This is such a weird example. Doctors are a professions with artificial limits specifically to raise the income of doctors in the profession. There are no starving doctors because they don’t let enough people become doctors to lower the wage.

>Show me the reduction in cost for medical care when 1/4 of the doctors in the US are foreign born medical grads, the bulk of whom came through the H1B program.

If this is true it is a genuine national security emergency, not least because foreign standards for practicing medicine are not the same as they are here. I've never encountered a foreign born medical grad in all my years. Where do they work?

>These are smart people who end up in high level roles who end up staying and becoming Americans (agin raising the bar).

I didn't make any claim about the intelligence of H1b visa holders, though it's interesting that you immediately went on the defensive there. I'll say this: if you had a poor experience with American engineers that suggests there is a pipeline problem, no? Ostensibly, my government should be interested in fixing that problem since, allegedly, that's where its priorities lie. I totally get it that the H1b program allows companies to lower their demand signal to US-based institutions that would otherwise produce more of these people that you need. Sorry you worked with some shitty engineers, it happens.