For the past four years my eye prescription remained relatively unchanged. Unfortunately, my glasses haven’t remained unscarred through an infant’s grabbing hands, a puppy’s curiosity, and life in general.

I took advantage of a coupon to buy an emergency pair of bifocals for $250. During a recent week of travel I wore that pair. My eyes never adjusted to the left lens, the one the optical tech said was stronger than my old prescription. Each afternoon I found it difficult to zip through messages on my phone, enjoy a book, or read small print on a menu. Headaches started early in the day. I panicked about fulfilling writing obligations and tried to not think that maybe my eyes were in trouble.

This is the kind of bad decision I made because of a high deductible health insurance policy. The $175 eye exam would be out of pocket so spending $400 for the security of back up glasses felt prohibitive. I shopped around and spent less. Fortunately, my discomfort ended when I returned home and put on the old glasses. Scratches and all, my vision cleared, and the headaches stopped.

Others are making more difficult decisions—taking the gamble of not purchasing an asthma inhaler for themselves to make it possible to pay for a partner’s insulin, cancelling necessary lab work or tests to pay for their child’s asthma inhaler, not following a physician’s directions in using an expensive medication to stretch its use, staying in a hated job to hold on to health insurance, not replacing bald tires on the family car because of a health emergency.

Most of my adult experience was in a health maintenance organization. We groused about wait times for appointments, lack of choice in the optical area, going to a hospital across town, but we never faced decisions like today. If we hesitated about taking a child to clinic for a possible ear infection, it was about traffic or workload and not about the $125 bill.

These decisions are made in all zip codes throughout our wide metropolitan area. Only the very wealthy or very fortunate are exempt. We don’t comment on a good friend’s darkened tooth, push a neighbor to join in a night out, or question why a kid’s wheezy cough doesn’t improve. We’re all too polite to talk about the healthcare monkey choking America’s sense of comfort and scared about what’s coming next.