Breaking NPR news, "With Medical Debt Rising, Some Doctors Push For Payment Upfront." Medical practices are feeling the crunch, so they are making patients pay their copays before they are seen. Welcome to our world. Over 20 years ago, as a young health center CFO, I quickly learned that we were ALWAYS the last to be paid. So we asked the patients to pay their relatively small discounted fees before they were seen. Nobody liked this very much. Not the Board, the staff, or various HRSA reviewers. Certainly not the patients. We followed the regulations to the letter. If you didn't have the money, we still saw you. It just took longer because you had to see the financial counselor. We didn't do it to be cruel, or because we liked to have insults hurled at the staff. We did it because providing quality health care costs money, resources were (and still are) short and people don't value what they get for free. As the private medical community learns to deal with increasingly inadequate reimbursement, is it any wonder that they are following in our footsteps?