[Joint House and Senate Hearing, 117 Congress]
[From the U.S. Government Publishing Office]



                                                        S. Hrg. 117-338

                   THE ECONOMIC TOLL OF GUN VIOLENCE:
                     HOW OUR NATION BEARS THE COSTS

=======================================================================

                                HEARING

                               before the

                        JOINT ECONOMIC COMMITTEE

                                 of the

                     CONGRESS OF THE UNITED STATES

                    ONE HUNDRED SEVENTEENTH CONGRESS

                             SECOND SESSION

                               __________

                             JULY 20, 2022

                               __________

          Printed for the use of the Joint Economic Committee




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        Available via the World Wide Web: http://www.govinfo.gov


                               ______
                                 

                 U.S. GOVERNMENT PUBLISHING OFFICE

48-309 PDF                WASHINGTON : 2023









                        JOINT ECONOMIC COMMITTEE

    [Created pursuant to Sec. 5(a) of Public Law 304, 79th Congress]

HOUSE OF REPRESENTATIVES             SENATE

Donald S. Beyer Jr., Virginia,       Martin Heinrich, New Mexico, Vice 
    Chairman                             Chairman
David Trone, Maryland                Amy Klobuchar, Minnesota
Joyce Beatty, Ohio                   Margaret Wood Hassan, New 
Mark Pocan, Wisconsin                    Hampshire
Scott Peters, California             Mark Kelly, Arizona
Sharice L. Davids, Kansas            Raphael G. Warnock, Georgia
David Schweikert, Arizona            Mike Lee, Utah, Ranking Member
Jaime Herrera Beutler, Washington    Tom Cotton, Arkansas
Jodey C. Arrington, Texas            Rob Portman, Ohio
Ron Estes, Kansas                    Bill Cassidy, M.D., Louisiana
                                     Ted Cruz, Texas

                  Tamara L. Fucile, Executive Director
                Kevin Corinth, Republican Staff Director









                            C O N T E N T S

                              ----------                              

                     Opening Statements of Members

                                                                   Page
Hon. Donald Beyer Jr., Chairman, a U.S. Representative from the 
  Commonwealth of Virginia.......................................     1
Hon. Mike Lee, Ranking Member, a U.S. Senator from Utah..........    12

                               Witnesses

Ms. Sarah Burd-Sharps, Senior Director of Research, Everytown for 
  Gun Safety Support Fund, New York, NY..........................     5
Dr. Chethan Sathya, M.D., Pediatric General and Thoracic Surgeon, 
  Cohen Children's Medical Center; Director, Center for Gun 
  Violence Prevention at Northwell Health; Assistant Professor, 
  Zucker School of Medicine at Hofstra, New York, NY.............     6
Mr. Ryan Busse, Author of Gunfight, Former Firearms Industry 
  Executive, Senior Advisor, Giffords, Kalispell, MT.............     8
Ms. Amy Swearer, Legal Fellow, The Heritage Foundation, 
  Washington, DC.................................................    10

                       Submissions for the Record

Prepared statement of Hon. Donald Beyer Jr., Chairman, a U.S. 
  Representative from the Commonwealth of Virginia...............    28
Prepared statement of Hon. Mike Lee, Ranking Member, a U.S. 
  Senator from Utah..............................................    29
Prepared statement of Ms. Sarah Burd-Sharps, Senior Director of 
  Research, Everytown for Gun Safety Support Fund, New York, NY..    52
Prepared statement of Dr. Chethan Sathya, M.D., Pediatric General 
  and Thoracic Surgeon, Cohen Children's Medical Center; 
  Director, Center for Gun Violence Prevention at Northwell 
  Health; Assistant Professor, Zucker School of Medicine at 
  Hofstra, New York, NY..........................................    56
Prepared statement of Mr. Ryan Busse, Author of Gunfight, Former 
  Firearms Industry Executive, Senior Advisor, Giffords, 
  Kalispell, MT..................................................    64
Prepared statement of Ms. Amy Swearer, Legal Fellow, The Heritage 
  Foundation, Washington, DC.....................................    66
Report ``The Economic Toll of Gun Violence'' submitted by 
  Representative Beyer...........................................    31
Report ``The Role of Social Capital in Preventing Mass Public 
  Shootings'' submitted by Senator Lee...........................    36
Charts submitted by Representative Schweikert
    Gun Restriction Rank Against Total Firearm Death Rate 
      (Everytown), July 2022.....................................    49
    Gun Restriction Rank Against Firearm Suicide Rate 
      (Everytown), July 2022.....................................    50
    Gun Restriction Rank Against Firearm Homicide Death Rate 
      (Everytown), July 2022.....................................    51
Article links submitted by Ms. Sarah Burd-Sharps
    The Economic Cost of Gun Violence Report.....................    55
    Methodological Note for The Economic Cost of Gun Violence....    55
Response from Ms. Sarah Burd-Sharps to Questions for the Record 
  submitted by Senator Klobuchar.................................    91
Response from Dr. Chethan Sathya to Question for the Record 
  submitted by Senator Klobuchar.................................    91








 
                   THE ECONOMIC TOLL OF GUN VIOLENCE:
                     HOW OUR NATION BEARS THE COSTS

                              ----------                              


                        WEDNESDAY, JULY 20, 2022

                    United States Congress,
                          Joint Economic Committee,
                                                    Washington, DC.
    The hearing was convened, pursuant to notice, at 2:33 p.m., 
in Room 1300, Longworth House Office Building, Hon. Donald S. 
Beyer Jr., Chairman, presiding.
    Representatives present: Beyer, Trone, Pocan, Schweikert, 
and Estes.
    Senators present: Lee.
    Staff: Ismael Cid-Martinez, Kevin Corinth, Chelsea Daley, 
Sebi Devlin-Foltz, Ron Donado, Tamara Fucile, Owen Haaga, Erica 
Handloff, Colleen Healy, Jeremy Johnson, Adam Michel, Alex 
Schunk, Isabel Soto, Ivan Torrez, Emily Volk, and Brian Wempte.

