I married a Brazilian and have my permanent visa there (equivalent of a green card). We have young kids (3 years and 1 year) and currently spend about half the year in Brazil staying at in-laws and the other half in Texas. Besides enjoying the change of pace, we are doing this because we really want our kids to be fluent and feel native in both countries. We plan for them to go to school in both countries as well but at some point we will settle down and stay in one school system (probably back here in the States).
My wife is from Florianopolis (also known as Floripa) which is an island in the southern state of Santa Catarina. It's a great place, I really enjoy it. When we first met 8 years ago it was affordable. I was taking advantage of geo-arbitrage by living in places that were less expensive so I could try and bootstrap a small business. Unfortunately the cost of living and exchange rates make it a pretty expensive place now. We buy everything we are going to need in the States and take it down there with us. Every time we go into the grocery store, shopping mall or out to a restaurant for dinner we laugh at how expensive everything is. I honestly think there is some kind of scam going on and someone is getting very rich because the prices are sky high and the average wages are much lower then the US. So that makes the relative buying power of the people lower.
Here you can see how it ranks on the Big Mac index.
Daily chart: The Big Mac index | The Economist
Here you can see GDP per Capita:
List of countries by GDP (PPP) per capita - Wikipedia, the free encyclopedia
I remember paying about $800 for a round trip ticket for a longest time, now it's up to $1,200 and maybe a little north of that. With the World Cup and Olympics in the next 4 years flights are going to be full and ticket prices high.
Real estate has appreciated a tremendous amount and some bubbles are bursting (according to a friend of mine in real estate in Sao Paulo). Buying in at this time is pretty pricey.
As for health care, I found it hit and miss. My first daughter was born in Brazil the second in the USA. Both are fine but had their been an emergency, I would have much preferred to be in the USA. On the other hand, new facilities down there are buying new equipment. My wife's OBGYN here had an older sonogram machine in his office, down there you go to a sonogram clinic where they had newer 3D machines.
Taking our kids in to the pediatrician down there is interesting, we basically pay some cash on top of the insurance so we don't have to wait in long wait (and it's a top notch doctor). It's not very fun to wait for an hour or more with a sick kid or to keep a healthy kid around sick kids who are playing with toys (check-up or shots). I haven't needed to use the medical system but I have been with my wife and it's okay but I'd want to come back to the States for anything major or to Albert Einstein Hospital in Sao Paulo. I think the same thing holds true for many other countries/regions, there is a great hospital a couple hour flight away but the smaller regional ones might be hit or miss. The doctors are caring and very nice they just don't have an MRI machine or other advanced tools downs stairs like many facilities do here. There is usually one in town somewhere but they are not used as much since they are not as readily available.