Hacker News Reader

Comment by alephnerd | Hacker News Reader

They've also begun heavily pivoting hiring for dev roles to India now as well. I have cousins who attended no name universities in India getting SWE roles in Amazon - something that was unimaginable 5 years ago - and expanding Dev offices to lower CoL cities like Hyderabad while slowly pivoting away from Bangalore.

Addendum:

Also, the Indian branches (edit: of companies that aren't Amazon) are fairly remote work friendly. Now you have people earning $20-40k/yr living in their ancestral towns and villages where median incomes might be $3-5k

This is why I warned HN that remote first will make tech more competitive.

View on HN

I see the same trend with Google, Facebook, okta etc. There are multiple factors. Ofcourse from orgs perspective it is cost saving measure. But from another phenomenon that has happened is that graduates from lower tier colleges have gotten good in cracking leetcode, faang style interviews.

There YouTube channels, blogs, website tuned to pass these interviews in India.

> graduates from lower tier colleges

Lower tier colleges have gotten much better in quality too.

I remember Indraprashta came to recruit Indian PhD students at my Ivy League tier college to become tenure track CS/ECE/EE professors.

Plenty of lower tier IIITs and regional engineering colleges are getting Western or Top Tier IIT trained faculty, and students are higher quality now as well.

As the child of a dad who attended one of these no name RECs who ended up becoming tech leadership here in the Bay, I'm glad that this democratization has occurred. The BITS Pilani and IITian uncles were very snobby and annoying.

What you cite is one factor. Another factor is access for students. Once upon a time, curious students had two choices: buy books to learn on their own; or go to whatever low quality teachers they had. Cheap internet, YouTube, LibGen, other resources help students as long as the latter desire to learn.

Quality is a relative term. We have been hiring in India for past 2 years. I can tell you there is lot of noise and no substance. There is only handful of good candidates and they know they are good.

In India it's crazy because culturally they focus so much on the credential. It wasn't that long ago that if you were an Indian engineer and you weren't a graduate of IIT, you had no chance of working for these companies. The entire Indian hiring funnel is based on that system and it will be hard to change.

There is a a reason why people focussed on IITs. To be very clear, not every engineer graduating from IIT is good. But chances of finding a good engineer is probabilistically higher in IITs than other place. Also, when you are manager or startup, credential-led hire is medal of honour.

> I see the same trend with Google, Facebook, okta etc

Facebook doesn't have a Engineering office in India.

Doesn't Infra have a presence in Bangalore?

https://www.metacareers.com/jobs/634858362137026/

I have encountered this during my time recruiting as well, where the same position I applied for was also listed for 1 day (then taken down) in Hyderabad. Likely stealthily collect applications. Ultimately, they said I passed the rounds, but the role was cut.

Microsoft has also explicitly expanded their hiring in India robustly for dev positions.

When companies tell you how infeasible remote work is and that you need to come in to the office, take it with a grain of salt that it is solely infeasible for you to wfh at your billing rate.

> They've also begun heavily pivoting hiring for dev roles to India now as well. I have cousins who attended no name universities in India getting SWE roles in Amazon - something that was unimaginable 5 years ago - and expanding Dev offices to lower CoL cities like Hyderabad while slowly pivoting away from Bangalore.

Amazon always had a policy to not judge candidate based on their universities. It's not new.

> expanding Dev offices to lower CoL cities like Hyderabad while slowly pivoting away from Bangalore.

Please don't call hyd low CoL if you don't know about it.

> Also, the Indian branches are fairly remote work friendly

3 days from office like all the other office.

> Now you have people earning $20-40k/yr living in their ancestral towns and villages where median incomes might be $3-5k

Covid time is long gone.

> hyd low CoL

Lower than Bangalore or Gurgaon. It's easier to operate a tech company from HYD financially than in Haryana or Karnataka.

> Covid time is long gone

Well, tell that to my cousins who are still working remotely in tech from their ancestral villages in Himachal/Jammu/Punjab.

> Well, tell that to my cousins who are still working remotely in tech from their ancestral villages in Himachal/Jammu/Punjab.

What I can say is that there is no special treatment for SDEs working from India, especially regarding the WFH policy.

Oh, you're talking solely about Amazon. Ok fair.

Same hiring dynamic in Mexico.

