The High Price of Being Shot
In the naivety of my youth, I believed that people would not be charged for medical treatment resulting from being wounded by criminals. After all, my younger self reasoned, their injuries were the fault of someone else and it would be unjust to expect them to pay for the misdeeds of another. Learning that this was not the case was just one of the many disappointments when it came to the matter of justice and ethics. As such, I was not surprised when I learned that shooting victims were presented with the bills for their treatment. However, I was somewhat surprised by the high cost of being shot.
Dr. Joseph Sakran, who had been shot in his youth, co-authored a study of what shooting victims are charged for their treatment. Since gunshot wounds range from relatively minor grazing wounds to massive internal damage, the costs vary considerably. While the average is $5,000 the cost can go up to $100,000. These costs are generally covered by insurance, but victims who lack proper coverage become victims once again: they must either pay for the treatment or pass on the cost as part of the uncompensated care. When the cost is passed on, the patient can suffer from severely damaged credit and, of course, the cost is passed on others in the form of premium increases. There can be costs beyond the initial medical bills, such as ongoing medical bills, the loss of income, and the psychological harm.
In addition to medical expenses of those who are shot, there are also the costs of the police response, the impact on employers, and the dollar value of those who are killed rather than wounded (and do not forget that dying in the hospital obviously does not automatically clear the bill). While estimating the exact cost is difficult, a mass shooting like the Pulse Nightclub shooting will probably end up costing almost $400 million. While mass shootings, such as the recent one in Las Vegas, get the attention of the media, gunshot wounds are a regular occurrence in the United States with an estimated cost of $600 million per day. While some will dispute the exact numbers, what is indisputable is that getting shot is expensive for the victim and society. As such, it would be rational to try to reduce the number of shootings and to address the high cost of being shot.
While the rational approach to such a massive health crisis would be to undertake a scientific study to find solutions, the 1996 Dickey Amendment bans the use of federal funding for gun research. There is also very little good data about gun injuries and deaths—and this is quite intentional. Efforts to improve the collection of data are dealt with by such things as the Dickey Amendment. Efforts to impose more gun control, even when there is overwhelming public support for such things as universal background checks, are routinely blocked. While this serves as a beautiful object lesson in how much say the people have in this democracy, it also shows that trying to address the high cost of getting shot by reducing shootings is a noble fool’s errand. As such, the only practical options involve finding ways to offset the medical costs of victims. Naturally, victims can bring civil suits—but this is not a reliable and effective way to ensure that the medical expenses are covered. After all, mass shooters are rarely wealthy enough to pay all the bills and often perish in their attack.
Some victims have attempted to address their medical bills in the same way others who lack insurance have tried—by setting up GoFundMe pages to get donations. While this option is problematic in many ways, the main problem is that it is not very reliable. This, of course, lays aside the moral problem of having people begging so they can pay for being victims of a shooting. To address this problem, I will make two modest proposals.
My first proposal is that gun owners be required to purchase a modestly priced insurance policy that is analogous to vehicle insurance. In the United States, people are generally required to have insurance to cover the damage they might inflict while operating a dangerous piece of machinery. This helps pool the risk (as insurance is supposed to do) and puts the cost on the operators of the machines rather than on those who they might harm. The same should apply to guns—they are dangerous machines that can do considerable harm and it makes sense that the owners should bear the cost of the insurance. Naturally, as with vehicles, owners can also be victims.
It could be objected that owning a firearm is a right and hence the state has no right to impose such a requirement. The easy and obvious reply is that the right to keep and bear arms is a negative right rather than a positive right. A positive right is one in which a person is entitled to be provided with the means to use that right (such as how people are provided with free ballots when they go to vote). A negative right means the person must provide the means of exercising their right, but it is (generally) wrong to prevent them from exercising that right. So, just as the state is not required to ensure that people get free guns and ammunition, it is not required to allow gun ownership without insurance—provided that the requirement does not impose an unreasonable infringement on the right.
Another easy and obvious reply is that rights do not free a person from responsibility. In the case of speech, people cannot simply say anything without consequence. In the case of the gun insurance, people would be acting in a responsible manner—they would be balancing their right with a rational amount of responsibility. To refuse to have such insurance is to insist on rights without responsibility—something conservatives normally rail against. As such, both liberals and conservatives should approve of this idea.
