Outsourcing, Offshoring, and L1 Visas – The Flip Side - Ernest Nounou*
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Introduction
In early May I coauthored an article "The Challenge to America of Business Process
Outsourcing" of which the salient points were:
1. The "jobless recovery" of the past three years and loss of close to two million jobs in the
US economy is more than casually linked with the growth of jobs in low cost centers
offshore, and the increasing use of L1 visas to bring foreign workers to take US jobs.
2. This trend is an unstoppable outgrowth of globalization and will only increase. It has
benefits and consequences that must be realistically addressed.
3. Response to it should not be the erection of barriers, but rather sensible policies
emanating from reasoned dialogue. The article called for that dialogue, especially
among government policy makers.
Reactions were on the whole very positive, with the exception of those from economists, who
were (to put it charitably) skeptical:
"Since all kinds of numbers do this or that for the first time, you'll have a very busy career
wondering about implications. On the other hand, if you have some kind of conceptual
analysis showing that the number is the beginning of a trend, then you might be worth
listening to. Forgive me, but what you have to say conceptually is just another repetition
of an old economic cliché." - Economist at weekly business publication
"I cannot agree that outsourcing is a zero sum game. If outsourcing leads to higher specialization
and moves factors of production into the most efficient use, then total output and production will
increase. I do not think there is that much difference between the white-collar jobs that are being
exported and the blue-collar jobs that were exported in the past." - Bank Economist
"You may have a point, but I am sympathetic to the raising of the economy and standard of living
these jobs create in various third world countries. This benefits us in the long run." - Economist
and editorialist for major daily publication
On Further Reflection
What if these economists are actually right, and yours truly is a latter day Chicken Little? Maybe
this is a good thing, a current example of creative destruction that impacts an economy from time
to time, making it more efficient and productive. If so, it stands to reason that more of it will be
even better, and this paper will show how increased use of offshoring and L1 visas can achieve
these positive results.
Let’s assume the US economy is one giant corporation, currently lacking pricing power for its
products – sales/the economy is not growing fast enough – while some components of its cost
structure are rising – healthcare and education in particular. What to do? You do what
companies are doing, cut cost and hold spending, with the savings resulting in greater profits.
Healthcare Industry
Fact: few US hospital systems can function without nurses from the Philippines, India, and other
countries producing wonderfully trained nurses. They enter via L1 or H1b visas and contribute
significantly to our healthcare delivery. Building on the success with nurses, let’s expand the L1
visa program to bring in one million doctors to start. Even a cursory look at average salary
differentials of comparable US and Indian doctors reveals the scope of available opportunities:
Medical Cost Comparisons in US$ *
| Doctors – Avg. Salary | US | India | Difference |
| Family Practice | 145,121 | 90,000 | 55,121 |
| Pediatric | 141,676 | 65,000 | 76,676 |
| Cardiology | 300,073 | 65,000 | 235,073 |
| Urology | 301,772 | 65,000 | 236,772 |
| Ave. Salary | 222,161 | 71,250 | 150,911 |
| Procedures |
| MRI | 326 | 148 – 170 | 156 |
| Chest X-Ray | 40 | 2 – 3 | 37 |
| Vaginal Birth (Doctor Only) | 3,000 – 7,000 | 200 - 300 | 2,700 |
Insurance companies with medical networks (HMOs, PPOs etc.) already outsource business
processes, so this will pose no great challenges. If they haven’t already, they can easily
incorporate a subsidiary in India, hire well-trained and already English speaking doctors, and
bring them to work in their US network at 40% - 50% cost of their American equivalent.
Certification and accreditation is a largely academic procedure, and easily administered; so these
doctors, from primary care to specialists, would have no problem qualifying.
Given the salary and cost differentials between Indian and American doctors, along with
outsourcing various procedures such as X-Ray and MRI interpretations offshore, greater
productivity and efficiency at lower cost will permeate the healthcare system. Based on the
average salary difference per doctor of $150,911 alone, one million doctors on L1 visas
would achieve a savings for the economy of at least $150 billion (give or take).
Benefits include:
Significant dent, if not elimination, of rise in medical costs for the general population
Medicare/Medicaid projected deficits shrink, if not eliminated completely
A sounder footing for Social Security with influx of productive workers to shore up the
ratio of retirees to workforce.
The increased demand for middle-incoming housing by incoming doctors will underpin
the housing market and assuage concerns of a real estate bubble.
To be sure there will be some temporary dislocations as displaced American doctors retrain and
move to more productive work, but the combined net benefits to the economy of great savings
and productivity increases mentioned above are clearly worth it.