They started hiring heavily for various roles in the country's 3 major metro cities. Senior engineering roles going for $60K/yr USD.

Amazon, the retail side, has been operating in the country for years, but the hiring spree that started this summer 2023' has been for positions in Music, AWS, Devices and Real Estate.

I heard about that. A good buddy of mine who attended UT ended up moving to CDMX to work remotely for Reddit. He's earning around $70k which is honestly pretty great.

If he's single, $70k for CDMX (Mty or Gdl, the other two metro cities) it can work, if he wants to raise a middle-class family not so much.

Rents are $1.5-2K/month in nice neighborhoods (buy range $250K up); taxes are high with a 16% VAT across the board, income taxes are high as well for this bracket; and don't get me started with schools, cars, insurance and the like.

Yeah probably half the population would 'kill' for a $70k job, but they want English fluent, highly-educated, middle-class people, cherry on top, with top notch tech skills. Those candidates either want, U.S. SDE level packages or can make more with run of the mill no-name companies remotely.

I still don't know anyone who has worked for U.S. level pay as a FTE or contractor, take a position with a subsidiary office in Mexico, the salary discrepancy is too great.

The U.S. government should be concerned. The U.S. tax base could very well implode with outsourcing, ai, and offshoring in the next 10 years.

This is why you encourage immigration.

If you prevent talent from coming to the US, companies will follow the talent.

This is why American cybersecurity and networking has almost entirely been outsourced to Israel and India and chip manufacturing to Taiwan and South Korea.

I do not understand how we got to this point. India is not in the U.S. sphere of influence and has not even voted to condemn Russia.

It’s really a sign of how weak the U.S. government has become, which is heartbreaking. US has found it too expensive to invest in its own citizens. It’s almost a ticking time bomb.

> India is not in the U.S. sphere of influence

Financing the Abraham Accords [0], using American engines in tanks [1], American fighter jet engines in Indian fighter jets [2], and being a part of 2 bilateral treaty organizations [3][4] absolutely puts India in the US Sphere of Influence.

> has not even voted to condemn Russia

India will never piss off Russia, because India doesn't want Russia to join the Chinese camp [5]. By keeping trade and defense ties with Russia, India minimizes the chances of Russia becoming pro-China instead of neutral during an India-China war (which almost happened in 2020) [6].

Mistreatment of Indian students in Ukraine during the war made a vote in favor of Ukraine politically untenable during election season [7]

[0] - https://www.axios.com/2023/09/07/saudi-india-uae-us-railway-...

[1] - https://www.thehindubusinessline.com/economy/logistics/ameri...

[2] - https://www.reuters.com/business/aerospace-defense/why-ge-pl...

[3] - https://www.state.gov/i2u2/

[4] - https://www.whitehouse.gov/briefing-room/statements-releases...

[5] - https://carnegieendowment.org/2023/11/06/india-in-emerging-w...

[6] - https://theprint.in/defence/nearing-breaking-point-gen-narav...

[7] - https://www.tribuneindia.com/news/punjab/ukraine-crisis-stra...

In some ways it is a U.S. ally. But don’t tell me you are going to buy Russian oil and not side with the us in Ukraine and tell me you are under our influence.

Any development in a country that has not washed its hands of Russia should be illegal for selling in the us.

In addition, the recent argument with Canada over the killing over a citizen on Canadian soil comes into play here. That is not what s country under western influence does.

> you

I'm American.

> are going to buy Russian oil and not side with the us (sic) in Ukraine

Well,

1. That oil goes to the EU. If there's a buyer, there's going to be a seller [0]

2. It's at margins barely above the cost to extract, which is as big a financial hit you make make [1]

3. As pointed above, China is the bigger bad to India instead of Russia. It's better to keep countries neutral in a future India-China war

> Any development in a country that has not washed its hands of Russia should be illegal for selling in the us.

Thank god you don't work at the State Department. That's how you alienate every country that isn't in North America and Europe.

China would have the pick of the litter.

[0] - https://www.bloomberg.com/news/articles/2023-11-27/europe-is...

[1] - https://www.reuters.com/markets/commodities/revenues-russias...

I understand the need for the us to sacrifice somewhat in order to tame the bigger bad.

However, the us is operating from weakness here which is not okay and the situation should have never been allowed to develop to this point. Ironically it may be outsourcing and offshoring in the first place that led us here.