My second proposal, which is consistent with the first, is that there be a modest state fee added to the cost of each firearm, accessory and ammunition box. This money would go into a state pool to help pay the medical expenses of the uninsured who are injured in shootings. Yes, I know that this money would probably be misused by most states, probably to bankroll the re-election of incumbents. The justification is, of course, that the people who buy the guns that could hurt people should bear the cost for the medical expenses of those who are hurt. People already pay sales taxes on such items, this would merely earmark some money to help offset the cost of people exercising their second amendment rights. To go back to the vehicle analogy, it makes perfect sense to add a fee onto the cost of gas to pay for roads and other infrastructure—that way the people who are using it are helping to pay for it. Likewise for guns.
An obvious objection is that this fee would be paid by people who will never engage in gun crime. This is a reasonable concern, analogous to other concerns about paying into anything that one is not directly responsible for. There are two reasonable replies. One is that the funds generated could cover medical expenses involving any firearm crime or accident and anyone can have an accident with a gun. Another is the responsibility argument: while I, as a gun owner, will probably never engage in a gun crime, being able to exercise my right to own guns allows people who will engage in gun crimes to engage in those crimes. For example, the Las Vegas shooter was operating under the protection of the same gun rights that protect me up until the moment he started firing. This fee would be my share of the responsibility for allowing the threat of gun violence to endanger everyone in the United States. Such a modest fee would be a very small price to pay for having such a dangerous right. Otherwise, I would be selfishly expecting everyone else to bear the cost of my right, which would not be right. So, to appeal to principled conservatives, this would be a way for taking responsibility for one’s rights. As people love to say, freedom isn’t free.
A Philosopher's Blog 
Gun owners already pay more for homeowner’s insurance, as do swimming pool owners.
I don’t think that helps the people who get shot. I could be wrong, but if I go out and bust some caps downtown, my homeowner’s insurance does not pay the medical expenses of the people I shoot.
Mike, you do know that gun violence has been declining for more than 20 years?
Why not focus on a problem that is getting worse?
Yes, violent crime is down. But, too many people still get shot-so it is a real problem. I can write about gun violence and other stuff, so it is a false dilemma to say that if I focus on X, I cannot focus on Y.
“…if I focus on X, I cannot focus on Y”
“Cannot” may be an accurate word in terms of the syllogism, but in the real world, if we believe that X is the root of the problem, then we simply do not focus on Y. After all, why should we?
If I have bad tires on my car, but I believe that they are not the reason my car rides rough, I will spend much time and money looking at the shocks, at the springs, at the undercarriage, at the engine mounts – while all the while my driving experience is worse and worse.
Further, if my mechanic doesn’t have an investment in selling tires, he will continue to steer me (no pun intended) toward those things that, by selling them to me, will improve his lot.
I continue to insist that guns are not the problem, but as long as we believe them to be we will continue to stay focused on the political issue of gun control. As long as politicians can benefit by selling us that political concept, we will continue to ignore the real root(s) of the problem. Why should we worry about gangs, about drugs, about mental illness, about alcohol abuse and other causes of violence when we are told day after day that they have nothing to do with the problem, that if only we can get rid of the guns they will all go away?
“If I have bad tires on my car….”
I’m not sure that any event can be said to have a single cause, but I’m quite sure that no consideration of social policy is due to a single cause. If going the analogy route, you really need an analogy that considers that your tyres, shocks, and every other part of the car is not optimised.
I do think that a lot of the arguments around gun policy in the US seem to be aimed at reinforcing a position rather than exploring causes and solutions, and contain internal contradictions and wilful omissions as a result. Guns may not be the cause of crime, but they do make violent crime easy to commit; it is not really practical to do a drive-by of a street throwing knives. The easy availability of guns in the US must amplify the amount of violent crime, and the question of how to limit this effect is worth considering, alongside questions of deeper causes.
it is a false dilemma to say that if I focus on X, I cannot focus on Y.
Define focus. Or better yet, which shoul be you highest priority? Also, what DH said.
