It was around the second dose of fentanyl going into my IV bag that I stopped trying to control how much all of this was going to cost. I had been arguing with every decision the caregivers at the emergency room were making – “Is this Cat scan actually necessary or is there another diagnostic tool?” “Is there a cheaper version of this drug you’re giving me?” – and reminding them repeatedly that I was uninsured, but either the opioids in my bloodstream, or the exhaustion of trying to rest in a room next to a woman who, given the sounds she was making, was clearly transforming into a werewolf, forced me to surrender.

I walked out of there four years ago alive, yes. And, as the doctors and nurses kept reminding me, if I had waited another 48 hours to discover I didn’t actually have the magical ability to self-diagnose and self-treat serious problems with Google and herbs, I might have gone septic. But all said and done, I was also walking home to a $12,000 bill, which was approximately half of my annual income as a single woman.

It took me several years of hardship, contributions from my friends and the assistance of the hospital’s charity program to pay off the $12,000.

Then, last month, it started again. I was at home. I turned my head a little, the whole world started sliding away from me, and I crashed to the floor. I tried to crawl back into bed, insisting, “It’ll pass, it’ll pass.” My husband, on the other hand, was raised in a country with compulsory public health coverage, so his first instinct upon something weird happening isn’t to lie down for 48 hours and see if it goes away. He immediately started plotting the route to a hospital on his phone.

I was back, but this time I was married. The whole hospital visit cost us $30, including the prescription. Everything was covered by his insurance. That’s when I realized I can never divorce my husband.

The first emergency room visit might have been an anomaly – a freak health problem that the nurse explained as “sometimes these things happen”. The intense vertigo was the result of the deterioration of the condition of my ears. It has been a problem since childhood, one left in “let’s wait and see what happens” condition until a weird virus last year – yes, I was the big idiot who caught a debilitating non-coronavirus virus during a coronavirus pandemic – forced me to a doctor, who discovered significant hearing loss and structural damage that will require lifelong treatment and intervention.

As a freelance writer who has tried and failed for years now to get a real job with real benefits, the costs of the surgeries and hearing aids and other treatments the doctor sketched out as part of my future would be suffocating. But almost all of it is covered by my husband’s insurance, making my health and ability to access healthcare dependent on his presence in my life.

While I convalesced from the virus last year, I watched the discussion about health insurance take over the Democratic primary debates. I had little hope that the bright, sparkly Medicare for All plan championed by candidates like Bernie Sanders would be made reality. But still I despaired of the excuses other candidates made for why they did not support guaranteed coverage for all. It angered me to see Amy Klobuchar, Pete Buttigieg and the eventual winner, Joe Biden, defend their plans to largely maintain the status quo – a system in which employment and marriage determine access to healthcare – as though they were protecting our “freedom” to “choose” coverage that was right for us.

The coercions built into American social welfare programs limit freedom, not preserve it. People who are not financially independent are forced to maintain ties with family members who might be abusive or violent unless they want to relinquish their housing, healthcare or other forms of support. And as outlined by Melinda Cooper’s Family Values: Between Neoliberalism and the New Social Conservatism, the dismantling of protections like food and financial aid in the 80s and 90s had the express purpose of increasing familial obligations in the name of “duty” and “responsibility”. Single parents seeking public support for their children’s wellbeing now had to first seek assistance through their partners, no matter how fraught or harmful those relationships might be. While politicians spoke of “strengthening families” and repairing the social fabric, one of the consequences of these policy changes was to limit the ability for people to make the basic decisions required to live the lives of their choosing, unless they had the money that in this country is our substitute for freedom.

It’s not just unhealthy families we are stuck in: a Gallup poll revealed that one in six Americans stay in jobs they want to leave because they can’t afford to lose their health benefits. Politicians on both sides claim to support innovation and entrepreneurship, but the cost of healthcare is a huge barrier for many, and something that could be easily resolved with a public option. It’s almost as if we believe people who are sick, unlucky or not blessed by inherited resources deserve to have their choices constrained and stay trapped in perilous circumstances. (That last part is a joke. We Americans definitely believe this.)

We have a Democrat-led Congress and a Democratic president, yet there is no public option or significant overhaul of our broken health insurance system on the horizon. As a result, when my husband got offered his dream job at an emerging non-profit startup, one so new that when the offer was made they could not yet offer health benefits, he hesitated. There would be a gap in coverage, of indeterminate length, and there was still that $12,000 emergency room visit in recent memory.

In the end, simply by luck, the startup found a way to enroll employees in a health program that left us with only a one-month gap in coverage. I am lucky to be married to someone I like, who I am not afraid of, who I do not want to leave. This hasn’t always been the case for women in my family, or even myself in my 20s. For now, and for the foreseeable future, my access to doctors is tied to my partner, and his to his employer. Land of the free indeed.

• Jessa Crispin is a Guardian US columnist