The get rich quick paradigm of tech makes everyone think they're not worthy.
Its a marathon. Not a sprint.
Probably a matter of time until programming is another power-law career like music or law is, where only the top hundred or thousand in the world can get by.
I don't think that's correct - music or law employs a ton of working professionals at all levels. If working at one of the big companies is the measure of "getting by" that means if you're a lawyer in a small town you're probably not getting by, which is absolutely not the case.
1. Get hired by an SV-area startup that cares more about how interested you are in them than the other way around (assuming you're good).
2. Relocate (or pretend you've relocated) to the SV-area, and suddenly you appear on recruiters' radar.
I did #1, but interest from random recruiters before/after the move was practically like a step function. I've heard stories of people doing #2, and it working out for them.
Just practice those types of problems, apply to a bunch of different companies, do the phone screens, get rejected, practice some more, get through the phone screens to the onsite, get rejected, repeat until you get an offer.