A few details here –
First of all, what you say about the Dickey amendment is merely a talking point. It was never intended as a ban on research, only on the conflation of that research with gun control advocacy. To so many, the idea of “gun control” is a foregone conclusion, and, as I have pointed out in so many posts, to blame gun violence on the mere existence of guns is not only short sighted, but takes the focus on a whole host of potential causes and diminishes the research.
Dickey himself, in a 2012 op-ed, uses an analogy of a woman who had been killed by a car while running. “Her death was tragic”, said Dickey, “but it wasn’t ‘senseless. In scientific terms, it was explicable. The runner wore no lights or reflective vest, she crossed the street within crosswalk lines that had faded to near-invisibility, there were no speed bumps to slow cars down”.
He goes on to say that scientists don’t view traffic injuries as senseless or accidental, but susceptible to understanding and prevention. This leads to better urban planning – “what is the problem? what are the causes? Have effective interventions been discovered? Can we install these interventions in our community?”
If we take the same approach to violence, we can understand an event like what happened in Las Vegas as one that has underlying causes that can be understood and used to prevent similar shootings.
I suspect that Dickey, like me, is disappointed in the lack of critical thinking (there, I said it again! , and a willingness on the part of so-called “researchers” to reach the politically-correct conclusion and then take the money and apply it to gun control measures.
Gun violence in Chicago isn’t due to guns, it is due to gangs, poverty and drugs. Gun violence in domestic situations is not due to guns, it is due to alcoholism, abuse, poverty, and racism. Gun violence in mass shootings isn’t due to guns, it is due to psychosis, alienation, political and/or religious discontent.
Just because firearms are a common denominator in these varied acts of violence does not mean that they are a common cause – and to believe so takes us further away from a solution.
What if, to expand on your modest proposal, there were a tax on all marriages that would be used to compensate victims of domestic violence? There’s a commonality there – and it wouldn’t discriminate against those victims who were stabbed, beaten, or whacked on the head with a beer bottle in favor of those who were shot. That money could be used to study domestic violence in all its forms.
While it may sound cold, why should the victims of the Boston Marathon bombing or the World Trade Center bombing receive less compensation for their injuries than the Fort Hood victims, simply because the latter were victims of gunshots instead of explosives? The cause of Fort Hood was no more about guns than the cause of the others were about bombs – in fact, a much stronger case can be made that regardless of the weapon of choice, the victims were all victims of terrorism based in an extreme view of Islamic Fundamentalism.
Your essay is exactly what the Dickey amendment is about. You have reached the conclusion that the issue is guns. You are unwilling to consider any of the other facts – from the statistics that show that gun-violence has decreased while gun ownership has increased over the last 25 years because you are so invested in your conclusion. You are unwilling to allow for research into other causes of violence, as I outlined in my last post and as were carefully researched in peer-review studies done by Pew and others.
Dickey’s op-ed piece was titled, “We won’t know the cause of gun violence until we look for it”. I think that says it all. But we’re not looking, because we think we’ve found the answer.
Perhaps this will result in a new breed of “compassionate offenders”. They will still commit acts of violence against innocent victims, but they will use firearms so the victims can at least get free medical treatment. I can totally see this in the love/hate world of domestic violence.
Doing my usual round of look-ups, I am struck by two ways in which the US is unusual, perhaps unique, among developed nations:
1. Medical treatment is two to six times more expensive in the US than elsewhere. Yes, double to 6 times as expensive for ordinary drugs or standard procedures, Regardless of how the costs are paid, how is it possible that the US can sustain monopoly pricing levels in an ostensibly competitive system? Some economist should look into that.
No, that doesn’t address the core question at hand, but day-um it’s worth mentioning.
2. The US does not have a fund to compensate the victims of unidentified drivers. I would expect there to be a body like the Motor Insurers’ Bureau that draws on individual insurers for funds to cover damages from auto accidents where the party at fault cannot be identified or cannot be made to pay. So, in the US, if you are the victim of a hit and run, you are on your own. Wow. I don’t even know what to say to that.
Living with such structural differences, I find it difficult to understand how Americans might perceive the main point here.
Certainly while US citizens have rights to bear arms, it is reasonable to partner those with some responsibilities, and I have often thought that a permit should be contingent on a competence test. However, when even the motor insurance provides such gaps, I find it hard to see how gun insurance can be usefully applied.