America's most dangerous health epidemic

From my rooftop, I watched the New Year's Eve fireworks at the riverfront, but with trepidation. Along with the faint booming of dazzling fireworks 25 blocks away was an added effect. All around me were the echoes of nearby gunfire. "Pop-pop!" peppered with "Prrrrrop!" sounded from all directions. Anyone who lives in Philadelphia learns what hot semi-automatic gunfire sounds like. It sounds like firecrackers that kick your heart. Dull cracks as sharp and precise as bad news. So crisp and clear was this winter night, there was no mistaking the annual ritual to let your neighbors know that you are drinking, that you are packing and that what you keep in the nightstand is a little more deadly than what they might have hoped. Like your computer and your car, you've upgraded. This isn't your father's shotgun. This New Year's Eve felt not like Philly on a good day, but like Beirut on a bad one. For 2002, I'll issue army helmets to the guests. There's an item for the to-do list: "Dry French champagne, cheese, swing, jazz, plus a few army surplus flak jackets." I live in a middle-class neighborhood, and gunfire reports came from Fitler Square as often as from South of central South Street this December 31. West Philly and Northeast Philly answered each other in equally rapid retorts. Whether for protection or amusement, guns represent a top-10 health risk for morbidity and mortality in the U.S., making it mandatory for the U.S. Centers for Disease Control and Prevention to monitor gun-related injuries and deaths in Philadelphia and the rest of the nation. It is a myth that those who are shot usually die. Not only does a large percentage live, but it costs the Commonwealth of Pennsylvania more than $200,000 a year per gunshot wound paraplegic, and more than $400,000 a year for a GSW quadriplegic. Here in Philadelphia, the city created a gun brigade to increase gun safety awareness on New Year's Eve. Now there's just 347 more days to go. With federal Medicaid payments dipping to all-time lows, and urban hospitals such as the Hospital of the University of Pennsylvania posting record losses, coping with gunshot wounds continues to become an even more daunting challenge. Foreign doctors point out that they do a routine rotation in the U.S. and end up trained for wartime at the front. In 1998, HUP lost a shocking $215 million, as Medicaid and Medicare reimbursement legislation sneaked quickly under barbed wire. In disbelief and in vain, HUP administrators waited for the restoration of previously accepted minimal federal reimbursement. In spite of this crisis, which helped force takeover talks of our world-renowned University hospital, the response to sensible handgun legislation remains buried in the bank accounts of politicians who forgot that they were elected to protect the public interest and who owe their gun-lobby pimps. American cities are ripped apart by needless death, injury and broken lives. But industry cash does pay for all those nice suits, the mortgage on the mansion and annual hair implants. Where, after all, are the good, bald, badly dressed politicians living in ranch-style houses? Prevention of only a small percentage of handgun injuries would result in dramatic cost savings for beleaguered urban medical centers. But how would the pols ever afford a mindlessly overpriced election campaign without those tasty National Rifle Association dollars? Can politicians continue to take lavish funds from the NRA with the understanding that their payments will be killed with just the slightest movement forward on gun safety issues? Mind you, we are speaking of such heresies as mandatory trigger locks and locked gun cabinets, to say nothing of the closure of gun show regulatory loopholes to prevent purchases of the sort that allowed the Columbine shooters to amass an arsenal worthy of a minion of Osama bin Laden's. Can Philadelphia afford the rash Congressional conservatism that penalizes urban health centers for the unavoidable burden of their location? That's some kick-ass Second Amendment. As you walk around the city, or sit quietly in your study, you may come across a situation that would have ended much less tragically if these laws had been in place yesterday. Should you ever have one of those unfortunate days, let's hope that the legislation you supported prevented the involvement of some nine-millimeter in the jittery fingertips of some agitated man. Let's not just bid each other a nice day. Let's give each other a good shot at them.

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