A lot of doctors already require payment at the time of service and have been doing so for awhile. An ER likely will not turn you away even if they do hound you throughout your visit. They are pretty pathetic about it. That said, you cannot repossess a service and medical bills are unsecured debt. I used to do collections work when I first started out. I mostly did consumer finance loans but also did some work for some doctors/dentists. The Hospital and I got to share a special assigned time on the docket every other week because the two of us would be there for a couple hours together every time just churning out stacks of judgments. I very seldom will work for someone without payment in advance unless they are known and reliable or are a business or government entity. Despite the stereotype otherwise, rich people are just as bad if not worse than poor people about not paying their bills.