It's difficult to do a comprehensive cost-benefit analysis of American gun culture. It fuels a multibillion-dollar industry employing around 142,000, and it kills more than 30,000 and injures an additional 70,000 annually.
A new study by researchers at Stanford University tries to come to grips with one of the less frequently mentioned costs of gun culture -- the hospitalization expenses resulting from firearm injuries.
The study tracked a total of 267,265 patients who were admitted to a hospital for firearm-related injuries from 2006 through 2014. Costs for initial inpatient hospitalization were about $730 million annually, or a total of $6.6 billion in constant 2014 dollars. Much of that expense landed on the public in the form of Medicaid, Medicare or unreimbursed expenses that the health-care system disperses among consumers.
Yet even that is only a partial accounting. As the report stated:
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"These values are a lower bounds estimate of the burden because they identify only costs associated with the initial inpatient hospitalization. These costs do not include the costs of readmissions, rehabilitation, long-term care, or disability. They also exclude the costs of those who were treated and released or died before admission. Finally, these health-care costs do not include the broader social cost of firearm injuries such as quality-adjusted life years or health-related productivity loss, which provide a broader but more abstract estimation."
In American mythology, the Wild West is the land of quick draws and six-shooters. But the study reinforced what other data confirm: that bullets and blood flow most freely in the South.
The study identifies 17 states as the South, a designation that includes Delaware, Maryland and Washington D.C. Over the decade, the region accounted for 43 percent of U.S. firearm hospitalizations. (Data from the Centers for Disease Control confirm the South is at the head of the pack in firearm fatalities, as well.)
According to the Law Center to Prevent Gun Violence, five of the 10 states with the highest gun death rates in 2016 were in the South. The region seems inclined to keep its lead. In recent years, many Southern states have aggressively weakened already weak gun laws, resulting in statutes ranging from Georgia's 2014 "guns everywhere" to the "campus carry" law that went into effect in Texas last year.
While the South accounted for a disproportionate volume of hospitalizations and deaths from gunshots, it led in another category as well -- the number of surviving gunshot victims who lacked health insurance to pay for their care.
Here, too, many Southern states seem unlikely to surrender their front-runner status. The region is strongly represented among the 19 states that have refused to expand Medicaid insurance under the Affordable Care Act. The study found that more than 80 percent of uninsured gunshot patients fell below the 50th income percentile, concluding "this group is unlikely to be able to absorb health care costs."
In the South, laissez-faire gun culture and laissez-faire political culture sometimes meet in the emergency room.