I never knew this was actually about George W. Bush. Little Carmine is Dubya... that "The fundamental question is, will I be effective as a boss like my dad was? And I will be. Even more so. But until I am, it's gonna be hard to verify that I think I'll be more effective" at the end is almost identical to something Dubya said
"The fundamental question is, 'Will I be a successful president when it comes to foreign policy?'
"I will be, but until I'm the president, it's going to be hard for me to verify that I think I'll be more effective."
-George W. Bush, as quoted in the New York Times, June 28, 2000
And Rusty sucking up to Little Carmine, talking about he had a quadruple bypass, and encouraging Little Carmine to make a pre-emptive attack on Johnny Sack, is supposed to be dikk Cheney. Cheney had a quadruple bypass too, and you know he's the one who encouraged Dubya to invade Iraq