US critical infrastructure development should not be outsourced to countries who have any contact with countries that are we are in a proxy war with.

Russia has supported India in multiple occasions when US was against Indian interests. The neutrality policy of India has supported it better than taking sides and it'll continue for the foreseeable future.

[0] https://www.reddit.com/r/india/comments/1751o2e/comment/k4dr... [1] https://www.reddit.com/r/NoStupidQuestions/comments/xssv8o/c...

No international relations expert, afaik, would say India is in the US sphere of influence; the US specifically says India is not (in what I've seen). India is an independent power that is growing its relationship with the US. It also has relationships with Russia and with others. China happens to be an adversary, which strengthens the US relationship for now.

India is nearly unassailable. Nobody can really conquer a country of 1 billion people anyway, economically they have the size (and therefore power) to be independent-minded, and geographically there is no neighbor that is now a serious threat: China can bicker and skirmish but would have to cross the Himalayas to fight a war, which is impossible. Pakistan has nuclear weapons, but those are useless other than to deter an existential attack by India - using them would be suicide. Bangladesh lacks economic, political, and military power. Others are too small.

India doesn't need to be in the US 'sphere' and serve US interests.

I think they are still mad about Ukraine supporting Pak on Kashmir in UN and selling them bunch of tanks 20+ years ago. What I don't get is why Pak FO didn't remind IK of that when he visited Russia. Maybe they were that hard up for oil.

India is assassinating people on US and Canadian soil. And more importantly, the US and Canadian governments are being very officially-public about it.

Let that sink in.

I'd be shocked if China isn't assassinating people too. They definitely have established "police stations" here and are conducting operations against dissidents and their families, but maybe it hasn't crossed into actual murder. If it has, the US and Canada aren't talking about it; they're barely talking about, or doing anything about, the secret police stations.

> India is assassinating people on US and Canadian soil.

I've clearly missed something here. Where can I learn more about what you're referencing here, or what Google search would point me in the right direction?

The Washington Post has written about this a fair bit, including an article from the editorial board. "washington post indian assassination" should give you some reading.

Basically India made plans to assassinate someone on US soil, got found out and then carried it out on Canadian soil.

Here’s the first hit for “India assassinate Canada” https://www.nytimes.com/2023/11/30/world/canada/india-assass...

Maybe Modi took a hint when Trump practically laughed off the Khashoggi assassination.

Is the issue not enough talent in the US, or not enough talent at a desired salary range? One of the guys here is talking about people making 30k USD. My guess is there is not much American talent at that pay range, even if there's plenty of talent available here generally.

Old story retold. The Claudian Roman government doubled down on the distinction between barbarian and Roman civilian and used shitty rhetorical tools to denigrate the barbarians. This all despite the fact that most Romans farms and undesirable jobs were still being done by "barbarians." It's almost like looking into a mirror of history. The end for Rome was not far beyond Claudius.

Which Claudius?

I never read Roman history beyond 6th and 7th grade history and AoE 1's campaigns, but I think Roman analogies would make it easier to drive my point to a couple people.

I feel like the correct compromise for our conversation would be requiring strict clearance control for products in certain sectors.

The reality is that if you work on a banking product for instance you might find an exploit you can use and keep secret and use to your countries benefit. That’s why these positions need clearance controls.

Even a benign program like a text editor could have a back door installed to spy on the us.

I am curious to hear your thoughts. Thanks.

There is no solution. US, Israeli, and Indian cyber-infrastructure is completely intertwined.

There's no possible way to decouple without reversing 30 years of development.

The only solution is to justify to Israel and India why they should continue to align to the US, instead of hacking it on their own.

This justification comes from the carrot (FDI, IP Transfers) and the stick (bad press, cultivating alternative allies, tarriffs)

The era of Hyperpower is over. Regional Powers have returned.

The US Policy world has recognized this for a decade and is operating under those assumptions. The issue is the type of person who gets their news from CNN, Fox, Reddit, Zeihan, Telegram, etc isn't exactly the kind to read policy papers or watch C-SPAN

> Even a benign program like a text editor could have a back door installed to spy on the us.

