To find a better thesis, we might ask, what's the difference between my dentist and WeCodeLikeNoOneElse, Inc?
I think the main difference is reputation, the role it plays the given marketplace. I'm not sure why, but the market for offshore development has never counted on reputation. I can't name a single firm. I can't even remember the name of the firm I recently interacted with as a contractor coming in to to clean up their mess. If I were to suss out any one of the unsolicited Linked In offers for cheap development I get each week, where would I even start?
My dentist has built up a loyal clientele by word of mouth in the community over a lifetime. The community is small enough that a shady dentist would be run out town in no time.
Conversely, I do know the names of some local dev shops, and I know their reputations. The ones with good reputations do not treat their clients purely as cash cows. Although they face the same, or worse pressures on utilization, they do quality work, at a premium. They have built brands and will grow or sink mostly on reputation. They still constantly face incentives to pump out shit, but there's a counter balance that's missing in the offshore outsourcing market.