management algorithms), digital transformation can reduce bottlenecks, streamline patient flow, and shorten wait lists without undermining the foundational principle of universal access.

These innovations do not depend on market segmentation or private-sector diversion. Instead, they enhance the functionality of the public system itself. A growing body of evidence from jurisdictions such as Denmark, Estonia, and the United Kingdom shows that integrated digital systems can reduce duplication, accelerate diagnostics, and enable data-driven resource allocation—all without introducing inequities or imposing user fees.

These evidence-based alternatives share a crucial characteristic: they focus on genuine capacity expansion, structural efficiency gains, and equitable access, rather than creating parallel markets that risk draining resources from the public system. In contrast to dual practice—which depends on redistributing existing labour while introducing powerful incentives that may destabilize public provision—these reforms strengthen the system from within.

Conclusion: A Crisis of Democratic Values, Healthcare Equity, and System Stewardship

The debate surrounding Alberta’s proposed dual practice reforms now stands as far more than a contest over administrative design or service delivery modalities. It has evolved into a decisive test of Canada’s democratic commitments, institutional integrity, and the foundational principle that access to medically necessary care should reflect clinical need rather than purchasing power. Alberta is not merely adjusting governance mechanisms—it is redefining the moral and constitutional architecture of Canadian healthcare.

The draft amendments would authorize physicians to determine, on a case-by-case basis and without notification requirements, whether a patient is treated within the public system or in a privately paid setting. This discretionary model is not benign. It creates structural and behavioural incentives—mapped extensively in comparative health-systems research—that enable systematic capacity diversion from public to private channels. The result is a predictable pattern in which patients with financial resources consistently secure faster access, while those reliant on public insurance face longer waits, diminished continuity of care, and reduced provider availability. The policy architecture itself manufactures inequity.

The promise of a market-driven solution that can simultaneously reduce wait times, lower public expenditures, and preserve investment for other public services is, as the evidence demonstrates, analytically inconsistent. Jurisdictions that successfully integrate limited private activity—particularly in Scandinavia—do so under regulatory regimes far more stringent, transparent, and resourced than anything contemplated in Alberta. They rely on rigid separation rules, real-time monitoring of clinical hours, mandatory disclosure, robust enforcement, and—critically—sustained investment in the public workforce. Alberta’s reforms include none of these safeguards. Without them, dual practice becomes not a supplement to public capacity but a conduit for its fragmentation.

International comparisons reveal a consistent reality: countries with shorter wait times do not succeed because they introduce more private financing or delivery. They succeed because they manage personnel, productivity, and investment more effectively. Their advantage lies not in ideology but in institutional design—activity-based funding that aligns incentives without abandoning universality; team-based models that expand real capacity rather than redistribute existing bottlenecks; digital infrastructure that reduces administrative frictions; and long-horizon workforce planning that stabilizes service availability. These principles, not privatized dual practice arrangements, are the evidence-based lever for modernizing Canadian Medicare.

On the balance of probabilities, the socioeconomic costs of a two-tiered system—where the speed and quality of care become contingent on financial means—will surpass the fiscal and political challenges posed by Alberta’s current wait time pressures. Once private financial incentives become embedded in clinical decision-making, reversal becomes not only administratively difficult but politically fraught. The erosion of universality is gradual, silent, and cumulative—yet once the equilibrium shifts, it cannot easily be restored.

The implications extend well beyond provincial borders. Premier Smith’s government is advancing regulatory changes that would inaugurate the most consequential restructuring of Canadian healthcare since the establishment of Medicare. The question facing Canada is not whether reform is necessary—system strain is real and mounting. The question is whether reform will be guided by evidence, stewardship principles, and the constitutional ethos of equality, or by untested market mechanisms that privilege the affluent while fracturing the collective foundation upon which Medicare rests.

History and international health-systems research converge on a clear conclusion: dual practice models, absent exceptional regulatory architecture and significantly increased public investment, systematically degrade access, equity, and public-sector performance. Alberta’s current trajectory aligns not with the successful hybrid systems of Northern Europe but with jurisdictions where privatization has entrenched inequality and weakened public care. The balance of available evidence suggests that the reforms as proposed will not deliver innovation or efficiency, but rather initiate an incremental dismantling of universal Medicare—one that, once underway, may be effectively irreversible.

At this moment, courage is required—not the courage to experiment with market ideology, but the courage to pursue genuine, evidence-based system renewal. Canada’s commitment to healthcare as a core democratic right is being tested. The future of that commitment will be determined by whether policy-makers choose to reinforce the principles that have long safeguarded equitable access, or to abandon them in favour of a model whose risks are well known, and whose consequences will be borne most heavily by those with the least ability to pay.