The High Cost of Being Shot

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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.



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  1. This is something that I have been arguing for. To own and drive a car you need a diver’s license, registration of that car and proof of insurance. Car theft is not absolutely rampant, even though most of us leave our cars unattended out in the open all day and all night, because a stolen car cannot be easily sold, as a quick check of the registration will identify the true owner. While there are bad drivers, licensing assures a minimum level of competence. People are injured or killed by automobile accidents, mandatory liab8ility insurance assures that few victims will be forced to pay for injuries inflicted by others. Gun licensing could assure that people who own guns and least are not legally blind and know the laws of the state affected where and how a gum may be carried and the obligations of the owner to use it safely. Registration would limit sale of stolen weapons and guns could be confiscated from people who lack registration. A portion of insurance costs would be used to cover part of the medical costs for injured individuals where the shooter could not be identified. The associated fees and paperwork would also somewhat discourage people from keeping more fire power than they really need. Why pay the extra registration fees and higher insurance rates to own an assault rifle when it is not a practical weapon for self defense or hunting?

  2. I realise that this probably isn’t the right way to report this, but I can’t find a contact e-mail address listed anywhere on the website.

    It looks like your blog platform has picked up some sort of malware, as it is being used to link to fairly dodgy looking pharmacy websites. These links aren’t visible in the displayed page but are there in the source code (presumably to improve these websites ranking in Google search results etc, as Google will see the links even if humans can’t)

    For example, if you do “View Source” in your browser to see the HTML of this page (or the front page, or another article – I think it’s affecting everything), and then search for the name of the most well known male potency treatment, you should find a number of links. (I’m reluctant to mention the actual name as this might result on my comment being blocked by your spam filter!)

    These links are also getting syndicated out through your RSS feed, where they are unfortunately much more visible. This is how I noticed the problem – I read this blog through InoReader. At the bottom of each entry, I see a massive block of links to these websites.

    I realise that you (Mike) probably aren’t responsible for the blog platform, but I am hoping you can pass this information on to whoever runs it for you.

  3. I agree with your idea. There should be some form of assistance for medical bills resulting from gun injuries that victims had no control over. I also agree that this assistance should ultimately be funded by gun owners and/or gun purchasers.

    However, your first proposal of gun owner insurance may not be a workable solution. The car insurance analogy isn’t really applicable (in my opinion) because while you need car insurance to operate a vehicle publicly you do not need insurance to own a vehicle. Just because someone owns a gun, it’s not necessarily assumed that it will be used. So should someone have to insure something that may be locked up in a box all the time? It can still be potentially used unlawfully and cause harm, but if a car is unused and sitting in a garage somewhere, should the owner be required to insure it seeing that it can also be used illegally and potentially cause bodily harm too? I think most people would answer no.

    The other reason why this probably wouldn’t work, besides the obvious resistance of gun owners, is enforcement. To enforce this would require some form of gun registration and monitoring, which is specifically forbidden on private gun owners in some states, Florida being one. Even though gun registration may probably be the norm one day, it wouldn’t be something practical to implement now.

    I agree with your second proposal. There should be a tax, probably federal, on the sale of guns. A federal, rather than state tax would be more convenient to administer and it would allow uniformity of assistance for victims in all states. There isn’t a known way to identify which gun owners or which guns will be used to cause injuries to victims, so it would make sense that gun purchasers pay this one-time tax. Similar to what you said, a gun owner has the freedom to, at their will, unlawfully use a gun to cause injury to another body. So that freedom should be taxed, but only as a means to help rectify the effects of that same freedom being exercised by others. So yea, freedom is not free.

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