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What explains the massive difference between the reception to this post and self_made_human's last on wanting to move to the states?
There is something deeply unsettling to me about the way that subcontinentals talk and think about the US. First of all, I want to do my best to empathize with them. Millennials entering the job market post 2008, racked with student loan debt often had a very tough time getting a foot hold in their careers, and I was one of those. There was a feeling among many that a promise had been that if you make it to a state school and get a bachelor's degree that companies will roll out the red carpet for you and you'll be on a glidepath to the upper middle class. Many of us did those thing and then languished in food service or retail for a period while struggling to make ends meet and coping with crushing student debt. The promise didn't pay off. And we resented the promiser.
For Indians, America is the promise. And you can sense that in this post. If you're going to work hard in India, get grades, pass tests all in the hopes that some richer country will let you in, then America is the destination of choice. You'll have friends and relatives who make it. If you get left behind, you'll see your cousin Rajesh posting a photo of his McMansion in Cincinnati. He'll be holding his little son, an American citizen, which means he'll have a hell of a time being deported even if his H1B falls through. He'll be with his beautiful wife, because families in your home village were eager to throw their daughters at him. And, if after 15 years he becomes an American citizen, he will be able to sponsor other relatives for green card consideration -- a huge boon to the family. And, he'll be making more money than he could anywhere else in the world even though he's working at a discount compared to every other American citizen.
Why is he working at a discount? Because the ability to offer him legal residency in the US and all of the status and opportunity that comes with that ESPECIALLY to his friends and neighbors back home and especially in terms of his children being American citizens is HUGELY valuable. The government giving his employer the opportunity to do that are subsidizing his wages to compete against American citizens. And in doing so, they've created a situation where the whole world in general, but subcontinentals in particular, think they are getting cheated if they can't come here.
Obviously, I'm not in favor of this arrangement. It is grossly unfair to Americans. H1Bs, insofar as they're needed, should come at a cost to the company that wants to issue them. They should be paying more than they would pay any American in that role, and they should be paying a tax on top of that to the government. A tariff on foreign labor if you will. Otherwise we are stuck in this gross situation that breeds resentment.
I think the extreme lengths Indians are willing to go to to gain entry to the United States puts normal Americans in a difficult position.
On the one hand, I don't think many Americans actually want very large numbers of Indians to immigrate to the United States. Probably a minority does, many are largely indifferent, and a sizeable proportion does not.
In many cases this goes even for the ones who, like this poster, are obviously intelligent and have marketable skills. Frankly, we don't really need them. We're already doing fine.
On the other hand, Americans like to think of ourselves as being easygoing, tolerant and well-meaning people. This is an important part of our self-image. We would like to prevent very large numbers of Indians from moving to the United States, many of whom will do literally anything to do so, but this requires us to say 'no' over and over again and to erect ever higher barriers to filter them out. This forces us to admit that we aren't as nice and altruistic as we like to let on. This is psychologically exhausting.
It's actually similar to Scott's experiences dealing with street beggars in India, which he blogged about. I don't mean that the situations are identical, just that the psychological difficulty is similar.
As the poster mentions, one solution to this would be to auction off residence spots. The EB-5 visa can be seen as a step in this direction. I would actually support a system that just replaces all visas of any kind with a single auctioned visa. I don't think this is morally unreasonable. Residency in the US is extremely valuable. It is also more economically efficient to put a price on scarce and valuable goods.
If this system were implemented, it would reduce demand while allowing American citizens to collect more of the proceeds from immigration. This would be psychologically less unpleasant (for us). But if we needed to salve our consciences further, we could spend some or all of the proceeds on poverty relief in the third world.
However, I wouldn't demand the price be paid up front; it would be possible to pay an additional tax on your earnings in the US instead. This might actually allow entrance to many people who are denied under the current system.
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Assuming self_made_human is as competent as the median American doctor, it is obviously not "unfair to Americans" for them to get a new Doctor willing to charge less. Unless their hatred for Indians outweighs their desire for access to cheaper medical care. It is of course "unfavorable" (unfair is a loaded word) for the 0.3% of Americans who are already doctors if a doctor for any country, including America, enters the market, which is why labor unions take great steps to increase the barrier of entry for their industry.
That is very kind of you to assume, though I can't agree or disagree beyond saying that all the American doctors I personally know are scary good. Look at @Throwaway05, who I highly respect, though I think he's well above median. And I hope for the sake of my self-esteem that he is significantly older and more experienced than me, because god knows I have stiff competition as is.
(I don't know many American doctors, but they have very high quality training, even by First World standards)
I do expect to be a better doctor by the time I'm (eligible) for the USMLE, and a rather good one if I can overcome the strong competition for the positions that are bookmarked for international doctors (around 4.5k the last time I checked, and you better believe the competition is an order of magnitude larger).
I'm early in training! I've only been a psychiatry resident for 6 months and change, so God knows that you wouldn't want to leave me entirely on my own to handle truly difficult cases. I'd probably not bungle it, because I can always look up treatment guidelines, but the mark of a competent doctor these days is the ability to make good decisions when operating outside the cut and dry, where guidelines and standard practice no longer apply.