It goes both ways. Meta is an American company with development done in the US. Everyone uses WhatsApp at the senior levels outside of North America. Everyone other than China uses Google as their primary search engine. Everyone uses MS or Apple as their primary OS

I don’t agree with the premise that it is impossible to reverse . Frankly , security concerns should be treated as a priority one and heaven and earth should be moved to rectify the situation. It’s definitely not impossible just difficult. Frankly, we should be focused on solving hard problems that have high impact like this.

I also think that in sourcing is an investment in the us citizen, something that all companies operating in the us should be obliged to do.

https://en.wikipedia.org/wiki/Claudius_Gothicus who's reign was pretty late in the Empire phase, though good news for the U.S. it took another 150 years once they started crowning barbarians emperors before it all went to shit. Ironically, it was the emperors from barbarian territory who led the effort to keep second class and first class from mixing; which also rings a little true in our current U.S. political climate.

I thought it was Gothicus!

I would feel better if some of positions being outsourced required some sort of clearance . I really feel like certain development , like banking products / power grid / cyber security products for instance, should require a clearance to work on.

> This is why you encourage immigration.

Our problem doesn't really seem like a lack of encouragement for immigration. We have plenty of people trying to come here, we either don't want the people attempting to come or don't want immigration at scale at all.

Social programs and entitlements are really all the encouragement needed for immigration, as long as you're legally allowed to immigrate and get a job at all. Is the question really how do we encourage the "right" kind of immigrants for the skills or roles we want to expand?

> how do we encourage the "right" kind of immigrants for the skills or roles we want to expand

Remove a decade long backlog for Indian nationals coming to work in Skilled fields (STEM, Accounting, Healthcare, Finance, Law) by speeding up processing times by hiring more bodies at USCIS Processing Centers.

And also maybe not forcing every Chinese national who studied STEM in China to go through enhanced background checks [0].

And also hiring more immigration judges (I knew a former Immigration Judge with the DHS - they de facto had a hiring freeze since the 2010s, leading to case backlogs).

Tl;dr - stop defunding the DHS and USCIS

[0] - https://www.federalregister.gov/documents/2020/06/04/2020-12...

Agreed all of those can and should be done. IMO none of those are related to encouraging immigration though, only removing legal blockers.

The incentives exist, we just need to get out of peoples' way and let people immigrate here.

Alternatively, we could alter the statue of liberty and remove the poem if we collectively don't want to welcome immigrants of all skills and situations.

> encouraging immigration though

Skilled Immigration is already encouraged by the salary bump.

The issue is skilled immigration has been backlogged, as the existing system hasn't been reformed since the 2000s.

It's the backlog that pushed Chinese, South Korean, Taiwanese, and now Indian immigrants to consider staying put instead of spending 5-10 years living under the fact that you might be asked to leave in 60 days.

Sure, but that was my point. We need to remove barriers, we don't need to further encourage immigration.

There are plenty of federal agencies that are underfunded or being tacitly defunded, DHS is absolutely not one of them.

USCIS:

https://immigrationimpact.com/2023/01/17/uscis-funding-crisi...

Maybe we're thinking of different things, but isn't the backlog for Indian citizens caused by a fixed number of visas per year and per country caps? If you track the visa bulletin [0] they call out when a green card number is ready for your category, and India has its own set of dates because their country is so oversubscribed.

0 - https://travel.state.gov/content/travel/en/legal/visa-law0/v...

Maybe ... but this is almost word for word what my college counselor told me in 2001 when encouraging me not to study computer science, and I've heard some variant of it again and again ever since. What I think is that supply and demand will continue to ebb and flow, as will compensation, but that the ability to create software is a useful skill that will continue to be compensated pretty well for the foreseeable future.

It will need to be tied in with a real abet engineering discipline the future , at least domestically.

This is more or less why I said the useful skill is the ability to "create software", not to "write code".

One end game may well be that a lot of people who are today "product managers" will use increasingly capable AI assistants to "create software" without writing much, if any, code. But in that world, I think a lot of people who are today "programmers" will also be very well suited to creating software in that way, and will have no trouble transitioning into those roles if that's where the opportunities are.

Saying that kids shouldn’t need to study computer science is like saying kids shouldn’t need to read and write because the market for literate people is saturated. Code is the toolset for the modern economy.

So, this is an easier case to make today (though to be honest I remain pretty skeptical of this), but in 2001 this was very far from being clear cut. The dot-com bubble had just burst and software looked like it might be a small niche or even just a fad in permanent decline.