*Note: Statistics for US doctors and procedures were obtained from "Compensation Monitor" in
the December 2001 Edition of Managed Care. Indian expatriates provided a range of estimates
for Indian equivalents. Where ranges were provided, I selected the highest value for India and
the lowest for the US. Although the exactitude can be quibbled with, the general magnitude of
the differential (hence opportunity) is a fair representation.
Education
For decades the cost of higher education, both at private and state universities has been growing
faster than the rate of inflation (choose your index). A comparison of tenured and associate
professor salaries and tuition at 4-year universities in the US with their counterparts in India
reveals logical opportunities:
Education Cost Comparisons in US$
| Ave. Salary | US | India | Difference |
| Professors - Tenured | 70,000 | 11,000 | 59,000 |
| Professors - Non-Tenured | 50,000 | 9,000 | 41,000 |
| Ave. Salary | 60,000 | 10,000 | 50,000 |
| Ave. Tuition + Board |
| Private College | 35,000 | 2,000 | 33,000 |
| State University - In State | 12,000 | 2,000 | 10,000 |
American universities can take advantage of the differentials in professor salaries by using the L1
visa route to bring large numbers of professors from offshore to reduce their salary cost structure.
In doing so, they will also arrest the escalation of tuition expenses.
Based on the considerable differential in tuition costs, American parents should seriously
consider sending children abroad to attend college. From the perspective of the parents and
students, the benefits are considerable:
Lower tuition costs, with savings of $40,000 - $130,000 available for other purposes
including retirement.
Better cost/benefit returns of a foreign education, given there are few jobs available on
graduating. Note the experience of graduates in the Class of 2003, as documented in the
New York Times and elsewhere.
Cultural experience and benefits to 4 years abroad – not just "junior year abroad."
Better positioning at graduation; graduating from a college in India positions American
graduates closer to where job growth is occurring. Note also:
Lehman Brothers is opening an office in India for 1000 business analysts, at the
same time as Smith Barney and other banks are laying off analysts in the US.
An AT Kearney survey of financial institutions states they plan to export over
500,000 jobs to offshore locations within the next five years.
The combined impact of large numbers of foreign professors and students attending 4-year
universities in low cost centers will no doubt take some air out of the tuition inflation bubble of the
last few decades. The economy will not only benefit from greater productivity asprofessors move
up to higher value added work; but financial resources will be freed, increasing the national
savings rate, and reducing the burdens on social security to provide for retirements.
And the US Military
An article in the June 2003 edition of “Wired” documents in fascinating detail examples of the
technology’s transformation of military command and control, underpinning the swift capturing of
Iraq. Tanks and other military vehicles download their daily orders via Internet technology on
built-in computers. An officer responsible for technology proudly mentioned the Army’s “Premier”
tech support contract with Microsoft for live technical assistance.
Logical industry questions:
If Microsoft tech support were offshore (best rates in Pakistan), would Military Intelligence
permit that? (Consider what havoc an unsympathetic local techie could wreak.) Note,
Microsoft recently announced layoffs in the US, and is establishing operations offshore.
Was the 1 ½ day delay in US troops drive to Baghdad really due to sandstorms, or was
there a problem with Windows? Too much rebooting?
The military has experience with offshore outsourcing. In November 2002, a group of Russian
technology companies were introduced to the New York business community, and one of them
proudly referred to work performed for the US Airforce. (Amazingly, not one question regarding
national security came up!) Of course not all forms of military outsourcing have happy endings.
When they outsourced responsibility to local and Pakistani soldiers in Afghanistan to prevent
enemy escape, it seems that among the hundreds that did escape was the 6’4” leader, his wives,
children, entourage, and a dialysis machine.
Conclusions
Outsourcing/Offshoring and L1 visa usage to date has been small potatoes; opportunities
abound for more extensive usage.
Significant savings will result with greater use of “offshoring” and L1visas, producing a
more productive and cost-effective US medical and education sectors. Displaced doctors
and professors will move on to higher value added jobs, benefiting themselves and the
US economy.
Healthcare and education costs, to name a few areas hitting the middle class wallet, will
actually go down, and the national savings rate will go up.
Medicare/Medicaid and Social Security deficits will shrink dramatically, if not totally
eliminated.
Expanding the program to other areas will inexorably follow, such as outsourcing CEOs –
which will bring sanity to compensation, if not performance as well.
Note to the reader: You are encouraged to think of other sectors of the economy where similar
opportunities exist for these processes.
*A graduate of Wharton, Ernie is a Founding Partner of Catalytic Group, Inc., a Technology consulting and execution firm. A former banker he enjoys writing on business topics and can be reached at ernie@catalyticgroup.com.