An important addendum is that you don't have to be a median or better doctor to be a net value add! This is important, and the joke about half of all doctors being below average in their class is (mostly) a joke. A 10th percentile doctor is probably the point where I'd start having strong second thoughts, and that number depends on how strong the filtering is for both med students and fully qualified doctors with MDs. This is fair, because 90% of doctors will do an adequate job of treating you.
I have no firm numbers on hand for the relative difficulty of getting into medicine in either the States, the US or the UK (I'm tipsy at a pub), but I can definitely admit without shame that the average American doctor has better training than the rest.
I would very much like to charge as much money as people would pay me, especially in the States, but on a macro level letting more foreign doctors in will both suppress local wages and also increase access to healthcare for the average American. The former is likely going to be barely perceptible, unless the AMC does something drastic like allowing all Western doctors from near-peer nations to practise in the States automatically (and they never will). The latter also depends strongly on multiple factors, but the average IMG who does get into the States will probably be forced to take a role that pays less than the median (because it's easier for us to get into the unpopular things like Family Medicine), which will make IMG doctors cheaper on average for the average Joe.
If you want to peg my capabilities, I was around 75th percentile for all doctors, both British-trained and foreign (who met the eligibility criteria to sit it) in the clinical section of the exam I gave to enter higher training. When you include both the clinical knowledge and the ethical section of the exam, I was around 65th percentile. I will say that the ethics section of the MSRA, called the SJT, is universally panned as absolute bullshit and barely better than random noise on a good day.
I meant "my analysis holds if you're as competent as the median American doctor" not that I already assume that.
This seems plausible but I'm unsure. I did realize my analysis depends on the belief that the median doctor is a net value add, which some people dispute.
You do agree or at least consider it plausible, so I guess I can only express frank confusion about those who don't. I can only hope they're a small minority (haha).
I don't know if my opinion about doctors is invalid because I'm one, but I've never felt myself having to exercise particular caution when looking for a doctor, and I'm usually happy with the treatment I receive. This is, of course, confounded by the fact I've been a doctor for a while, and a med student for about as long, and the scion of doctors for as long as I've been alive. Other doctors will treat you differently for any of the above, but I expect not to the point they wouldn't do a good job for the average person. They'll treat you regardless.
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A nation is a group of people with shared heritage and language. It is not an economic zone, and it is not a above-median-skilled person. GDP is not a nation. Ideals are not a nation.
I will not give away my inheritance, and the inheritance of my children, for cheaper healthcare. I will not do it for cheap fruit or cheap cotton. My ancestors lived and died on the frontier without healthcare, and I'd rather my descendants do the same than live in a country where they are a hated minority. We already are hated, by blacks and asians and yes, indians, and as soon as we're a minority we will see the landscape shift rapidly against us.
Additionally, he's a shrink. Not even a PCP or surgeon or ER doc. He's not curing diseases, or treating the sick, he's treating depression and anxiety and ADHD. I don't think we need to be importing people for that purpose at all, and to conflate this with that is part of the shell game.
This sounds like you mostly agree with my analysis, it's not exactly "I hate Indians" (though it might be) but "I think the presence of even competent Indians that benefit the economy is bad for my descendants" and you basically do think he's less competent than the median American doctor because you don't think psychiatry is all that useful (or that it's just saturated).
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The last post came across as "I want to move to the states myself, as I see it as good, and wished more people saw it as good".
This post came across as "I want more people (or at the very least don't want less people) to move to the states, and I am going to criticize a place I wish to move to for its policies on who can move to it".
These are not the same thing, and it does not surprise me that some people overall like the former but not the latter.
I don't know if you read my comment below, but I do agree with you. Critique of a country by a foreigner will almost certainly go down harder than praise (by a foreigner).
If someone went to /r/India and began extolling the virtues of chicken Tikka masala, they'd have a very different reception to someone in the West who complained about street shitting.
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The 'vibe shift' also changed the equation somewhat. Some unabashed american chauvinism from an outside 'mirer in the mid biden years feels like a breath of fresh air, leaving many people saying 'you've got better spirit than a lot of my actual neighbors, hope to see you here soon bro'. Or at least respecting the contrarian take (especially framed as an argument with a more cosmopolitan/europhile girlfriend).
But right now and for the past few months, practically every day has already felt like christmas to an american chauvinist. So there's no longer much feeling of thirsty drought of that kind of spirit -- making it exactly the wrong time to air any kind of annoyed entitlement over the changes from the shift, based on taking the previous sentiments for granted. That exposes the cracks in the 'more american than actual americans' fantasy.
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I'm not entirely sure myself. I didn't expect it to be remotely as polarizing! Before the vote count became visible, my expectations would have been a 65:35 spread at worst.
If I had to guess, and I am guessing, it's because I explicitly discuss a particular means of immigration that might strike people as being "unfair". I'd wager people have different opinions on a prospective migrant crossing hurdles like licensing exams versus one who even considers the option of buying entry.
It might be that I'm actively criticizing the current administration and Trump in particular, whereas my previous post was a paen of praise for the US of A that made hearts swell and tears shed across the aisle. America is Great is an easier statement to get behind than America is Great and You Shouldn't Make it Harder For People Like Me To Get In.
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