I wouldn't underestimate the tolerance our system has for paying people to do otherwise unnecessary jobs simply to keep employment high and people distracted.

Our system would indeed implode if many went unemployed. Companies would go down with it though, they need people employed so they can spend money and keep the gears of capitalism turning.

I know I sound very cynical here but I don't even mean it as a bad thing. Its just the way this works, for anyone looking to down vote a cynical sounding take I'd be really interested to hear what I might be misrepresenting.

This is nonsense. There is no "system". Individual companies don't hesitate to lay off employees if that improves profits. While a few worthless employees can slip through the cracks at large companies, there is zero chance that employers continue paying large numbers of employees to do unnecessary jobs. Boards have no loyalty to abstract concepts like capitalism.

More jobs can always be invented/created in the name of safety. More regulators, more regulations, more psychological councilors, more child protection specialists, more DEI councilors, more lawyers for more lawsuits, more military divisions (to keep the country safe)... etc. Mainly supported with public funding.

Not saying those aren't real jobs (many certainly are), but I think the scope & number of those jobs can be expanded to fill the void left by more "productive" / "survival" jobs.

Now you're just making things up. Safety professionals make up a minimal fraction of the workforce which has barely increased in recent years. If anything, we should be spending more on workplace safety. Those are hardly useless jobs.

https://www.reuters.com/investigates/special-report/spacex-m...

Companies have been quick to cut DEI jobs as soon as the outside political pressure died down.

https://nypost.com/2023/12/28/tech/google-meta-other-tech-gi...

The military has been cutting personnel. The number of divisions has gone down. Higher military spending has been going towards procurement programs, not towards more uniformed jobs (although some defense contractors have expanded a bit).

With so many companies having layoffs in the last 12 months, were those all unnecessary jobs? If not, were revenue targets or company valuations lowered to match the loss of productivity with fewer necessary positions in the company?

Companies will absolutely continue paying large numbers of employees to do unnecessary jobs, they're incentivized to do so. A growing company is often seen as a good sign by shareholders and no one can really tell whether the new roles are any more or less productive. Existing employees and managers have the benefit of growing teams and getting promoted before anyone sees if the teams over-hired. Holding expendable positions also has the benefit of making for an easy layoff when investors get spooked.

Meaning the company and employees have good reason to hire and keep unnecessary jobs, don't have many short-term downsides as long as it doesn't directly cause a drop in key metrics, and have a built-in backup plan when things turn south and they can show good leadership by trimming the fat.

>living in their ancestral towns and villages

I mean its great to make more money than anyone where you are. However I've known a number of Indian people that have moved to the US that say they will never go back to India unless they are forced to even though comparatively make less money here.

Money is only good if it can buy things. If all your village has is mud huts you are still living in a mud hut. Sure you can now pay people to build you a nice house but you will be paying much more due to the lack of infrastructure. When your plumbing breaks it takes 6mo for someone to come fix it. Still you probably have lots of money. But now you have a visibly nice house. In other words a target in a poor area that is likely crime prone. Now you need to hire security. As expenses pile up it becomes just like in the US where people making $500k+ complain about barely being able to afford their life.

I guess I'm just saying I'm still not worried about India salaries being the magic bullet that companies need to kill high tech salaries.

> a number of Indian people that have moved to the US that say they will never go back to India

Yep! My parents and I are the same. The QoL in even a 3rd tier cow town in the US will be better than an economically vibrant city in India or China. Having clean tap water is (imo) the pinnacle of a developed country.

> things. If all your village has is mud huts you are still living in a mud hut

True, but most Indian villages aren't like that anymore. They have all fairly developed now with electricity, WiFi, decent schools, etc. Go use Google street view - Indian villages may seem messy by Western standards, but they've gotten much better now.

If you're someone who lived in small town or village India your whole life, and go to college to get a good job, if you have the option to earn a big city salary in your small town while being close to your family can be hard to beat.

It's the same reason you see plenty of Techies take remote jobs and live near their families in the Midwest.

Maybe it is just circumstance but I had been working with devs in Hyderabad since at least 2016 when I was at Amazon. I’m sure they are expanding the workforce there, though

They've been in HYD for some time, but HYD is fairly new in the Indian software scene.

