A bit risky is a bit of an understatement.

As I said, depending on the health of his family. Plus, as I recall, he is approaching Medicare age (maybe a few years behind me?).

In your case, it would be crazy to do it. In my case, as well. And there is the risk of the unexpected (e.g. accident, stroke, whatever).

In the end, it's all a gamble. You're betting you're going to get sick, and the insurance is betting you won't (with odds adjustments via premiums).

$40K per year is a lot if everyone is healthy. It may also be worth it for his peace of mind. I won't speak for him.

I don't know all his details, but if I were him, I would push my wife to move back to England. They get actual medical care there when needed, regardless of ability to pay. Just read an article yesterday that for many expats, once they lived somewhere else (e.g. attended university overseas) they couldn't imagine coming back here to this hellhole (guns and shootings, no healthcare, a political system that is broken and possibly can't be fixed, etc).