 OPENING STATEMENT OF HON. DONALD BEYER JR., CHAIRMAN, A U.S. 
        REPRESENTATIVE FROM THE COMMONWEALTH OF VIRGINIA

    Chairman Beyer. Good afternoon. We will come to order.
    I would like to welcome everyone to the Joint Economic 
Committee's hearing titled, ``The Economic Toll of Gun 
Violence: How Our Nation Bears the Costs.''
    I want to thank each of our distinguished witnesses for 
sharing their expertise today. And I now would like to turn to 
my opening statement.
    It is abundantly clear that the United States is facing a 
gun violence crisis that is unique in its deadliness and its 
scale. While mass shootings capture international attention, 
the use of guns in homicides, suicides, and accidental 
shootings impose widespread and long-lasting costs.
    Loss or injury to gun violence is immeasurable, but the 
economywide harms are real and calculable. According to new 
estimates from Everytown for Gun Safety, gun violence costs our 
economy more than half a trillion dollars every year. This is a 
staggering figure, one that is both gut-wrenching and entirely 
avoidable. To put it in context, at more than half a trillion 
dollars, gun violence costs our economy more than the national 
GDP of nearly 90 percent of the countries in the world.
    From healthcare to education, business development to 
housing, the toll of gun violence is borne by survivors, their 
families, and our entire economy. Each year, gun violence costs 
survivors and their families more than $1 billion in just 
initial healthcare costs, hospital care. It contributes to 
worse mental health outcomes, including higher rates of 
diagnosed psychiatric disorders in both survivors and their 
families. For children exposed to a fatal school shooting in 
their local area, antidepressant use increases significantly 
for years following an incident.
    Gun violence burdens our broader health system, stretching 
its capacity and taxing our frontline healthcare workers. And 
because treatment for firearm injuries cost more than double 
that of other types of hospital care, this epidemic further 
stretches our public insurance programs.
    Gun violence has also been shown to negatively impact the 
educational and life outcomes of children, particularly in 
instances of school shootings. Students that experience these 
incidents experience more frequent school absences and have a 
greater chance of repeating a grade, and they are less likely 
to graduate from high school or attend college.
    Gun violence reduces new business development and directly 
hurts job growth. Areas that experience gun violence are more 
likely to see businesses scale back and fewer new businesses 
form. Research has shown that one additional gun homicide in a 
neighborhood results in 80 fewer jobs the following year.
    Just gunshots being fired, even if there are no injuries, 
reduces home values, and because home ownership is the primary 
way to build wealth in this country, this has the power to 
reduce economic opportunities for generations.
    Tragically, we know that the economic toll of gun violence 
is rising. As firearm deaths, gun injuries, and mass shootings 
have increased in recent years, the gun industry has made money 
hand over fist.
    During the worst of the pandemic, gun sales spiked, leading 
to record high profits for the top two gun makers. As sales 
have surged, so too has gun violence.
    The Bureau of Alcohol, Tobacco, Firearms, and Explosives 
documented a connection between pandemic gun sales and 
increased violence, and found that guns sold in 2020 were more 
likely to wind up at a crime scene within a year of purchase 
than in any previous period.
    And like a storm creating its own weather, increased gun 
violence spurs a corresponding increase in gun sales. For 
example, it is a well documented trend that gun sales rise 
after mass shootings.
    Investors also anticipate this effect, which drives up the 
share prices of gun and ammunition companies. For example, 
shares of the two largest gun companies rose more than the 
market average in the immediate aftermath of the massacres in 
Sandy Hook, Connecticut, San Bernardino, California, and 
Parkland, Florida.
    This self-perpetuating cycle is not an accident. After gun 
purchases plateaued in the early 2000s, the gun industry took 
action to revive sales, lobbying for the successful passage of 
legislation that granted gun manufacturers and sellers immunity 
from legal accountability for the harms caused by their 
product.
    The immunity provided by the Protection of Lawful Commerce 
in Arms Act is markedly different from the treatment of nearly 
all other industries. While other industries can be held 
accountable for products or practices that result in harm to 
consumers, gun manufacturers cannot. For example, tobacco 
companies were famously held accountable for the harms caused 
by smoking, which led directly to changes in the way tobacco 
products are marketed and sold.
    Protection from accountability has facilitated the launch 
of a new and booming market for increasingly lethal weapons. In 
the past, gun companies focused their marketing efforts almost 
exclusively on the sale of guns for hunting and recreational 
shooting purposes. Yet their marketing tactics have shifted in 
recent years. Manufacturers now push guns for personal 
protection, self-defense, and concealed carry. This has created 
a new civilian market for products that had previously been 
seen exclusively as weapons of war. The firearm industry has 
met the growing demand by flooding the market with more lethal 
weapons.
    The human toll of gun violence is unbearable, but so too is 
the economic one. Today, the United States will spend $49.3 
million--today--$49 million on just the medical care, first 
responders, ambulances, police, and criminal justice services 
related to gun violence. And $49 million tomorrow. We will pay 
this price, tomorrow, the next day, and every day thereafter 
until we as a Nation decide to address this epidemic.
    Last month, for the first time in nearly 30 years, 
Congress, in a bipartisan fashion, took action to curb 
violence--gun violence. This an important step, but more is 
needed.
    To address the growing violence and the significant costs, 
we must work together to pave a more peaceful path forward.
    I would also like to submit our new report, ``The Economic 
Toll of Gun Violence,'' for the record.
    [The information referred to appears in the Submissions for 
the Record on page 31.]
    [The prepared statement of Chairman Beyer appears in the 
Submissions for the Record on page 28.]
    Chairman Beyer. Now I would like to turn it over to Senator 
Lee for his opening statement if he is here.
    Okay. The Senate is voting, so we will wait for Senator 
Lee, but I can turn it over to the ranking member.
    Would you like an opening statement, sir?
    Representative Schweikert. Actually, I won't be as eloquent 
as Senator Lee, but he is in the middle of a vote.
    And, Mr. Chairman, I have actually shared this with you. I 
fear often we are squandering decades of reputation of the 
Joint Economic Committee of being about the math. And the fact 
of the matter is, if we are going to lay out the math, we need 
to understand every possibility of what is the inputs. And if 
my brothers and sisters on the left think input is firearm 
manufacturers, great. Vacuous, but great.
    Look, the fact of the matter is suicide rates--or homicide 
rates jumped 29 percent in 2020 alone. What was going on 
societally at that time? What happened societally?
    I am going to show some charts here that, when we adjust 
for suicide rates, there is a problem in our society, and the 
body's hunger to politicize it instead of distill the math, 
distill the math, distill the math, and then get to an honest 
solution that makes our society safer. And I don't know if the 
politicization of a once honorable committee that did the math 
is the path to get there.
    When it is my question time, I will walk through the math 
and see if I can drive us to a place where we could actually 
work on policy that makes society safer instead of more 
political.
    And, with that, I yield back.
    [Charts submitted by Representative Schweikert appears in 
the Submissions for the Record on page 49.]
    Chairman Beyer. Thank you, Mr. Schweikert. And I too look 
toward that, and would love to rebuff any thought that this 
committee is anything less than mathematically high integrity 
and honorable.
    And, with that, let me now introduce our four distinguished 
witnesses.
    Ms. Sarah Burd-Sharps is the senior director of research at 
Everytown for Gun Safety Support Fund. Everytown is the largest 
gun violence prevention organization in the United States. Ms. 
Burd-Sharps' research on gun violence is featured in multiple 
New York Times articles and other national publications.
    Ms. Burd-Sharps previously served as the co-director of the 
Social Science Research Council's Measure of America, where she 
studied economic equity and social justice. She earned a 
master's in international affairs from Columbia University.
    Dr. Chethan Sathya is the associate trauma director and a 
pediatric trauma surgeon at Cohen Children's Medical Center. 
This is the largest Level 1 trauma center in the State of New 
York, treating children from across the five boroughs of New 
York City, Westchester, and Long Island.
    Over the course of his career, Dr. Sathya has treated 
gunshot victims in places like Toronto, Chicago, and now New 
York City. He is also an assistant professor at the Zucker 
School of Medicine at Hofstra, and serves as the director of 
Northwell Health Center for Gun Violence Prevention.
    Dr. Sathya completed med school and surgical residency at 
the University of Toronto, and then attended Northwestern 
University for his pediatric surgery fellowship. Dr. Sathya 
holds a master's degree in clinical epidemiology from the 
University of Toronto, and completed a global public health 
program at the Dalla Lana School of Public Health in Toronto.
    Mr. Ryan Busse is a proud outdoorsman, gun owner, and a 
former firearms executive who helped build one of the 
industry's most iconic gun companies. He has been nominated 
several times by industry peers for his prestigious Shooting 
Industry Person of the Year Award, and has also served as an 
adviser for the U.S. Senate Sportsmen's Caucus.
    Mr. Busse is the author of the book ``Gunfight: My Battle 
Against the Industry that Radicalized America,'' and now serves 
as a senior adviser at the Giffords Law Center to Prevent Gun 
Violence. Mr. Busse resides in Montana.
    Ms. Amy Swearer is a legal fellow with the Meese Center for 
Legal and Judicial Studies at The Heritage Foundation, focusing 
her recent work on firearms and the second amendment.
    Prior to joining The Heritage Foundation, Ms. Swearer 
served as an associate of the Charles Koch Foundation. She is a 
graduate of the University of Nebraska where she received her 
bachelor of science in criminal justice and her juris doctor 
degree.
    Welcome all of you. Thank you so much for being here. And 
we will begin with Ms. Sarah Burd-Sharps, your testimony, and 
then we will continue.
    Ms. Sharps, you have the floor.
    Ms. Burd-Sharps, can you make sure that that microphone is 
on, please.
    Ms. Burd-Sharps. I apologize. I thought it was.
    Chairman Beyer. Okay. Thank you.

