Colorado Shooting Victims to Get Free Health Care. Why Not Everyone?

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Three of the five hospitals treating the 58 surviving victims of the Colorado movie-theater massacre will waive some or all of the medical fees involved in their care, the AP reported yesterday. The other two hospitals, which are considered “safety net” hospitals because they frequently treat the uninsured for free or at low cost, did not reveal their plans to help the victims.

It’s not clear how many of the shooting victims are uninsured, but the issue raises a larger question: why should only survivors of highly public tragedies receive affordable medicine?

Federal law requires hospitals to medically stabilize all patients who cannot pay. After that, however, patients without insurance are on their own in finding ways to afford necessary ongoing care. Often, the bills are unmanageable: the No. 1 cause of bankruptcy in the U.S. is medical catastrophe; one Harvard study [PDF] found that it accounted for two-thirds of all bankruptcy cases. Worse, in such cases, 78% of people actually had at least some health insurance. And the patients involved in these medical-bill-related bankruptcies were primarily middle class, well-educated homeowners.

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In Colorado, nearly one-third of residents are either uninsured or underinsured, with a health policy that doesn’t cover basic medical needs cheaply enough to allow them to afford necessary care, according to The Colorado Trust, a health care advocacy group. Among the shooting victims, the percentage of those who completely lack insurance or whose coverage won’t be enough to avoid bankruptcy is almost certainly higher. Most of the shooting victims were young, of working age — a group most likely to forgo health insurance because they tend to be healthy and, if employed, often earn low wages.

One survivor who is known to be without insurance is Caleb Medley, a 23-year-old aspiring comedian who suffered a head wound so severe that he is being kept hospitalized in a medically induced coma. His wife Katie, 21, who was not physically injured in the shooting, gave birth to the couple’s first child, a boy named Hugo, on Tuesday. The family has been told that Medley may face $2 million in medical expenses.

Major fundraising efforts are underway to help victims like Medley, who, like other victims of shootings, may require medical care that even for many insured people is frequently not covered. Severe brain injuries tend to require the most lengthy and expensive rehab efforts, but even injuries to limbs that require rehabilitation can be costly and difficult.

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The horrifying, random and highly publicized nature of the Aurora shooting means that it’s likely that victims will get all of the help they need, whether through charity or medical cost waivers. But, again, the circumstance makes you wonder about patients who aren’t victims of such tragedy: what about the working mother injured in an ordinary car accident or the innocent victim of a drive-by shooting or the uninsured diabetes or heart disease patient who isn’t harmed by a newsworthy disaster?

The U.S. is alone in the industrialized world in not providing health care coverage for all. After last year’s shooting and bombing massacre in Norway, which left 77 dead and 242 injured, the survivors did not have to spare a moment worrying about how they would pay for the expensive treatment and rehabilitation they needed. Their national health system covered everything.

A British tabloid has claimed that the alleged Colorado shooter, James Holmes, was directly inspired by the Norway mass murderer, Anders Breivik, apparently dressing exactly the way Breivik recommended in his manifesto and following his advice to have as much sex as possible before the event (Holmes reportedly hired prostitutes to do so).

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Perhaps we can take some far more sensible advice from Norway by ensuring that any citizen who suffers medical catastrophe — whatever the cause — doesn’t also have to undergo financial distress and disaster. President Obama’s Affordable Care Act is certainly a step in the right direction. It requires everyone to have insurance and caps out-of-pocket spending on treatment. But it is under heavy political attack and some states have vowed not to implement it.

Setting aside the debate over gun control, do we really want to be the only rich country in the world where a shooting, a car accident or a major disease risks both physical and financial ruin, and where looming fears of bankruptcy haunt patients’ efforts to heal?

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Maia Szalavitz is a health writer for Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland‘s Facebook page and on Twitter at @TIMEHealthland.