As a H1B holder who's also a cancer survivor and suffering from severe health issues, I can tell you it's hell. I cry at least once a week at the fact that I cannot take a break without having to destroy my life and my family's life and 20+ years of life built up here. Everything this person said is absolutely true. The high compensation comes at a very high cost. It's not just mental or physical but also moral. You follow some arbitrary process since some higher up decided that it's the best way to measure productivity or performance. You underlevel people because you have to have a high bar. So someone with 20+ years of experience with subject matter expertise (not me) is a 'developing' Principal engineer. You have to hit arbitrary dates with moving goal posts and convince your team that they are doing God's work.