 STATEMENT OF SARAH BURD-SHARPS, SENIOR DIRECTOR OF RESEARCH, 
      EVERYTOWN FOR GUN SAFETY SUPPORT FUND, NEW YORK, NY

    Ms. Burd-Sharps. There we go.
    So my name is Sarah Burd-Sharps. I am the senior director 
of research at Everytown for Gun Safety Support Fund.
    With tragic and numbing regularity, we hear of shootings on 
our streets, in grocery stores, schools, hospitals, and too 
many other places. Each day in the United States, roughly 300 
people join the toll of those killed and injured with guns.
    Without a doubt the human cost of gun violence is the 
people who are taken from us, and survivors who are wounded is 
the most devastating.
    But examining the serious economic consequences of gun 
violence offers a wider lens for understanding just how 
extensive and expensive this crisis is.
    Our hope is that this research will help guide you and your 
colleagues as you weigh different actions to build safer 
communities.
    To garner this understanding, we worked with the leading 
U.S. health economists, researching the cost of many types of 
injuries, to analyze highly detailed Federal and State data 
sets and extensive peer-reviewed research.
    We would like to submit the report and the methodology for 
the record.
    As Chairman Beyer just said, we found that the unrelenting 
epidemic of gun violence is costing our Nation $557 billion a 
year, year after year. While not everyone directly experiences 
gun violence, we all pay an economic price for this epidemic, 
and the government share of these costs, paid for by taxpayers, 
is $12.6 billion every year. That is nearly $35 million tax 
dollars each day that could instead help pay for secure firearm 
storage education, community violence intervention programs, 
and other efforts proven to prevent this violence from 
occurring in the first place.
    This $557 billion estimate is conservative. It starts with 
the costs at the scene of a shooting, such as emergency care 
and police investigations. It continues to the longer term 
physical and mental health care survivors need, lost earnings 
of those killed or disabled, and criminal justice costs. And it 
puts a dollar value on the pain and lost well-being of victims 
and their families, but it doesn't even begin to include the 
wider ripple effects on whole communities.
    If you talk to any superintendent, mayor, or even 
pediatrician in a town that has experienced a shooting, they 
can produce a long list of costs that extend far beyond the 
narrow items we are counting. These include costs to address 
the trauma of children who don't want to go back to school, to 
neighborhood businesses and home values, and the larger 
reverberations on all of those who live in a community where 
gun violence happens.
    Using our conservative estimate, the annual cost for 
overall gun violence in the U.S. averages $1,700 for every 
resident. However, in States with stronger gun laws, the 
economic toll is less than half this amount.
    For example, Mississippi has long been challenged by high 
levels of gun homicide, suicide, and unintentional shootings. 
It has the weakest gun laws in the country. At an average cost 
of over $3,300 per resident each year, Mississippi has the 
second highest per resident cost of gun violence. This is a 
steep burden for Mississippians.
    On the other hand, Massachusetts has the lowest rate of gun 
deaths and some of the strongest gun laws in the Nation. The 
average cost for Massachusetts is $503 per resident. This is 
the lowest outlay in the U.S., allowing Massachusetts and its 
residents far more dollars to invest in essential public goods, 
like schools and workforce development, and in building 
healthier, safer, more sustainable communities.
    Following each major shooting incident, some key in on 
mental health as a primary cause, yet the U.S. is not an 
outlier in rates of mental illness compared to our peer 
nations. Where we are an outlier is in gun violence. Our gun 
death rate is 13 times higher than these other high-income 
countries.
    Our research shows we are spending precious funds on a 
preventable epidemic that brings nothing of benefit and plenty 
of heartbreak. We place ourselves at a severe economic 
disadvantage in the global economy with these enormous outlays.
    Thank you again, Chairman Beyer, Vice Chair Heinrich, and 
members of the committee, for allowing me to testify today. I 
look forward to your questions.
    [The prepared statement of Ms. Burd-Sharps appears in the 
Submissions for the Record on page 52.]
    Chairman Beyer. Thank you very much.
    We will now hear from Dr. Sathya.

