One somewhat daring approach to immigration would be to encourage a reverse flow of older immigrants from developed to developing countries. If older residents of developed countries took their retirements along the southern coast of the Mediterranean or in Latin America or Africa, it would greatly reduce the strain on their home countries' public entitlement systems. The developing countries involved, meanwhile, would benefit because caring for the elderly and providing retirement and leisure services is highly labor intensive. Relocating a portion of these activities to developing countries would provide employment and valuable training to the young, growing populations of the Second and Third Worlds.
This would require developing residential and medical facilities of First World quality in Second and Third World countries. Yet even this difficult task would be preferable to the status quo, by which low wages and poor facilities lead to a steady drain of medical and nursing talent from developing to developed countries. Many residents of developed countries who desire cheaper medical procedures already practice medical tourism today, with India, Singapore, and Thailand being the most common destinations. (For example, the international consulting firm Deloitte estimated that 750,000 Americans traveled abroad for care in 2008.) Never since 1800 has a majority of the world's economic growth occurred outside of Europe, the United States, and Canada.
Never have so many people in those regions been over 60 years old. And never have low-income countries' populations been so young and so urbanized. But such will be the world's demography in the twenty-first century. The strategic and economic policies of the twentieth century are obsolete, and it is time to find new ones.
No matter what your opinion is regarding US healthcare one thing is clear: you have to know where to go for honest medical care--a challenging feat already for many of us in the United States, let alone a foreign country. Goldstone reminded me of a recent trip that my husband and I took to the Maldives. The island we stayed on was extremely remote, even by Maldivian standards--upon landing at the capital of Male we had to take another microscopic plane for an hour, then take a speedboat for an additional hour before finally arriving to our destination (and, coming from Los Angeles, this was already after a full 24 hours of travel time). A few days into the trip we visited a neighboring island to see a doctor at the local hospital. Our female Indian doctor behaved in the same rushed and disinterested manner that so many people complain about regarding their American counterparts (this is not a busy hospital by the way)—and gave us the wrong medication to boot. Some extra money was made off of us buy the medicine they prescribed (we're talking like an extra fifteen US dollars here), which I’m guessing was the point of the “mistake.” No harm done, but duly noted.
Entrance of the hospital in the nearby atollFrom what we experienced, the simple Maldivian hospital above fits perfectly into Goldstone's scenario of influencing Second and Third World medical care to standards of the First World. The first paragraph in his excerpt reminds me of a form of gentrification--but broader in its transnational context and more specific because it is a healthcare related focus. Undoubtedly his suggestion, which Goldstone himself labels as "daring," invites much critique and debate. I'm sure that this gentrifying angle can be taken further to the issue of modern day colonization. While I do not think that this was his objective, perhaps his well intentioned motives are precisely what constitute an imperialistic and purely Western perspective.
Realistically, can Second and Third World infrastructures remain uninvaded by technologically superior foreign cultures in our globalized, interconnected world today? Further, can these infrastructures grow without external influence and investment?
And just in case you’re contemplating retiring abroad, here’s a great link to compare the cost of living in a foreign country with that of a New York City lifestyle: https://eiu.enumerate.com/asp/wcol_WCOLHome.asp