Traditionally, Delhi NCR and Bangalore were the big 2 tech hubs since the 80s-90s, but politicians who were also massive landlords in Hyderabad [0][1][2] began giving tech companies tax incentives to move to Hyderabad in the early 2000s

It began as low tier Infosys type work, but began climbing up the value chain in the 2010s

[0] - https://en.m.wikipedia.org/wiki/N._Chandrababu_Naidu

[1] - https://en.m.wikipedia.org/wiki/K._Chandrashekar_Rao

[2] - https://en.m.wikipedia.org/wiki/Y._S._Rajasekhara_Reddy

I mean, I don't know what they do there, but haven't Microsoft had an office in Hyderabad for over 20 years?

Delhi NCR and Bangalore were tech hubs since the 1980s, hence why I'm calling Hyderabad (and Pune) new as they began sprouting in the early 2000s

Indore is becoming the next Hyderabad now as well. It's in the same position that Hyderabad was in the early 2000s.

The only issue I have with that is that they will not allow us citizens to live there and take on jobs.

If it truly were free trade then we could choose to live there and accept a lesser salary.

Eventually offshoring to South America will probably hurt India as that is poised to expand and has overlapping timezones.

Who says you can't do that? They would be thrilled to have silicon valley (or equivalent) talent working for India salaries.

I doubt India government would grant a business visa for that.

They don’t want other countries citizens competing for jobs in their own country, which is effectively what is happening in the us now.

They do, and plenty of Westerners (Indian origin and non-Indian origin) return to India to work for Indian companies, found their own companies, or manage American operations.

Though, IME, it tends to be Japanese, Israeli, Singaporean, and Korean expats who can hack it in India. Western European and Americans are too soft.

I have not seen it happen in a permanent way.

I doubt a visa for generic remote based web dev work would get approved. In fact, I believe the visa even states you have to have a skill that is not readily available in India.

The reality is your generic dev would probably not qualify especially if they are outside of a company.

Humana is starting to hire nurses in the Philippines. One would think that’s a national security hole but what do I know.

The first candidate to promise an outlawing of outsourcing gets my vote.

You don’t have to outlaw it, just make it so economically painful as to be outlawed.

Oh, yes please!

As much as I would like labor laws to be improved Globally, I doubt governments will allow this.

That said, I am dying to see some country try something similar again. There is something beautiful when voters hold politicians up to their values, and politicans fail to explain the competitive realities to their voters.

Making outsourcing economically unviable is a magnicificent contender.

Nursing was always dependent on Pinoy labor.

Because PH used to an American territory until 1946, the education system is largely the same [0].

PH is to the US Medical system as India/Pakistan/Bangladesh are to the UK NHS

[0] - https://nursing.uw.edu/article/filipinos-and-filipinos-ameri...

Indeed, Filipinos are a big part of the US military, and someone's worried about Filipino nurses being a security threat? Hahaha.

https://news.mit.edu/2020/philippines-us-military-alliance-0...

But I'm not sure how well the history of the US in the Philippines is taught even in gen-ed college history classes, let alone, say, high school. One of those topics I think most folks learn about either through personal interest, or as part of a history or politics major in college, apart from maybe a passing mention when covering the tail end of 19th century US history, or maybe a low-context entry in coverage of WWII. I guess it's not as bad as mistaking Puerto Ricans for "foreigners", at least.

> history of the US in the Philippines is taught even in gen-ed college history classes, let alone, say, high school

Depends on the state. I grew up in California, so Asian American history is extremely prominent since 1st grade.

Ah. Plains state here. Maybe that’s to California as Native American history was to us. That, the “age of exploration”, western expansion, very bad revolutionary war history, and the “cradle of civilization” (Mesopotamia) must, collectively, have represented 95% of all our time spent on history, K-6.

We have to import medical professionals (or hire offshored ones, for telehealth or whatever) if we don't want our healthcare system to collapse. We're gonna need to do a lot more of it as the years go on, too.

Too bad we can't import doctors. That's the worst bottleneck.

We're all gonna spend our twilight years being cared for almost exclusively by people who speak English with a heavy accent. The ball's been rolling that way for some time and it's got enough momentum that making anything else happen will take many decades.

It's like a health care ponzi scheme, what happens when the imports get old? The solution again is more imports. What about the source countries, did they not need medical professionals?

