When I was a kid, I believed if a person was shot by a criminal, their treatment would be paid for.  I wasn’t sure how this would work, but I reasoned it would be unjust for them to have to pay for the misdeeds of another. As has turned out with most of my beliefs about American justice, I was wrong. Shooting victims are usually presented with the bills for their treatment and unless you are a presidential candidate, being shot comes with a high cost.

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 grazing wounds to massive damage, the costs vary greatly. While the average is $5,000 it can be as high as $100,000. While such costs are often covered by insurance, uninsured or underinsured shooting victims become victims again: they must either pay or pass on the cost. When the patient cannot pay, their credit can be damaged and the cost is passed on 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 psychological harm.

In addition to medical expenses, 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 dying in the hospital 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 and assassination attempts 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 might dispute the numbers, it is indisputable that getting shot is expensive and it would be rational to reduce the number of shootings and 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 death, and this is no accident. Efforts to improve the collection of data are routinely blocked 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 consistently blocked. While this shows 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 unlikely to succeed. As such the most practical option involves finding ways to offset the medical costs to victims. While victims can bring civil suits, this is not a reliable and effective way to ensure that the medical expenses are covered. After all, shooters are rarely wealthy enough to pay all the bills and are sometimes killed.

Some victims have set up GoFundMe pages to get donations to pay their medical bills and this has become a common practice for many medical expenses. One problem with this approach is that it is not reliable and depends heavily on luck and being appealing to the crowd. There is also the moral problem of people needing to beg so they can pay the bills arising from getting shot. I have two proposals to address this problem.

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 usually 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 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 cannot 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 or free TV or radio time to exercise their freedom of speech, it is not required to allow gun ownership without insurance, provided that the requirement does not impose an unreasonable infringement on the right.

Another reply is that rights do not free a person from responsibility. In the case of speech, people cannot simply say anything without there even being consequences. In the case of gun insurance, people would be acting in a responsible manner. They would be balancing their rights with a rational amount of responsibility. To refuse to have such insurance is to insist on rights without responsibility, something conservatives usually pretend to hate. 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 firearms and ammunition. 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 many states. The justification is that the people who buy guns that could hurt people should bear the cost for the medical expenses of those who are hurt. People already pay sales taxes on these items; this would merely allocate some money to help offset the cost of people exercising their second amendment rights. To go back to the vehicle analogy, it makes 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 many people who will never engage in a 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 uninsured medical expenses involving any firearm crime or accident and anyone can have an accident with a gun. Another is the responsibility argument: while you or I, as gun owners, will probably never engage in a gun crime, being able to exercise our right to own guns allows people who will engage in gun crimes to engage in those crimes. For example, the person who tried to kill Trump was operating under the protection of the same gun rights that protect all gun owners up until the moment he started firing. This fee would be our 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, we would be selfishly expecting everyone else to bear the cost of our rights, 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.