 STATEMENT OF DR. CHETHAN SATHYA, M.D., PEDIATRIC GENERAL AND 
 THORACIC SURGEON, COHEN CHILDREN'S MEDICAL CENTER; DIRECTOR, 
    CENTER FOR GUN VIOLENCE PREVENTION AT NORTHWELL HEALTH; 
ASSISTANT PROFESSOR, ZUCKER SCHOOL OF MEDICINE AT HOFSTRA, NEW 
                            YORK, NY

    Dr. Sathya. Thank you.
    Chairman Beyer, Ranking Member Lee, and members of the 
committee, thank you for inviting me here today. It is a true 
honor.
    My name is Chethan Sathya. I am a pediatric trauma surgeon, 
and I am an NIH-funded firearm injury prevention researcher, 
and I work for Northwell Health, the largest health system in 
New York. I am also fortunate to lead our Northwell Health 
Center for Gun Violence Prevention, which our CEO, Michael 
Dowling, launched three years ago to help energize the 
healthcare sector around this public health crisis.
    Throughout my career in Chicago and New York, I have had 
the unfortunate fate of treating multiple kids with bullet 
wounds, and seeing firsthand the eyes of the inconsolable loved 
ones.
    This is not a political issue to me. This is not about the 
Second Amendment. It is very important to understand that this 
is about firearm safety for me and making our communities safer 
and saving our patients.
    In the last year, so in the last six, seven months, we have 
seen more kids with bullet wounds at our children's hospital 
already than any other year total in our entire history. And I 
have seen kids who have pulled guns that were not stored safely 
in the household and accidentally shot their parents, their 
best friend. I have seen kids who have tried to commit suicide, 
and I have seen kids who were involved in gang-related firearm 
homicide. I have seen the whole spectrum just in the last 
month.
    You know, we recently had a kid, two weeks ago, who was 
walking down the street, studying, got shot in the neck, she is 
now paralyzed. We see this day in and day out.
    There is a spectrum of gun violence when we talk about this 
issue, and we need to acknowledge that this affects each and 
every community in America no matter where you live.
    It is important to also point out that the costs are borne 
most directly by victims and their families. As we begin this 
conversation about the financial cost of gun violence, it is 
really important to acknowledge that.
    My main message is that if we want to take a public health 
approach to address this crisis, we need more research and 
data. At the same time, there are tangible steps we can take 
based on the evidence we have. So my testimony is going to 
focus largely on the costs associated with providing medical 
care to victims of gun violence, and I hope that this will 
underscore the need to act.
    Let me begin very broadly with the big picture. Even 
without a fully funded effort to research the causes, efforts, 
and treatments for gun violence, a few things are clear. Gun 
violence is incredibly expensive, treating firearm injuries is 
far more expensive than treating other injuries, and among our 
peers, only the American health system bears this level of 
cost.
    So first with respect to direct hospital costs. As you 
mentioned with the indirect costs, you know, this epidemic is 
costing our country hundreds of billions of dollars. When it 
comes to initial medical care alone, we spend $1.1 billion per 
year on gun violence, and 84,000 patients come to a hospital 
every year for this issue. The large bulk of that is paid for 
by public payer insurance, Medicare, Medicaid, and 20 percent 
of that comes from private insurers.
    Second, treating gunshot injuries is way more expensive 
than any other type of injury, and this is an important concept 
to understand. I invite any of you to come to the trauma bay to 
see what it is like to treat a child or a adult with a bullet 
wound, versus a stab wound, versus a car accident. It is just 
devastating. The amount of damage that one bullet causes, 
especially in a child whose organs are all next to each other, 
very close to one another, cannot be described, and you have to 
come and see it firsthand. For that reason, it is obvious that 
it is a more expensive injury than any other trauma that we 
see.
    There was a study in 1997 that actually showed that for 
gunshot wounds, on average, just the surgical costs amount to 
$154,000 per year, and only $12,000 for a stab wound. Let that 
settle in. And when it comes to motor vehicle accidents, the 
cost to care for a child who has a firearm injury is five times 
that of a kid who comes in with a motor vehicle accident. So it 
is by far more expensive. And for inpatient stays in general, 
the cost is three times that of the inpatient stay for any 
other disease.
    And third, there is no comparison when it comes to our 
American counterparts--our peer nations. Of all other developed 
countries, our gun homicide rate is 25 times higher, our gun 
suicide rate is 8 times higher, and our unintentional firearm 
rate is 6 times higher. More than 80 percent of all firearm 
deaths happen in America when you look at the worldwide 
developed world.
    These statistics, of course, don't even touch on the hidden 
cost of gun violence with respect to victims and their long-
term issues, law enforcement, neighborhoods, and the trauma to 
our society as a whole.
    I would like to conclude by emphasizing that minimizing the 
economic burden that firearm injuries put on the health system 
is not enough. We must reduce the potential for firearm 
injuries in the future, through more research, better care, and 
evidence-based policy changes.
    As you mentioned earlier, you know, we shouldn't pretend to 
know what we don't, but we need the resources to be able to 
understand this further.
    There is no single solution. I am confident that if we can 
build consensus based on our common mission to keep our 
children safe, make our communities safer, and together be 
responsible gun owners, that we can make a difference. I know 
we can prevent our fellow Americans from ending up on the 
operating table in the first place.
    Thank you.
    [The prepared statement of Dr. Sathya appears in the 
Submissions for the Record on page 56.]
    Chairman Beyer. Dr. Sathya, thank you very much.
    I now recognize Mr. Busse for his testimony.

