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/...

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.

> 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.