Same thing that happens to most who aren't doing pretty damn financially well in the US, I guess? All their savings gets siphoned into the system, then they die younger than they might have, and less comfortably than they should, unless family takes very good care of them? Then debt collectors try to trick anyone connected to them into paying for medical & other debts they aren't responsible for? The usual.

Anyway, worker visas don't have to be a path to citizenship, so this may fall, for better or worse, under "not our problem", depending on how it's all structured.

Which visa is that for the US? The ones I looked at are dual intent. I'm more familiar with the UK (NHS) where imports are expected to stay. I'm also pretty sure that the dual intent is part of the ability to pay under market rates where the immigration potential is a fringe benefit captured by the employer.

Honestly when the current crop of adults from the 'healthy at any size' era get old it's going to be a medical shit show, I'm pretty sure governments will end up resorting to Canadian style MAID for the poor, sick, and old as no-one will have the money for proper care.

Oh yeah, it’s gonna be real bad when the “our ‘thin’ people would have been considered fairly chubby 40 years ago” millennial generation (mine) gets old.

Science might be about to rescue us from that with Ozempic and friends, assuming those don’t turn out to do horrific things to a person over time. Once some of those go generic and the prices plummet, anyway. But failing that, yeah, it’s gonna be a lot of skinny immigrants helping obese, diabetic 70-year-olds with shot knees & backs get to the bathroom. Or maybe we’ll get robots for that, by then, go full Wall-E, who knows.

Yeah it’s the millennials I’m currently worried about, they’re also quite relatively poor so I suspect not many will be able to afford to retire let alone a high level of medical care.

I’m actually quite hopeful that ozempic mainly works by helping reverses hormonal damage caused by bad diets. Ozempic causes low gut motility which can be very unpleasant and potentially dangerous, there are already conditions with the same effects so it’s possible to benchmark what long term effects will be like (It’s not great). I think there are safe ways to do it and that will be figured out. I think it has already changed the culture for the better. I’m hopeful this high BMI era turns out to just be a phase instead of a one way ratchet. Where I live there are few overweight people so it’s always a bit of a shock to me whenever I travel.

I know that if you have a PhD it's way easier to get permanent immigration status than it is with a MS or BS.

I'd be surprised if the same weren't true for MDs.

Edit: it's an O-1 visa. To get one you need to show "special skills" in your area. For an academic (and I presume for physicians) that would be things like good research publications and so on. You have to be above the norm in some way.

The advantage of this visa class is apparently that it feeds directly into the green card system.

All of society has that Ponzi scheme dynamic, due to the declining utility of a human being as they age, and the extended time that they remain a net loss as technology allows them to live longer.

> Too bad we can't import doctors.

My current two doctors appear to be native speakers of English, but the previous four or five were all clearly from the Subcontinent or East Asia.

Note that I'm not criticizing them in any way... they were all perfectly fine doctors. I'm just wondering where OP is from that there aren't tons of imported doctors on staff.

Not can’t at all but the licensing hurdles can be really difficult if they didn’t go to med school in the US, as I understand it. Even from other countries that are clearly pretty good at educating & licensing doctors.

In Canada, the “brain drain” of Canadian-trained doctors to the US is very well known. It’s comparatively easy for Canadian doctors to start practicing in the US (much easier than the opposite).

For all this talk about "importing" human beings, why not "export" them instead? As in sending the patients abroad to be treated. Or is it wrong to uproot them to save some money?

Candidates can promise many things, but they won't pass laws to ban outsourcing. Even if they do, they dilute it to an extent that these laws become impotent by creative loopholes.

They might if the tax base decreases substantially and unemployment shoots up to unsustainable levels.

The government definitely cannot afford , with the national debt, to lose tax dollars or to subsidize high levels of unemployment.

I'm pretty sure there's something in HIPAA or SOC 2 that ought to be preventing people outside the US from having any access at all to US patient data, but Humana likely has more lawyers who know these things than I do....

I'm pretty sure you're wrong.

https://www.hhs.gov/hipaa/for-professionals/faq/2083/do-the-...

I don’t think outsourcing is the main problem with the American healthcare system. I encourage you to go a bit deeper and to not give your vote on a single bit of info. Try to expand to 1Kb.

What do you think nurses do that having Filippino nurses would be a national security hole?

Reply on news.ycombinator.com