 STATEMENT OF RYAN BUSSE, AUTHOR OF GUNFIGHT, FORMER FIREARMS 
  INDUSTRY EXECUTIVE, SENIOR ADVISOR, GIFFORDS, KALISPELL, MT

    Mr. Busse. Thank you to the members of the committee for 
inviting me here today.
    My name is Ryan Busse. I grew up on a ranch where guns were 
an integral part of our lives. When we had time to have fun, it 
often involved guns, hunting and shooting with my brother, my 
father, my friends. Guns were also tools for work and for 
protection. For me, firearms came to represent important parts 
of my culture, something quintessentially American.
    But I was also taught that responsibility and safety are 
required to maintain this freedom. My dad insisted on this 
every time we touched a gun. Today I teach my own boys the same 
things.
    I got a job in the firearms industry after I graduated from 
college. I helped build a gun company, and I was nominated for 
the most prestigious industry awards.
    For the first part of my career, the industry insisted on 
the same responsibility that my dad had taught me. In fact, 
prior to the mid-2000s, the industry would not allow any 
tactical gear to be displayed in the main portions of industry 
trade shows, because the industry knew that proliferating that 
sort of gear was dangerous in a complex democracy like ours.
    AR-15s and inexpensive pistols were outliers and 
represented only a very small fraction of gun sales. But by 
2007, that self-imposed responsibility was almost gone, and 
everyone adhered to the same messaging, praising anything that 
sold more guns and attacking anything or anyone that might slow 
sales.
    Even after mass shootings, we were to cheer the ``hell no'' 
everyone knew would be the response to any proposal, no matter 
how modest. Everyone knew the debate around these proposals 
would create profitable sales booms and nothing else mattered.
    The industry transformation was dramatic. Before 2007, gun 
sales never exceeded 8 million units in a single year, with 
almost no sales of AR-15s. By 2016, the industry was selling 
more than 16 million guns. And between January 1, 2020, and 
January 7, 2021, the industry told more than 22 million guns.
    Most of those were handguns, and about 4 million were AR-
15s. This represents a tripling of annual sales in less than 15 
years. This expansion has produced huge increases in profits, 
with Smith & Wesson alone recently reporting an annual profit 
of more than $243 million.
    When people talk about our national challenges and what has 
changed in this country, no rational person can look past this 
monumental transformation in the gun market. This growth made 
fortunes for some. It also brought modernization to the gun 
industry.
    Inexpensive, polymer-framed handguns became the primary 
focus for most gun companies. Business pressure sped 
investments that increased efficiencies, leading to much lower 
prices for what we call commodity handguns. These are the same 
guns that are now flooding into urban areas of our Nation.
    These guns are cheap to make, many with hard costs of less 
than $100 each, but with average retails of more than $400.
    As profits increased, companies found more freedom to 
maneuver on price. When dips in the market happened, prices 
could be lowered to spur sales. Sometimes manufacturers even 
gave away guns to keep up volumes. It was not uncommon to see 
buy 3, get 1 free offers that drove prices even lower.
    I saw this happen dozens, if not hundreds of times in my 
career. I never heard anyone question the proliferation of what 
low-cost guns might do to this country.
    Growth pressures from the industry also meant that dealers 
and sales practices that should have received far more scrutiny 
were excused in order to maintain volume. No one was supposed 
to slow down or ask questions because doing so would slow 
sales. This is why there has been such vehement opposition from 
the industry to confirming an ATF Director. A good regulator 
will ask questions.
    I wrote a book about my time in the industry, about my 
battles to confront all this, about how our country has 
changed. The experiences that inform the book, and my 
experiences since the book came out, have taught me much that 
is important for this hearing today.
    First, balancing gun ownership with responsibility is 
absolutely central to the well-being of our democracy. I hear 
it from people across the country every day.
    Second, and very importantly for this committee, the 
feedback to my book proves to me that there are millions of gun 
owners who want to maintain their rights but also want to be a 
part of the solution. They welcome reasonable policies that 
address the changed realities of guns and gun violence in 
America. They are tired of the loud extremists hogging the 
mike.
    Third, we need to move forward on policies like universal 
background checks and raising the minimum age of purchase on 
long guns to 21. The vast majority of gun owners agree.
    I am one of these gun owners. I am here today to represent 
the people who understand that we cannot exist in a country 
where rights are not balanced with responsibilities and 
regulation. We cannot continue to allow profits to outweigh the 
rights of all citizens in places like Uvalde, in Buffalo, and 
Highland Park in Chicago.
    I am here to say that I know much has changed over the past 
15 years because I lived it, and it is high time we do some 
rebalancing to address these changes.
    Thank you for having me, and I welcome your questions.
    [The prepared statement of Mr. Busse appears in the 
Submissions for the Record on page 64.]
    Chairman Beyer. Mr. Busse, thank you very much.
    I now recognize Ms. Swearer for your testimony.

