Cash Please

In the age of $3+ per gallon gasoline you can’t fill your tank without first paying for the gas. Now the same approach could be coming to an ER near you.

HCA Inc., which owns JFK and St. Lucie Medical, is enacting the policy at several of its hospitals nationwide. The punitive measure reflects the near-chronic clogging of emergency rooms, often with patients whose minor scrapes, coughs and aches could be treated - cheaper - at a doctor's office or clinic. The worst result of the pay-first policy would be a seriously ill patient being turned away because he did not appear sick enough and could not pay the $140 upfront fee. Some doctors are worried they might become targets for malpractice lawsuits. And apprehension about the policy could deter patients with genuine emergencies.

The ER crisis includes crowding, long waits and patients being turned away, especially during the winter tourist season, but it also reflects a shortage of nurses, hand surgeons, neurosurgeons and other specialists - a problem Palm Beach County hospital executives, doctors and health-care specialists have been working to solve for more than two years. Clinics such as Martin County's Volunteers in Medicine site help, as would federal attention to immigration, requiring employers to provide some level of health benefit for the workers they hire. But the crowding reflects a problem that pay-first policies will not solve: lack of insurance