Hi, yes I agree that it is pretty routine if you are in the country although you do have get the bank accounts or pension signed off each year.Technically, each year one requests a 1 year extension to their visa. Except for waiting at the immigration office, it's a painless experience.
In six years I've yet to hear or read of anyone being denied an extension to their 'retirement' (usually a non-immigrant type O) visa. Most of the expats I know agree that to be denied an extension, one has to have pissed off somebody important, or there was a major change to the system. But we're speculating.
If you are applying outside of the country however you must get another doctor's check and yet another home country police clearance (that must be notarized by an official before submission to the embassy). If you don't happen to be in your home country, getting the properly notarized police clearance is not easy.
I went through this whole process once for my Philippines residency. And it was more expensive. Although it is permanent (pay a fee once every 3 years only), I don't have to go through the application process ever again. Anyway, I was just trying to make a distinction. I think the My Second Home program in Malaysia is also more towards a permanent visa although it must be renewed every 10 years.