     STATEMENT OF AMY SWEARER, LEGAL FELLOW, THE HERITAGE 
                   FOUNDATION, WASHINGTON, DC

    Ms. Swearer. Chairman Beyer, Ranking Member Lee, and 
distinguished Members of the Congress, my name is Amy Swearer, 
and I am a legal fellow at The Heritage Foundation. A major 
focus of my scholarship is the Second Amendment and gun policy.
    I am not an economist, but it doesn't take an economist to 
tell you that gun violence has an enormous negative impact on 
the Nation's economy. Of course, it does.
    At the end of the day, though, what this committee wants 
isn't a debate over the total dollar amount we can attribute to 
gun violence. Instead, you want to know who is responsible for 
it--for those costs and what Congress can do to save lives and 
lower the economic burden. In other words, this is 
fundamentally a gun policy hearing, just like the dozens of 
other gun policy hearings held on Capitol Hill in recent years.
    In that respect, my testimony should sound fairly familiar. 
The reality of gun violence, who causes it, and what to do 
about it hasn't changed just because we put an economic spin on 
the question.
    To summarize, lawful gun owners are largely not the ones at 
fault for gun violence or its costs. On the contrary, the 
protective economic value they provide is underacknowledged and 
underappreciated.
    The bulk of gun violence costs are due to criminal actions, 
which are most often committed by unlawful gun owners. Yes, a 
small minority of lawful gun owners will, at some point, use 
their legally purchased and possessed firearms to commit 
crimes. But the overwhelming majority of them will never harm 
themselves or others with their guns and will never add a 
single cent to the overall economic burden of gun violence.
    On the contrary, most violent crimes, including gun crimes, 
are committed by a small number of serial offenders who are 
often prohibited from possessing firearms but who obtain them 
anyway through illegal or informal channels.
    It is not just that lawful gun owners aren't the problem or 
that they, as a class, are unfairly blamed for crimes they 
don't commit. It is that to whatever extent a few lawful gun 
owners may be responsible for gun violence and its economic 
costs, other lawful gun owners foot their bill and then some.
    The research is clear that Americans use their guns 
defensively far more often than many people realize, somewhere 
between 500,000 and 3 million times a year. And those defensive 
gun uses are not just about gun owners protecting their 
property. Often those lawful gun owners save lives, sometimes 
many lives.
    Consider the 22-year-old who just this week fatally shot a 
would-be mass shooter at an Indiana mall, one of three armed 
citizens who stopped active shooters in just the last two 
months without any injuries to themselves or others as a result 
of their defensive actions.
    This is not an uncommon outcome for defensive gun users. 
Based on the research and my experience with The Heritage 
Foundation's Defensive Gun Use Database, victims who use 
firearms to defend themselves or others from criminal actions 
are rarely injured. When they are injured, the majority of the 
time, those injuries are relatively minor, especially compared 
to how serious they might otherwise have been.
    The chronology of those injuries is important. Most of the 
time those injuries occur before the defensive gun use, meaning 
the defensive gun use stopped the victimization and limited the 
economic impact of crimes that were already in progress.
    Not only do lawful gun owners regularly thwart crimes, but 
there is a lot of evidence that every year a good number of 
criminals are deterred from committing a good number of crimes 
precisely because they are afraid victims might be armed. It 
turns out, many criminals are rational actors who don't like it 
when people shoot back.
    Despite this, commonly proposed gun control policies 
nonetheless often assume that lawful gun owners comprise the 
bulk of the problem. And some of those policies are, frankly, 
just unconstitutional.
    At the same time, many of the policies that would be most 
effective at combatting gun violence don't fit neatly into the 
current national narrative, but they would save lives and 
lessen the economic impact of gun violence.
    My written testimony is far more in-depth, and I hope you 
read it, but I will highlight just one avenue that is 
particularly relevant for this committee.
    Gun violence is inextricably linked to social capital; that 
is, to all of the various elements of associational life, like 
our connections with our families, our jobs, communities, and 
civic institutions.
    Americans are often best served by government simply 
getting out of their way, especially when it comes to private, 
voluntary associations.
    But from a Federal policy perspective, one solution to the 
decline in social capital is to promote economic growth and 
employment, which increase family stability and individual 
connectedness through the workplace. And I hope we talk more 
during this hearing about how exactly to accomplish this. And I 
also hope we talk more about better enforcing existing laws, 
expanding access to and options for mental health treatment, 
and encouraging responsible gun ownership without preemptively 
hindering gun owners from defending themselves.
    Congressmen, none of these are new solutions, but this 
isn't a new problem or even a new conversation about an old 
problem. The analysis is the same because the problem is the 
same. I hope the response is different. And I look forward to 
your questions.
    [The prepared statement of Ms. Swearer appears in the 
Submissions for the Record on page 66.]
    Chairman Beyer. Ms. Swearer, thank you very much.
    Now let me recognize the ranking member, the lead from the 
U.S. Senate, Senator Lee, for your opening statement.

