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Sunday, March 19, 2017

#HealthIT and the H-1B

CBS 60 Minutes, March 19th, 2017, Just watched it.
Are U.S. jobs vulnerable to workers with H-1B visas?
60 Minutes investigates how some businesses have fired American workers and replaced them with cheaper labor: temporary, foreign workers with H-1B visas

...The UCSF Medical Center is a highly regarded state-run institution. Administrators say outsourcing the IT jobs could save $30 million taxpayer [sic] over the next five years. That’s a fraction of the university’s $5.8 billion annual budget, but to Robert Harrison, it’s his job...

UCSF? Google "UCSF Benioff." As in Salesforce CEO Marc Benioff. In that regard, see my April 2016 post "On Disruption: OMG! Awesome!! Dan Lyons for President!!! Specifically the lengthy excerpt on Mr. Benioff (The Ron Burgundy of Tech") in Dan Lyons' hilarious book Disrupted.

Wonder what Mr. America First will have to say about this.


From Naked Capitalism:
Is Trump Going to Punt on H-1B Visa Reform?
Posted on March 21, 2017 by Yves Smith

visa program, appeared to be in Trump’s crosshairs. The president had issued an executive order calling for a review of all visa programs, with an eye to improving US employment and economic productivity. The new Administration had also circulated a draft calling for the head of Homeland Security to review work visa programs within 90 days. One of the idea featured in the document was that visas go to “the best and brightest” when the H-1B program uses a lottery that outsourcers like WiPro and Tata Consulting game effectively.

Even if the Administration had acted immediately, that 90 day timeframe now looks too leisurely. As Bloomberg describes tonight, H-1B visa applications are due at the beginning of April, so if the Trump Administration fails to implement its fixes by then, it’s at least a year before they’ll have any effect. Moreover, the lack of apparent momentum on this front does not bode well for meaningful changes.

The article describes how the program has moved almost entirely away from its original goals. One aim was to import workers when employers couldn’t find qualified Americans. The second was to cap the number of H-1B holders, since both the bill’s drafters and industry lobbyists wanted companies to bring in “talent” via green cards and help them become citizens, rather than rent them.

The result instead has been the creation of a large industry of foreign workers who largely work abroad. Not only do they undercut US wages and eliminate entry-level jobs, meaning the US is no longer developing its own tech professionals, but the fact that much of the work is done overseas also results in reduced taxes to states and municipalities...
As I noted in my post about Uber, Yves Smith's site rocks. Make sure you scroll down and read the many accruing comments, which are consistently of unusually high quality in the aggregate.
"...the US is no longer developing its own tech professionals..."
Well, see my prior post 12 weeks, 1,200 hours, and $12,000, and you're a "Software Engineer"? They're apparently crankin' 'em out (U.S. citizens, I assume?) by the litter in Wilmington, DE.

apropos of this topic, see my prior post His Serene Highness Trumplethinskin Summons Silicon Valley Technocracy Titans to Trump Tower.

Also of relevance, my 2014 post The healthcare workforce today. Where do we stand, and what should we do to expand and improve it? See specifically my review of the Dr. Kate Tulenko book "Insourcing."

...On the surface, insourcing may appear to be a harmless or even win-win solution to the country’s healthcare-worker shortage. The hospital receives a much-needed worker, and the worker escapes life in a struggling country for a better life here. But we should be training more people in this country to work in those professions, especially people from rural poor and minority communities. Rather than investing in our own people and communities, however, we have decided to take the best and brightest workers from struggling countries...
Try buying a cow from a feedlot and see for yourself how much negotiating power your consumer status bestows on you...
Margalit has a new post up at THCB. Excerpt:
The Free Market Delusion
At some point we will need to collectively disabuse ourselves of the notion that a market in health care insurance could be created without abolishing the provision of health insurance benefits through employment. I know everybody is talking about Flo and the little lizard selling health insurance on TV as the ultimate solution to health care affordability, but that is nothing short of demagoguery. First, practically all auto insurance is business to consumer (B2C), while health insurance is overwhelmingly business to business (B2B). I suggest you try buying a cow from a feedlot and see for yourself how much negotiating power your consumer status bestows on you in a B2B market. If you want to try a free market solution for health insurance, you would need to do more than just kick a few poor people off their subsidies. You would need to kick 150 million people off their employer health insurance plans. Good luck with that...
"...collectively disabuse ourselves of the notion that a market in health care insurance could be created without abolishing the provision of health insurance benefits through employment." That proffer is not exactly news. See Elhauge, 1994, "Allocating Health Care Morally" (pdf, pp. 1453-1454).
...The analysis of the moral paradigm offered here supports, when coupled with the strengths and weaknesses of the other paradigms, a health care system having the following elements.

(1) A politically set annual health care budget with an associated tax not linked to employment.

(2) Free access for all individuals to a care-allocating plan.

(3) Individual choice about which plan they wish to join for some significant period (I suggest three years).

(4) Competition among care-allocating plans that each receive a share of the government budget based on the number of individuals they enroll, adjusted for each person's health risk, and that cannot retain profits from their budget (other than a possible bonus linked to total number of enrollees) but must instead spend it on those enrollees. Plans must accept all who wish to enroll.

(5) Management of those care-allocating plans by professionals who have the range of diagnostic expertise to evaluate the health care needs of plan enrollees, who have salaries unaffected by spending decisions (other than a possible bonus per enrollee), and who have a duty to decide how to allocate each plan's budget to purchase those health services that maximize health benefits for the unit’s enrollees. Their sole incentive should thus be to do a good enough job at rationing to keep and attract enrollees.

(6) Maintenance of the vast majority of health care providers as private suppliers of procedures, tests, and technologies that compete with each other to sell to the care-allocating plans. This should create incentives for cost-effective innovation because suppliers will now face purchasers who have both the knowledge and incentives to trade off the costs and benefits of care.

(7) A politically appointed agency, the members of which are insulated from removal, that has only two tasks: setting risk adjustments and licensing care-allocating plans by verifying their diagnostic expertise and fiscal soundness. In particular, this agency would not dictate a uniform schedule of covered services because that would be up to each care-allocating plan.

(8) The individual right to purchase additional care outside these plans on the open market.

Twenty three years later, we continue to endlessly debate this stuff.

See my prior post Rationing by "Price."


I may buy one of these.

Maybe. Due diligence first. Recall my prior post Is the Fitbit "For Entertainment Purposes Only"?



From my New Yorker. I'm reading his new book.
A philosopher’s lifelong quest to understand the making of the mind.

Four billion years ago, Earth was a lifeless place. Nothing struggled, thought, or wanted. Slowly, that changed. Seawater leached chemicals from rocks; near thermal vents, those chemicals jostled and combined. Some hit upon the trick of making copies of themselves that, in turn, made more copies. The replicating chains were caught in oily bubbles, which protected them and made replication easier; eventually, they began to venture out into the open sea. A new level of order had been achieved on Earth. Life had begun.

The tree of life grew, its branches stretching toward complexity. Organisms developed systems, subsystems, and sub-subsystems, layered in ever-deepening regression. They used these systems to anticipate their future and to change it. When they looked within, some found that they had selves—constellations of memories, ideas, and purposes that emerged from the systems inside. They experienced being alive and had thoughts about that experience. They developed language and used it to know themselves; they began to ask how they had been made.

This, to a first approximation, is the secular story of our creation...

apropos, see also my prior post The Locus of Mind.

More to come...

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