Last year, my friend Chelsi took her family to Tennessee for a summer vacation. While her 8-year-old son was in the hot tub, he curiously picked up what he thought was a frog floating in the water, but immediately dropped it in shock when he realized it was a little living lilac. It all happened so fast that her son wasn’t sure if the bat had bitten or just cut off his hand as it flew.

A week later, when they returned home to Alabama, he developed a fever, chills, body aches, headache, sore throat, nausea and vomiting — all symptoms that could be consistent with rabies. Knowing that rabies is one of the deadliest infectious diseases, his parents panicked. They took him to the ER, where he received his first round of rabies immune globulin and his first rabies vaccine, as recommended by the Centers for Disease Control and Prevention. Because rabies is relatively rare in the United States, Americans do not routinely receive this vaccination. However, a full course of treatment also includes completing the vaccination regimen, which consists of three additional injections over the next few weeks.

After their visit to the ER, Chelsi called nearly every pediatric office in her area, only to discover that none had the rabies vaccine. This was not surprising given the rarity of the disease these days. She was told that only the health department would have the vaccine if she chose not to return to the ER. Each additional vaccine from the health department would cost $400, bringing the total cost of this potential rabies to over $4,000, including the initial emergency room visit. And because their family had a high-deductible health plan, most of that bill was on their shoulders.

We’ll never know if it was rabies—the symptoms of early infection are so generic that they’re indistinguishable from the common viral infections kids get every few months. This situation exactly illustrates the difficulty of decision-making in the field of health; it could either be an infection with a near 100% fatality rate, or it could be nothing. There was no time to lose if he was first; the sooner you get treatment, the better your chances of survival.

Our healthcare system was presented to us as one where patients can be considered “consumers” and can “shop” among the many options available. Chelsi’s experience is just one example of where this analogy breaks down. It’s the average consumer who can carefully compare options for predictable purchases, whether it’s curtains or a car. The Oxford Dictionary of Economics defines a consumer as “a person who purchases goods and services for personal satisfaction, exercising free choice in a market where preferences, tastes and resources determine demand”.

Did Chelsi have “free choice” when her son’s life was at stake? She could have rolled the dice, I suppose, on her child’s life, but it’s hard to imagine any parent choosing not to save their child no matter the cost. Furthermore, it may not even be legal for a parent to delay or deny her child this life-saving treatment. If a parent took the chance and their child developed worsening symptoms, not only would it be too late for treatment, but it could theoretically put a parent at risk of facing child neglect charges.

As we consider whether patients can truly be consumers with freedom of choice, it is critical to recognize that Americans are unique in the industrialized world when it comes to making health care decisions. These decisions are already inherently painful in themselves, only to be compounded by the uncertainty of what will and will not be covered by insurance.

After all, the real horror wasn’t the bat; it is our health care system that forces us to decide whether we can afford to save our own lives. This horrifying truth persists long beyond Halloween, continuing to haunt Americans year-round until we change the system.