Jason is a 47-year-old man who loves to work around the house. If there’s grass to be cut, gutters to be cleaned, or Christmas decorations to be hung, he’s your guy. His lawn is the envy of his neighbors, and he beams at his twinkling lights, but the next morning brings a different story: Debilitating low back pain that lingers for days.
Every step is a challenge, every bump in the road while driving steals his breath. Stiffness eases slightly when he moves, but the ache is relentless. He’s lost count of how many episodes he’s endured. Over-the-counter meds help a bit, but when the next project rolls around, so does the pain.
Jason is used to fixing things, but no hammer or ladder can fix a healthcare system that leaves his pain untreated. He’s not alone—24.3% of Americans live with chronic pain, with low back pain leading the pack, per the CDC’s 2023 National Health Interview Survey.
For Jason and millions like him, accessing care means navigating a maze of barriers. Start with insurance, which can feel like a full-time job.
Is your doctor “in-network”? If not, you’re paying more—if your plan even covers “out-of-network” care.
Need a spine specialist? That depends on your plan, too—some demand a primary care referral, adding weeks to the wait.
In Gainesville, Florida, where I live—a moderate-sized city in north central Florida that is home to the University of Florida and its hospital system—I hear horror stories of patients waiting six months or more for appointments. And it’s not just specialists. If you can find a primary care physician who is taking new patients, expect to wait half a year just to establish care…and then wait again for referrals to specialists in orthopedics, dermatology, neurology— you name it.
It’s not necessarily that these physicians have the best reputation; there simply aren’t enough appointments to go around. In an alarming statistic, the National Rural Health Association reported that urban areas have 263 specialists per 100,000 residents while rural areas have just 30 specialists for every 100,000 residents.
If you can find a physician, paying for it is the next obstacle. Over the past decade, I’ve seen cost-sharing in the form of deductibles balloon from $250 with 10% co-insurance to $5,000 with 30% co-insurance. Copays have seen the same increases with most going from $5-10 per visit to $50-70.
Let’s not forget, cost-sharing is what you get to pay AFTER you pay your monthly premium. Jason’s insurance ‘covers’ physical therapy but only after he pays his $1,000 monthly premium on his employer-sponsored family plan and meets his $5,000 deductible. When he hears ‘no charge’ at the pharmacy, it hardly feels like a win.
Costs add up with delay
For Jason, a $150 physical therapy session might as well be a private jet—unthinkable on a mechanic’s wage, with rent, childcare, and groceries getting the bulk of his paycheck. Even if insurance “covers” it, he’d need to meet that outrageous deductible first.
Meanwhile, his pain doesn’t understand that money is tight—it cuts into work hours, tests his patience with his family, and serves as a constant reminder that health seems to be another benefit of being wealthy.
Then there’s the question of actually attending appointments while working full-time. Orthopedic clinics may offer “after-hours” slots to keep sprained ankles out of emergency rooms, but good luck finding a neurosurgeon to examine your back pain available past 4 p.m. If you’re fortunate enough to get to the point of a physical therapy referral, good luck finding a clinic that (1) takes your insurance, (2) fits your budget, and (3) stays open late or has weekend appointments. Otherwise, you’re burning precious paid time off—and a beach vacation with back pain is better than no vacation at all.
It’s worse for some. A 2022 Centers for Disease Control and Prevention analysis found Black adults with chronic pain are about 40% less likely to access non-pharmacological treatments like physical therapy, often facing pills as the default. Low-income folks face similar traps—high costs force them to delay care 30% more often than wealthier patients, per a 2023 health policy analysis.
And here’s the additional rub from this: When delays push these patients to the emergency department, they get imaging, medication, and referrals at a far higher cost than timely care. In the end, all the delay does is cost the patient more money.
We can do better
Policymakers should fund community pain clinics and subsidize telemedicine that works for rural folks—no more spotty Wi-Fi excuses.
Insurers must cover evidence-based therapies like physical therapy; studies show they cut long-term costs by 20% compared to opioids. Employers could pitch in with flexible hours for appointments, so Jason doesn’t lose a paycheck to see a doctor.
And the rest of us? Friends, family members, neighbors, co-workers…we need to listen. Next time you see someone wince as they stand, ask their story. Their pain is real, even if it’s invisible.
Jason still mows his lawn, hangs his lights, but each project steals a piece of him. Chronic low back pain isn’t just a condition—it’s a fight for care in a system that too often looks away. Relief shouldn’t be a privilege for the wealthy or the lucky. Isn’t it time we built a system that wants people to feel well?
Related: [Why massage therapy isn’t covered by Medicare]
Penny Goldberg, DPT, ATC
Penny Goldberg, DPT, ATC earned her doctorate in Physical Therapy from the University of Saint Augustine and completed a credentialed sports residency at the University of Florida. She is a Board Certified Clinical Specialist in Sports Physical Therapy.
Penny holds a B.S. in Kinesiology and a M.A. in Physical Education from San Diego State University. She has served as an Athletic Trainer at USD, CSUN, and Butler University.
She has presented on Kinesiophobia and differential diagnosis in complicated cases. Penny has published on returning to sports after ACL reconstruction and fear of movement and re-injury.
Outside of the clinic, Penny enjoys traveling, good cooking with great wine, concerts, working out and playing with her dogs.
