Yes, I think the real trend is the rise of the overseas middle class which is competing with the US middle class.
I also believe that the idea that a President controls the economy is superstition. The economy is larger than the government, and Presidents are just lucky or unlucky for events to transpire while they are sitting at their desk.
Yeah medicine has long been considered one thing that can't be outsourced.
Except it can: and then careers are ruined. You picked the one aspect, nursing, that can never be outsourced. I guess we'll all be nurses in the long run.