The senseless shootings of people in a movie theatre, a place of worship and a college campus are barbaric.
But in a country without universal health insurance, the fate that awaits the survivors is, in many ways, just as barbarous. In addition to injury, they will face the insult of medical bills.
Take the case of Caleb Medley, one of 58 people injured during the July 20 mass shooting in a movie theatre in Aurora, Col. Twelve others were killed by the gunman.
The 23-year-old Medley was shot in the eye during the July 20 massacre. He has been in intensive care since the shooting, in a medically induced coma, and has undergone four surgeries and counting. In the meantime, his wife has given birth to their first child.
Mr. Medley's medical bills are expected to exceed $2-million (U.S.). He has no health insurance; as a struggling stand-up comic, he couldn't afford it.
Another victim is Ashley Moser. Her six-year-old daughter Veronica was shot to death, and she was left paralyzed by a shot to the neck.
The 26-year-old has some insurance coverage but not enough to cover the cost of her care. Her immediate medical bills are "going to cost a small fortune," her aunt told USA Today. More important will be the cost of her future care and rehabilitation.
Yet Mr. Medley and Ms. Moser are, in many ways, the lucky ones. Their heart-tugging tales have been featured in news stories, and fundraising initiatives have raised hundreds of thousands of dollars to help them pay their bills.
As these cases illustrate, the public shows tremendous generosity after mass shootings and other high-profile disasters. The hospitals where the Aurora victims were treated have also shown sensitivity to public perception and waived various charges.
However heartwarming this may be, charity, pity and public relations are not substitutes for universal health insurance.
Let that be one of the lasting messages of the Aurora shooting.
The reality is that everyone will, at some point in their lives, need medical care. Everyone needs health insurance.
That's why every developed country (save one) has universal health insurance, and so too do a growing number of lesser developed nations. (The most recent country to implement universal health care is Rwanda, a country rebuilding after a horrific genocide.)
Insurance for all – rather than the pay-as-you-go or charitable models – is seen as the most sensible approach because so many health care problems are unpredictable and costly. Pooling resources allows societies to spread risk and individuals to avoid financial catastrophe on top of physical woes.
Yet the U.S. remains a stubborn holdout. Instead of universal health care, it has some 50 million uninsured citizens and as many again who are underinsured – meaning there are caps on how much of their care will be covered.
The vulnerability of the poorly insured really comes to light when there are tragedies such as the Aurora shootings. (And we will save for another day the discussion of the perversity of U.S. gun laws that result in 32,000 firearms-related deaths and 67,000 other serious gun-related injuries each year .)
One in three Coloradans have inadequate insurance coverage, according to The Colorado Trust, a health advocacy group. In the 18-to-34 demographic – the majority of patrons at the movie theatre that fateful night – almost half are uninsured.
Having no health insurance is a game of Russian roulette.
USA Today recounted the case of Carolyn Tuft, who was shopping in a Salt Lake City mall five years ago when a gunman opened fire. Her 15-year-old daughter was killed but Mrs. Tuft survived bullets to the back, arm and chest. She spent three weeks in intensive care, running up medical bills of more than $100,000.
Uninsured, she was unable to pay and the hospital eventually wrote off the bill. Under U.S. law, hospitals must stabilize patients with traumatic injuries before discharging them. These costs get passed on to other consumers, but not in any rational, organized fashion.
Years later, Mrs. Tuft still has tens of thousands of dollars in debt from paying for follow-up treatment of chronic pain and lead poisoning from the bullet that remains lodged in her neck. Medical bills, she told the newspaper, "destroyed my life."
These tales of destruction occur every day in the U.S., where medical bills have long been a leading cause of personal bankruptcy. But those individual tragedies tend to unfold far away from the media spotlight.
So too does recovery. It has been a couple of weeks since the shootings in Aurora, and the flow of donations is already drying up even though survivors have years of treatment and rehabilitation ahead of them, much of it costly.
While gun violence highlights the unfairness of the current system, most medical woes do not occur as the result of spectacular events, but rather because of more banal ones: a motor vehicle crash, a stumble down the stairs, a heart attack, a small cut that becomes infected with flesh-eating bacteria, an ectopic pregnancy, a cancerous tumour.
Every one of those incidents or conditions can be just as random, debilitating and costly.
It is a cost no one should bear alone. Victims should not be re-victimized by financial barriers to health care and recovery – at least not in a civilized society.