Sorry to reply to myself but this was just so timely. This - https://news.ycombinator.com/item?id=48100005 - is the kind of thing that I think will accelerate. Companies currently usually have a mix of salaried (citizen) workers with an H-1B force acting as support. If companies can't bring that support staff in any more, because of these restrictions, then local staff become more expensive to support - they can't get as much done without this "glue" staff around. If all of the support is now in the offshore location, GM might find it better to beef up managerial/architect presence in offshore locations.

If the H1B program had been dominated by say nurses, there is a substitution effect of needing to find and train local (citizen) staff because of the onsite nature of the job. But that's not what IT work is like.

Pay would have to go up to attract health workers in small cities, towns and rural areas

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