what would have happen if the Shah of Iran had been healthy and alert

Not a whole lot because cycles of revolution don't change with the health of the monarch.
 
He would've probably cracked down instead of vacillating between appeasement and repression; it would have most likely worked as well.
 
He would not have gone to the US for medical treatment. So there is no hostage crisis. rrReagan wins by a narrower margin. I don't where the Shah goes into exile.
 
He would've probably cracked down instead of vacillating between appeasement and repression; it would have most likely worked as well.

I don't think his decision not to crack down on the protestors had to do with his health.
 
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