The bullet exploded like a fragment from the past, piercing his
present and laying waste to the future he envisioned. It tore through
Jerome Graham’s back, wrecked his spleen, damaged his pancreas and
kidney, and left him paralyzed from the waist down.

And while the direct medical consequences of that gunshot fired a year
ago in East Baltimore end there, the full force of its destruction has
reverberated more broadly, encompassing Graham’s friends, his family,
his community. It has carried into the American health care system,
while confronting American taxpayers with costs reaching hundreds of
thousands of dollars.

Before he was shot last year, Graham, 33, supported his wife and three
children by working as an electrician. Barring a medical miracle, he
will never walk again, greatly complicating his ability to earn a
paycheck. Since the shot went through his body, he and his family have
come to rely on government programs like Medicaid, Social Security and
subsidized housing.

In the American conversation, discussion of gun-related violence
generally centers on the tragic loss of life or permanent injuries
that result. But beneath these headline-grabbing, life-shattering
facts are costs measured in vast numbers of dollars.

Firearms-related deaths cost the U.S. health care system and economy
$37 billion in 2005, the most recent year for which the Centers for
Disease Control and Prevention attempted an estimate. The cost of
those who survive gun violence came to another $3.7 billion that year,
according to the CDC.

More than a year after the shooting, Graham still needs at least one
more surgery and he'll require lifelong medical care and other
assistance because of his disability. Graham spent three months in
Johns Hopkins Hospital and other facilities after being shot. Multiple
surgeries were followed by recoveries and rehabilitative therapy.

"I actually got a hospital bill for two-hundred-and-something thousand
dollars," Graham said. If his new disability didn't qualify him for
Medicaid health benefits, "I would probably be paying on those bills
for the rest of my life." Instead, the United States and Maryland
taxpayers who finance Medicaid are shouldering the cost.