Firearms, Taxes, and Universal Health Care

Members of the United States military serve in many areas of armed conflict, such as Syria and Afghanistan.  Compiled from several sources, Wikipedia reports that 5,684 Americans have been killed in combat since 2001.  An additional 52,339 have been wounded in these military actions.  One form of “collateral damage” is post-traumatic stress disorder, which may affect 15% of returning soldiers, leading to high rates of suicide among both veterans and active duty personnel.[1]  Consequently, whether or not we agree with the policies that place them in harm’s way, as a nation and society we try to honor and recognize their service.

As perilous as a war zone may be, the United States may be even more dangerous.  For a similar period (2001 – 2016), there were 191,546 gun homicides in the U.S. and another 9,828 unintentional firearm deaths, such as mishandling a gun while cleaning or a hunter accidentally killing another hunter.  6,175 Americans were killed due to legal intervention and another 4,057 firearm deaths were listed as due to undetermined intent for a grand total of 211,606 gun related deaths.  To put these numbers in perspective, between 2003 and 2011, 3,836 soldiers were killed in Iraq – an average of 426 combat deaths per year compared to an average of 18,700 firearm deaths in the U.S. per year for the same period.

As noted in the first paragraph, 52,339 soldiers have been wounded in action since 2001; about 3,100 a year.  This compares to an average of 67,000 here in the U.S. who are wounded annually.[2]

Firearms are also the leading cause of death by suicide in the U.S.  Between 1999 and 2016, 336,579 Americans killed themselves using a gun.[3]  Unfortunately, veterans and active duty personnel, particularly those who have served in war zones make up an increasing number of individuals who use a gun to commit suicide.

Gun fatalities occur in the health care system’s external environment.  With the exception of the mental health sector, which can help provide treatment for PTSD and depression, the health care system has little if any influence over the cause of these casualties.  Instead, the health care system reacts and responds to firearm deaths and injuries and it does so at considerable cost.  According to a 2017 Washington Post article, the cost to treat gunshot victims is $2.8 billion a year.  If the injury can be treated on an outpatient basis the average cost for emergency treatment is $5,000; however, if the wound is more severe, requiring hospitalization, it can cost $100,000 or more.[4]  These costs are understandable as, per a John Hopkins University study, “gunshot victims are five times more likely to require blood transfusions, require 10 times more blood units and are 14 times more likely to die than people seriously injured by motor vehicles, non-gun assaults, falls or stabs.”[5]

The Washington Post article also noted that 40% of the victims lack health insurance to pay for treatment.  In most cases, victims and their families will be billed for medical treatment and a monthly payment plan set up to compensate the hospital.  However, if the victim can’t afford to pay, then those costs are shifted over to patients with insurance in the form of higher charges.  Medicaid was the second most used source for payment; i.e., we pay for treating gun victims through our taxes.  Finally, the $2.8 billion represents direct costs for treating gun wounds.  It does not include the additional costs associated with mental health services for treating the trauma associated with being shot, lost time at work, or costs associated with long-term rehabilitation and possible loss of mobility.

In these initial blog articles I haven’t provided a lot of information about how I propose to pay for health care other than to refer to it as a health care transaction tax.  That’s because there is a lot of confusion and misunderstanding about how taxes work and influence the economy.  It will take several blog articles to provide the context for understanding how the health care transaction tax will work and its impact on individuals and businesses.  What I can say is that it will replace current forms of paying for health care, so most Americans will pay less for health care while having equal access to treatment.


Getting back to the cost of treating gunshot victims, under the universal health care plan I am proposing, gun users will contribute toward the payment of medical treatment above the cost of paying the health care transaction tax.  Specifically, they’ll pay a health surtax of .05¢ per bullet.  For example, if a box of 100 20-caliber bullets costs $15.00, buyers will also pay the state’s sales tax, the health care transaction tax, the Firearms and Ammunition Excise tax (currently 11%) and the bullet surtax which in this case would add $5 to the purchase.  Inclusive of all taxes, this will raise the price of a box of 100 bullets to about $24.50.

Looking online, I couldn’t find data reflecting annual bullet sales volume.  However, data from Statista indicates annual sales of about $16 billion including guns, accessories, and ammunition.[6]  If ammunition accounted for just 12%, a .05¢ per bullet surtax could generate about $1.9 billion in revenues; a lot of money to offset the $2.8 billion it costs to treat victims of firearm related injuries.

In some cases, such as the sale of cigarettes, high taxes tend to lower consumption.  However, I don’t believe this will be true with the sale of bullets.  Gun ownership is important to many Americans and the fear gun laws will in someway restrict ownership has actually increased sales.  Almost all developed countries with universal health care do not have the high costs associated with gun fatalities because those countries either ban or restrict gun ownership.  Given that guns aren’t going away, it makes sense to attach a cost to their use to offset the high cost associated with treating those injured by the product.  The NRA may not agree, but with rights come responsibilities and this is one way gun ownership can be tied to the negative outcomes associated when firearms are misused.







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