(FORTUNE Magazine) – IF YOU THINK YOUR JOB IS SAFE FROM OFFSHORING, think harder.

The election foofaraw over manufacturing jobs going to China--a hot-button issue in every swing state but Florida--was always nonsensical. The overriding reality isn't that manufacturing jobs are being exported but that they're evaporating everywhere, including China, as makers of everything become more productive. The briefly flaring media supernova about call centers in Bangalore at least illuminated a significant issue: Service jobs can be exported too, especially as global telecommunication increasingly becomes nearly free. Even more important, though not nearly as media-friendly, is the torrent of college graduates, hundreds of thousands of them in engineering, from Chinese and Indian universities. Earning $18,000 a year, they're often just as good as an $85,000 Westerner.

Millions of Americans in management and the professions are about to be blindsided by the next step. They have observed these developments with some detachment--a shame about the engineers, but it could never happen to us.

That's what doctors used to think. Conventional wisdom held that health care was perhaps the least exportable work in existence. After all, wherever you are, your doctor obviously has to be there also. Two problems with that reasoning: The first is advances in telesurgery--using robotic technology, a New York City doctor removed the gall bladder of a woman in France in 2001--and of course the technology gets better and cheaper every day. The second and more immediate problem is the rise of medical tourism. Americans facing bank-breaking surgery are flying to India, having their procedure done in a sparkling new high-tech Indian hospital, seeing the Taj Mahal while they're there, and flying home, all for a fraction of what they'd pay in the U.S. Examples: A hip replacement that's $39,000 in the U.S. is $3,000 in India. Heart-valve replacement that could total $200,000 in the U.S. was recently $10,000--including airfare--for a North Carolina man. An Indian service industry trade group estimates that next year Indian health-care companies will take $800 million in business from the U.S.

The offshoring of surgeons suggests a few realities we had all better face:

● Improved education will get us only so far. The remedy usually advanced for job losses to other nations--and I've advanced it myself--is that American workers need to be much better educated to be worth pay that is extremely high by global standards. But that advice does American doctors no good. They're already better educated than doctors anywhere else and about as well educated as doctors can be at any given moment. They aren't insufficiently educated; their costs are just too high.

● In a global labor market, pay levels will equilibrate. That is what markets do, and the advance of infotech means that ever more Americans are part of a global labor market in which they are the high-cost option. That uncomfortable fact, which many Americans are trying to wish away, means inescapable forces will be pushing their pay down (while pushing up the pay of Chinese, Indians, Thais, Filipinos, and others).

● If you aren't in a global labor market now, you will be soon. No matter what you do, think hard and imaginatively about whether someone on the other side of the planet could do it just as well for a lot less. No? Why not? If you're right, how long will it be before you're wrong? As two billion Asians become rapidly better educated and more experienced, how many years will it be until there's one of them--and one is all it takes--who can do what you do for a fraction of your salary plus bonus plus pension plus medical and dental benefits cost?

Of course I'm still safe. At least I thought I was until I noticed a small article in the Wall Street Journal recently. REUTERS TO TRIPLE ITS STAFF IN INDIA BY END OF 2005 said the headline. It sounded mildly threatening. I read with relief that Reuters is mostly moving data-processing jobs. But then, in the last paragraph, this: "... executives said India's journalistic talent also would be tapped for its news wires."

Well, obviously. India has many millions of well-educated English speakers; some will go into journalism. I have a telephone and a computer; they have telephones and computers. Being brutally honest, I think it's still just possible they may not have someone right now who can do the various odd things I do.

But for a great many of us, it's only a matter of time.

GEOFFREY COLVIN, senior editor at large of FORTUNE, can be reached at gcolvin@fortunemail.com. Watch him on Wall $treet Week With FORTUNE, Friday evenings on PBS.