  OPENING STATEMENT OF HON. MIKE LEE, RANKING MEMBER, A U.S. 
                       SENATOR FROM UTAH

    Senator Lee. Thanks so much, Mr. Chairman. And thanks to 
each of you for being here and agreeing to testify in front of 
this hearing.
    Violent crime is on the rise in communities all across our 
great country. Suicides and other deaths of despair are 
themselves at record highs. Homicides are climbing again, and 
meanwhile, police officers are retiring at unprecedented rates.
    Meanwhile, mass public shootings in Uvalde, Texas, in 
Highland Park, Illinois, have renewed the national conversation 
about how we can stop the evil perpetrated in these horrific 
events.
    Mass shooters who carry out highly visible acts of violence 
are fueled by an evil desire to inflict on others the extreme 
despair and isolation that they suffer themselves. And it is 
our collective responsibility to understand why deadly violence 
is increasing and how best to address its root causes.
    Research from my staff on the Joint Economic Committee 
shows that most mass public shooters are suicidal, and they are 
less likely to have significant connections to family or to 
other people at work. They tend to live in communities where 
violence is concentrated and where their support systems have, 
for one reason or another, unravelled.
    Similar trends are true for the less talked about but more 
prevalent violence that is reflected in the 29 percent increase 
in the homicide rate in 2020, and the decades' long rise in 
suicide and other deaths of despair.
    These findings on the role of supportive families and 
communities suggest that the circumstances that lead to 
violence go far beyond the simple presence of a firearm. 
Nonetheless, every time a horrific event occurs, like the 
shootings in Uvalde and Highland Park, for example, then we 
immediately hear demands from the same one-size-fits-all gun 
control mandates from Washington that many have pushed for many 
decades. And yet policies to stop violent crime must be 
faithful to the Constitution and must not inadvertently harm 
the very citizens we are trying to protect, especially those 
who are law-abiding.
    At its core, the Second Amendment guarantees the right to 
keep and bear arms, to defend one's family and community. My 
staff estimates that defensive gun use helped avoid more than 
$120 billion in crime last year alone. Limiting our fundamental 
rights under the Second Amendment makes us less secure, not 
more. Addressing our violence epidemic will not be achieved 
through top-down rules from Washington but with the much harder 
work of reversing the decline in social capital in communities 
across America.
    We should look to community-led solutions focused on 
cultivating stable, two-parent families, strengthening 
employment opportunities, boosting institutional trust, 
enforcing laws that are already on the books, and supporting 
local programs that help those at highest risk for violence. 
While far more daunting than proposals to simply restrict 
access to firearms, these solutions would be far more effective 
at preventing violence and providing support to struggling 
individuals in our communities.
    The decades' long decline in violent crime has ended. 
Deaths of despair are increasing and mass public shootings 
continue to scar our communities. Understanding the causes of 
increased violence is more urgent than ever.
    I hope that our conversation today considers how we might 
alleviate the childhood trauma, isolation, lack of stable 
employment, and low levels of community trust that contribute 
to increased acts of violence.
    Family and civil society breakdown come with dangerous 
consequences. Confronting the underlying causes of violent 
crime must play a key role in our efforts to keep American 
communities safe and prosperous.
    Thank you, Mr. Chairman.
    [The prepared statement of Senator Lee appears in the 
Submissions for the Record on page 29.]
    Chairman Beyer. Senator, thank you very much.
    I now will begin a round of questioning. Let me begin.
    Ms. Burd-Sharps, I am a very proud American, and I love the 
idea of American exceptionalism, you know, how we have been the 
source of innovation, the longest lived democracy. We have so 
many Nobel Prize winners, we are the melting pot.
    But you also pointed out that our gun death rate is 13 
times higher; our homicide rate, 26 times than our peer high-
income nations. Is there any connection, any possible 
connection between American exceptionalism in gun deaths with 
all the other things that we consider so wonderful about our 
country?
    Ms. Burd-Sharps. So often after shootings people look for 
solutions, and sometimes people talk about, it is a mental 
health problem, it is video games, it is whatever. And I would 
say that most of our--all of our peer nations, in Europe, in 
Australia, in Japan, and Canada, also have these video games 
and the same--very similar rates--challenges in mental health 
and rates of mental illness.
    What they don't have is more civilian guns than citizens, 
and that is a huge challenge that we face. We are exceptional 
in many ways, amazing ways, but that is a way in which we are 
exceptional that we really have to look into.
    Chairman Beyer. Let me just continue. Ms. Swearer, I think, 
makes the very credible argument that the lawful gun owners are 
not the cause of the gun violence in America. At the same time, 
when we have 400 million guns in America, we look and say the 
homicide rate in Germany is one-tenth what ours is, in the U.K. 
it is one-fortieth of what ours is.
    Let's avoid cause and effect. Is there at least a 
correlation between the number of guns we have and the homicide 
rates we have?
    Ms. Burd-Sharps. So let's remember that, according to CDC 
data, 60 percent of gun deaths in a year are from suicide, just 
under 40 percent are from homicide, and then there is 1 percent 
from mass shootings, and 1 percent from unintentional 
shootings.
    So if you look at what is happening in the course of a 
year, 60 percent of those gun deaths are from suicide. And, you 
know, the lethality of guns is absolutely contributing to half 
of suicides in this country being with a gun.
    Chairman Beyer. Thank you.
    Dr. Sathya, you talk about, of the ones who survived, in a 
Harvard study, 71 percent were unintentional. I think Ms. 
Swearer said 1 percent of the gun deaths were unintentional. 
But things like safe storage laws, improvements to firearm 
safety technology, universal screening would all make a 
difference.
    Why has it been impossible for Democrats and Republicans to 
find a middle ground on things like gun safety storage?
    Dr. Sathya. Thank you, Chairman, for the question. I think 
at its core, I will refer to what I said earlier in that this 
is a public health issue. You know, we treat kids and families 
from both sides of the political aisle. And at the end of the 
day, after we treat their children with bullet wounds, they all 
want the same thing. Gun owners are our biggest supporters in 
our efforts to approach this as a public health issue.
    Listen, we did it with tobacco use, we did it with motor 
vehicle collisions, we did it with HIV, stigmatized issues. We 
took a public health approach, we focused on safety, and we 
were able to transcend politics.
    It is important that we are using a lot of the words, 
violence and mass shootings together. When we talk about gun 
violence, we are talking about firearm-related injury, and it 
could be homicide, suicide, or unintentional injury.
    And I agree with what everyone is saying, we should not 
confuse these as the same, but it doesn't mean that we 
shouldn't act when we can. And each of these requires different 
interventions and solutions.
    Chairman Beyer. Thank you.
    Mr. Busse, again, Ms. Swearer says a mind-blowing number of 
guns are stolen from lawful gun owners. My local police would 
say it is the first thing they look for when they break into a 
house, many from unattended vehicles.
    You come from the gun industry. We heard earlier that 3 
percent of gun owners own half of all the guns. Why, with so 
many gun owners, so many NRA members agreeing to commonsense 
middle-ground, noninvasive gun-safety measures, like locking up 
your guns, why has it been so hard to get a single Republican 
to find some way to move forward?
    Mr. Busse. Thank you for the question, Chairman. It is my 
assessment, after having been inside the industry, that the 
very sort of ``hell no'' attitude that has propagated through 
the NRA and through the firearms industry, ``hell no'' to 
universal background checks after Sandy Hook, ``hell no'' to 
raising the minimum age of buying AR-15s to 21, that same 
attitude has wound throughout the DNA of the Republican Party 
and the GOP.
    And so these things that poll high, 82 percent on 
background checks and almost as high on raising the minimum 
age, when we go to attack those things as a society, we are not 
attacking this, what I--the analogy I use is, if it is a very 
small pebble laying on the ground, it looks like you ought to 
be able to pick it up and toss it over the fence.
    The problem is, is when you bend down to pick it up, it is 
attached to a much larger rock, that is attached to a much 
larger mountain. And that rock and that mountain are the 
politics and the approach of the GOP that have the same ``hell 
no'' attitude to making these highly--highly accepted poll very 
high through gun owners. Instead of accepting those and doing 
the responsible thing, we say ``hell no'' to those too.
    So those simple policies that poll high are attached to 
something much more difficult.
    Chairman Beyer. Great. Thank you all very much.
    Let me now recognize the Senator from Utah, Senator Lee, 
for his questions.
    Senator Lee. Thank you, Mr. Chairman.
    Ms. Swearer, I would like to start with you if that is all 
right.
