Whenever a mass shooting occurs, the headlines tell us how many were killed. These body counts then allow us to rank mass shootings: Robb Elementary (21 killed) was terrible, but not as bad as Sandy Hook (26 killed), which was worse than Parkland (17 killed). But what about the injured survivors, who often outnumber the dead? At the 2012 mass shooting at a movie theater in Aurora, Colorado, for example, 12 people were killed, but 58 were wounded; in the Route 91 Harvest Festival shooting, 60 people were killed, and at least 413 were wounded.  

Every day in the United States more than 300 people are shot, and just over 200 of them survive their injuries, according to data compiled by Brady. That makes for 76,725 gunshot survivors a year. While the emotional trauma certainly takes its toll, the financial toll can be just as devastating. The luckiest survivors get patched up at the local emergency room for, on average, about $5,200, and are sent home. The less fortunate require additional care — multiple surgeries, nursing home residency, rehabilitation treatment, physical therapy, for an average additional cost of  around $179,000. Many survivors live the rest of their lives with physical limitations like missing or disabled limbs, and they often require wheelchairs, modifications to their homes, and in-home care. Some of them go permanently to nursing homes or residential treatment facilities, where the lifetime costs of their care stretch into the millions of dollars.  

Some survivors, desperately relying on the kindness of strangers, set up GoFundMe campaigns to raise funds for  their medical and other costs. Survivors and families of those killed in the Uvalde, Texas, school shooting, for example, have 37 dedicated GoFundMe sites, which have collectively raised $6.7 million to date to cover medical treatment and memorial costs.

A 2017 study by researchers at Johns Hopkins University estimated that the U.S. spends $2.8 billion per year on medical treatments for gun violence survivors. Many survivors find themselves struggling with co-pays and deductibles if they are insured, and with mountainous medical bills if they are not. An insured person who has been shot can easily find that they are responsible for $20,000 of a $100,000 bill. Only 12 percent are able to pay their medical bills in full, per the study. In any case, Americans subsidize the gun industry and gun owners by picking up these unpaid bills through our taxes or increased insurance premiums.  

This approach to the medical needs of gun violence survivors is cruel, irrational, and unjust. A saner, fairer model for paying such costs is staring us in the face: automobile insurance. Americans have accepted the price we pay for living with cars, a cost of over 35,000 lives each year, and millions of people injured. We have devised an elaborate insurance system to make sure the medical costs of those injured by automobiles are paid for not by the victims, but by the community of automobile owners. As this system has evolved, insurance companies have developed nuanced ways of assessing the risk posed by each driver and adjusting their payments into the system accordingly. Men are higher risk than women. Teenagers are higher risk than middle-aged drivers. Those who have speeding tickets are higher risk than those with clean driving records. Porsche drivers are higher risk than Volvo owners.  

It is easy to imagine an analogous system that would pool the risks posed by gun owners and aim to ensure that innocent victims of gun violence do not pay insurmountable bills as punishment for having the bad luck to be in the wrong place at the wrong time. In such a system, older gun owners with clean records would pay lower insurance rates than 18-year-olds, and people with lots of guns would pay more than those with a single gun. And, just as insurance companies offer discounts to those who take defensive driving classes, so could they offer discounts to gun owners who have taken firearm safety classes, or who can demonstrate that they keep their guns locked up at home.  

The assumption that most American gun owners would never allow this infringement on their freedoms finds a counter in automobile owners, who by and large do not see mandatory auto insurance as intolerable, or as a portent that the government will take their cars away. With the exception of a small minority who illegally drive without insurance, they may complain about their own insurance rates, but they accept that a system for pooling the costs of risk is much better than a world where one mistake — made by oneself or another driver — can lead not just to a totaled car and hospital stay, but to financial ruin. Auto insurance is also set up to absorb the residual risk posed by those who refuse to insure their cars or have let their policies lapse temporarily. Insurance spreads these liabilities fairly and mitigates the risks of driving. Such a system, run by market institutions rather than the government, can do the same for gun owners, and for the more than 200 Americans who are shot by guns each day and live — people who do not deserve to pay the price for someone else’s mistake.

Gun owners have managed to externalize the medical costs of their gun ownership to the rest of us.

This is not a gun control proposal, but a proposal to more fairly distribute the costs of America’s love affair with guns. It might even have beneficial implications for gun safety: By increasing the costs of gun ownership, it might encourage Americans to buy fewer guns. And it might encourage gun owners, seeking discounts, to take more gun safety classes, or to buy gun safes for their homes, in which roughly 4.6 million minors live with unsecured guns

Gun insurance would probably not have averted the carnage of Uvalde or Buffalo. But it may mitigate the other 99 percent of gun accidents and violence in this country. If Americans have indeed decided, as a matter of principle, that they want to live in a society with more guns than people and few restrictions on who can own them, then the least we can do is make fair provisions for the innocents who will inevitably suffer the consequences of this choice.

Correction: An earlier version of this article misstated the year of the Aurora mass shooting.