I'm not sherr, so I can't speak for him. But I wanted to answer your questions to the best of my ability anyway.
So for example brining in an Indian doctor to practice medicine in a rural area is great for the US. It is helpful But it does nothing to advance us. Nothing.
Compared to the research scientists at a top university working on AI. That does advance us.
Innovation can happen from anywhere, not necessarily from a research lab.
Pandemic is the theme of the day. Imagine the difference a top quality doctor can make for the world if a novel Zoonotic virus breaks out in the rural area where that immigrant (or native) doctor is practicing - early warning and such.
I think you are underestimating the importance of day-to-day innovations. Vast majority of innovations are of this variety, and not big-nobel-prize-winning-discovery kind. You can't sustain an innovation ecosystem without the massive "day to day" practical innovations supporting the "research labs". US has this ecosystem, as far as I know - NONE of the other countries do, at least not to the same degree as US.
Again I think there is a core problem if we can’t fill lawyers accountants and general practitioners with citizens.
You sure can design an immigration system around this premise. Many countries (e.g. Canada up in the north, which admits almost double the number of immigrants per capita) tightly control what jobs/professions they want to source as immigrants. US currently does things differently - it lets markets and employers dictate what they want as long as they can substantiate the need in some way or the other (Note: even if they are playing legal games, the fact that they are spending so much money and waiting to go through the process must mean they really want the immigrant worker). Talk to American and Canadian immigrants and I think you will conclude that the market-driven system is far superior than the "control by legislation" one.
You never lose by bringing in capable people. Cite: Lump of labor fallacy.
Better question - what are these other counties doing right where they are churning out more doctors than they need ?
They are not. How much innovation currently comes out of India and China vs. US? How do the healthcare systems compare?
Having worked with people from everywhere, an average American University graduate (of any ancestry) tends to be more capable than the average native-but-still-in-India University Graduate. Same for China.
But the US immigration system lets America pick their best. Why not do it? Why break what you have going for you here?
Does the H1B scope and process need some re tooling ?
Yes. But not for the reasons immigration restrictionists want you to think.