Oh, I disagree 100%. Getting payment at the time services are rendered is very difficult for us. People are still stuck in the old insurance/copay mold, where they waited months to find out how much of everything was covered, adjusted, etc before even thinking about making a payment.
For a long time, from the time I was about 25 until my son was born, I was around 40...I didn't have insurance at all. On the rare occasion that I did bite the bullet and go to a doctor's office or a clinic I paid cash or used a credit card, of course that also meant I paid more for a prescription if it was necessary, but I couldn't afford health care and it didn't make sense...I was rolling the dice, I just didn't know it and I was too busy to give it much thought.
Then my mother got cancer. I would consider my parents to have been solidly middle class to upper middle class and my father paid for private insurance as he was self employed as an attorney. He felt very confident that he had set things up the right way, worked his whole life, did everything the right way.
Ultimately, my mother ended up in Hospice, which is an overwhelming expense. What I remember most about that time was my mother (until she couldn't) and father spending hours on the phone arguing with the insurance company, trying to make sense of the bills, what had been paid, what had not been paid, who was responsible for paying..."if I already paid it, why did you send me a bill" was pretty common.
It was awful.
I'm sure there are lots of folks that have gone through it, I bet it's pretty common. It shouldn't be though, people pay for or pay into, one way or another, a healthcare system through insurance companies that doesn't care about health or care...they care about making money off of sick people. That's what is wrong with the American system.
There's a way to do it, it's being done in other countries, but it requires cooperation and we aren't very good at that until there's a crisis...
Maybe that's where we are headed.