It's expected for many transactions. So why not for costly health care?
I stopped at a fast-food restaurant on my way to work the other day for a breakfast sandwich. They demanded payment -- before I got my food.
That afternoon I dropped off a broken storm window for repairs at my neighborhood hardware store. They demanded money up front, too, in the form of a deposit.
Should I decide this weekend to take in a play, or a movie, or a Twins game, or to visit a museum, I will again have to pay -- in advance.
The routine quality of these everyday shakedowns for payment in advance leaves one a little puzzled by the apparent outrage over news that hospitals in these parts increasingly press patients for payment -- before providing health care services.
Several days of front-page and newscast-leading stories were inspired by an indignant report from Minnesota Attorney General Lori Swanson. It detailed especially aggressive payment collection efforts at the Fairview system that, the report suggested, imperiled the proper hospital culture "that above all else respects human dignity."
Officials of the state hospital association and other hospital systems have hastened to reassure Minnesotans that they don't approve of asking for payment up front in emergency rooms. According to Swanson, Fairview did that for a time, although even Fairview claimed that no advance payment was sought from patients needing "emergent" treatment.
But everyone seems to agree that hospitals everywhere are becoming more serious about getting patients to pay their shares of bills -- and that people may be finding the change unsettling.
If so, it's easy to understand. Health care is different. When people are sick or injured, they long for a caring touch and some quiet reassurance, not what the hospitals seem to call "financial counseling."
And yet, this country needs to begin facing hard facts about the cost of health care. It isn't free; it's threatening to bankrupt the nation.
If anyone is shocked to learn that hospitals must either cajole patients into paying their share of bills or else try to stick somebody else with their costs (that is, the rest of us, through higher prices or increased insurance premiums or bigger taxes or all of the above), they have been living in fantasyland.
Fairview is admitting to mistakes, though not to breaking the law. It's tactics may have gone too far (although we haven't yet heard real horror stories of unattended patients writhing in agony while the "financial counselor" twirls a greasy moustache).
There may have been violations of privacy that raise altogether different issues. And of course those who truly can't pay are entitled to treatment all the same.
But it's hard to condemn reasonable attempts to collect from everyone else. The basic logic behind seeking advance payment is obvious. Why do ever more gas stations insist that you prepay or pay at the pump?
For that matter, what is the much-discussed individual insurance mandate in Obamacare but the biggest of all demands for upfront payment for health care services?
Meanwhile, the biggest advance-payment demand of any kind would be ... taxes. Your employer is required to withhold from your paycheck income taxes and payroll taxes (part of which pays for Medicare benefits you will only receive years or decades later). This forces you to pay the government a portion of your wages before you ever receive them.
Wouldn't it be more respectful of your human dignity if the government could just trust you to pay up when you can?
D.J. Tice is the Star Tribune's commentary editor. Follow him on Twitter @StribDJ.
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