What if, as a condition of the visa [0], the sponsoring high-performing immigrant guarantees that the relative won’t become a public charge, and becomes legally bound to reimburse the public purse if that happens?

I seem to recall the notion that elderly people are normally isolated, atomized wards of the “aged-care industry” as a relatively recent innovation, no? Versus people seeking to bring elderly relatives to reproduce the sort of multigenerational households that more traditionally handled aging care, and that do that today in other parts of the world?

[0] https://en.m.wikipedia.org/wiki/Public_charge_rule

The final years of healthcare for the elderly is unaffordabily expensive.

Nations are able to afford it with a healthy dependency ratio, but with the Baby Boom generation leaving the workforce, it will no longer be possible.

A young family who have recently migrated are saving for a house and college, to make them pay for a decade of end-to-life treatment (cancer treatment, dialysis) at United States price ranges is unaffordable even for very high income earners.

Remember the two parents have four grandparents, and two children (the receiving country would love for them to have a third).

That said, I am open to a special visa with a million dollar escrowed deposit per elderly parent to cover their healthcare. Without extreme restrictions they are bound to become a healthcare burden on the system.

Don’t the elderly people in question—where they or their sponsors can’t cover the cost—1) have their visa applications denied on public charge grounds, or 2) not receive those treatments?

I was of the impression that, in the US at least, such immigrants might be allowed to purchase Medicare if they’d been here for a long time and worked/paid payroll taxes for many years—but that they certainly wouldn’t qualify to get it for free in the way native-born people do. Native-born people with 10 years of formal employment, anyway.

Not sure how that works with Medicaid—it sounds like [1] some states have chosen to implement that in ways immigrants can access if they come in on green cards and spend their working lives in the US, paying in to the system—but that seems to me more like a local policy choice than a primary feature of the immigration system.

For that matter, in your formulation, should the working-age immigrants themselves, who permanently resettle and work their whole life in the US, be denied access to old-age benefits when the time comes?

[0] https://www.kff.org/faqs/medicare-open-enrollment-faqs/enrol...

[1] [PDF] https://www.health.ny.gov/health_care/medicaid/publications/...

> have their visa applications denied on public charge grounds

Oh, I wasn't familiar with the 'public charge' requirement of the US immigration system. That's excellent in principle, and wonderful if enforced adequately.

> Not sure how that works with Medicaid—it sounds like [1] some states have chosen to implement that in ways immigrants can access if they come in on green cards and spend their working lives in the US, paying in to the system—but that seems to me more like a local policy choice than a primary feature of the immigration system.

Yes, agree that's not a feature of the immigration itself but a local policy choice. Some states are very lax with Medicaid qualification rules eg, California recently expanding coverage to illegal immigrants with loosened criteria that legal immigrants won't qualify. I recall changes were made in response to federal tightening of rules. It's still a bad policy, but a local one.

> For that matter, in your formulation, should the working-age immigrants themselves, who permanently resettle and work their whole life in the US, be denied access to old-age benefits when the time comes?

No, one principle is they have paid into the system for a long period of time then they should of course be able to access benefits.

The other principle is by that time they are ready to retire they will certainly permanent residents but hopefully citizens, so not seen differently than other citizens.

Those rules are not enforced, every state has free (or almost free) healthcare that fresh immigrants are eligible for but sometimes they need to jump thru a few hoops. Many states have free “healthcare navigators” that will guide you how to jump thru those hoops.

Can you explain why "move to another country with your family, leaving your elderly parents to fend for themselves" is not abandoning ones parents? Most of the world doesn't believe that old people having a roof over their heads and access to healthcare is all it takes for them to not be considered abandoned.

Even moreso with arbitrary rule changes with zero deadlines meaning they can't even necessarily fly back in emergencies without risking losing their status in the US?

Generally speaking, those parents wouldn’t have the work history to qualify for SS benefits in the US. AND IIRC, they’d need some form of permanent residency to qualify for Medicare/Medicaid.

And the sponsoring immigrant would be responsible for the bill.

Technically yes but practically no. I did research - there were a few court cases in 60ies but after that gov gave up on trying to recover money.

Many Medicaid rules around minimum residency and work history are being (insanely) relaxed/removed. At least in California.

Based on my reading of the law, you can overstay a tourist visa and receive Medicaid coverage in California relatively quickly.

(But that's a different discussion)

Abandon seems to be the right word considering the context you have added.

Amusing that people like you get downvoted into oblivion and still think their opinions are unequivocal.