    I am struck by the connection between suicides and mass 
shootings. They go together. In fact, more than 70 percent of 
mass shooters have some indication that they intend to commit 
suicide before or during the attack or they are otherwise 
suicidal before carrying out the attack.
    This problem does appear to be bigger than guns. Certainly, 
mass shootings, by definition, involve guns, but it is a pretty 
narrow subset of--very narrow subset of those who have guns 
that carry out these particular types of attacks.
    And as we have seen with the rise of drug overdose deaths 
and resurgent violent crime, our country is in the midst of a 
crisis in which our culture appears to lack the once really 
robust support of families and other points of community 
contact, things amounting to what we refer to as social 
capital.
    So mass shootings, suicides, and violent crime are, in many 
respects, symptoms of these deeper problems.
    How can focusing on underlying causes, things like 
highlighting the importance of loving two-parent families, help 
us to prevent more tragedies?
    Ms. Swearer. Well, thank you for your question, Senator. It 
does so because when you address these underlying causes, one, 
you remove the problems of sort of going after the bulk of gun 
owners who are not part of this problem. But when you focus on 
the underlying causes, you are now dealing with issues of human 
flourishing generally. You are solving problems or at least 
addressing problems that are much broader than firearms.
    You know, the stat has already been thrown out at least 
once today. Only half of suicides are conducted with--or 
committed with firearms. So even if you take away all firearms 
and assume that no one else kills themselves without firearms 
who otherwise would, you still have a very significant problem.
    It is the same thing with violence generally. It is the 
same thing with, as you mentioned, these mass shooters, who are 
overwhelmingly suicidal and dealing with other deeper, 
underlying issues.
    When you address those issues, you are now addressing those 
parts of humans that are not flourishing. You are making 
society better on the whole and you are doing so in a way that 
doesn't go after people who are law-abiding, who are not ever 
going to be a danger to themselves or others.
    So on the whole, it is just a more economic and efficient 
way of dealing with societal problems, is getting at those root 
causes, instead of trying to play whack-a-mole, you know, going 
after things on the surface.
    Senator Lee. All right. If one could attach a value of zero 
to gun ownership and if one could somehow separate 
constitutional protections and assume the ability of government 
to enforce to a 100 percent degree any gun ban, one can imagine 
a world in which that sort of thing might proceed. But, of 
course, we do have constitutional protections.
    And one of the reasons we have constitutional protections, 
dating back more than two centuries in our country, dating back 
many centuries more than that under the English Bill of Rights, 
is because they do have some utility. That is why the 
Constitution did make that compromise, that bargain, 
understanding that some people would misuse them, but there was 
some utility to it, and that Americans should be able to avail 
themselves of that right.
    Can you tell us something about the benefits that you see 
attached to gun ownership and defensive gun use? For example, 
what would be the dangers to the personal safety and self-
defense interests that we have as citizens from undermining the 
constitutionally protected right to bear arms?
    Ms. Swearer. Senator, the Second Amendment, as I think you 
suggest, is premised on this right of self-defense, whether it 
is self-defense against tyrants or self-defense against 
criminals when the government can't or won't be there to 
protect you.
    You know, in terms of what that means to the benefit of 
individual gun owners, you know, again, a stat that has already 
been thrown out, there are 400 million firearms in this 
country.
    When you go after and restrict the abilities of lawful gun 
owners in a way that doesn't--especially when those ways don't 
also address the ways in which criminals are getting their 
firearms, or disarming criminals, you have now essentially 
limited the ability of law-abiding Americans to fight back, 
without going after the other segment of those 400 million 
firearms that are still going to be in the hands of people who 
are bent on criminal acts of violence.
    So if you think of it as like a scale with the cost and 
benefits of gun violence, you are removing the part that is 
beneficial while not doing anything to address the part that 
adds to the economic burden.
    So, again, you want to make sure that any sort of gun 
policy is focused on those more narrow channels through which 
criminals are getting their firearms, through which criminal 
actions actually happen, without broadly restricting the rights 
and abilities of law-abiding Americans.
    Senator Lee. Thank you. I see my time is expired.
    Chairman Beyer. Thank you, Senator, very much.
    I now recognize the distinguished gentleman from Wisconsin, 
Mr. Pocan.
    Representative Pocan. Thank you, Mr. Chairman. And thank 
you to the witnesses.
    Let me start, Mr. Busse, so you were an executive at a gun 
company. You know, when you hear all the numbers and you read 
about this, I mean, this is almost exclusively a United States 
problem, and yet I don't think we exclusively have that much 
more of a rate of suicide or anything else, and yet the gun 
deaths just stand out so significantly.
    Can you describe a little bit about the business model of 
the modern gun manufacturing industry? And specifically, I have 
got to imagine this is talked about at some point. You know, in 
2020, I think 3.6 million rifles were manufactured or imported 
to the United States and only a hundred thousand were exported. 
I mean, this is distinctly a United States problem. Can you 
just talk about that marketing model?
    Mr. Busse. Well, the marketing model has changed 
dramatically, again, in the past 15 years, really kicking off 
in 2007.
    Prior to that, the industry itself, as I noted earlier, 
would not allow any tactical gear, such as the gloves and hats 
and bulletproof vests--researched and worn by the Buffalo 
shooter, some of it by the Uvalde shooter--none of that was 
allowed even to be displayed or discussed or sold in the 
firearms industry in its own large trade show every year.
    That was a voluntary prohibition. It is not that it was 
illegal. It was voluntary. And it was voluntary because they 
were a group of responsible people who were in the industry 
then, who knew that, again, propagating those things throughout 
society and the marketing schemes that would follow to sell 
them, could lead to very dangerous outcomes. And I think we are 
now living with those dangerous outcomes.
    Likewise, even during the assault weapons ban, which is 
much discussed, 1994 to 2004--September 13, 2004 it sunsetted--
AR-15s were perfectly legal during that period. Most people 
don't understand that. Assault weapon was defined as a gun like 
an AR-15 with additional features on it. And so the industry, 
during that 10 years, could have sold hundreds of thousands, 
millions, of AR-15s, and yet they did not.
    They did not because, again, there was a voluntary 
prohibition. It was relegated to the darker halls of the 
industry. Those things were not sold and marketed in any kind 
of numbers, more than about 50- to 100,000 a year versus about 
4, 4.5 million now. Again, it was voluntary.
    Much like our politics 15 or 18 years ago, there were lines 
of decency across which company executives knew not to step.
    We have now removed all of that, and the only thing that 
matters--we have introduced essentially quarterly capitalism 
into our politics and into the gun market. The only thing that 
matters is winning the next election or making the next gun 
sale. The only thing.
    So any sort of voluntary prohibition about decency, about 
how we advertise, about selling guns to kids, about AR-15 
manufacturers by the hundreds now, about tactical gear, using 
sex and everything else to sell to very troubled young men, 
that is all gone.
    Is it illegal? No. Is it immoral? Absolutely.
    Representative Pocan. The second question I was going to 
ask specifically on the AR-15, you know, that huge increase in 
the sales. You know, I am from Wisconsin and, you know, 
everyone who runs for office puts multiple photos of the 
animals they have, you know, killed that season to show, you 
know, how tough they are.
    Mr. Busse. I am right there with them.
    Representative Pocan. Yes. I mean, literally, everyone from 
every party, I mean, how many, you know, deer you can have dead 
in your brochure tells you how you are going to do in the 
election cycle.
    But I don't know many people who actually use an AR-15. And 
yet I just went to Smith & Wesson AR-15, it is like the 
hunting, hunting they are selling it for. But it is really not 
that tradition.
    I understand when, you know, the Constitution was written, 
people had muskets, so they didn't have to worry about the 
weapons that we have now. They never even would have imagined 
that. But can you just talk a little bit more about 
specifically the AR-15 and how it is being marketed?
    Mr. Busse. When the AR-15 became both political symbol and 
tool to grow the industry, again in 2007, 2008, the industry 
undertook very expensive marketing studies to try to ascertain 
how it could make the gun and the marketing of the gun more 
acceptable in the general public. And the marketing came back 
and said, we essentially need to apply sporting terminology to 
this, because the general public approves of sporting 
terminology.
    I am one of those people who have the deer pictures with my 
kids, my family does, all of my friends do. That is a very 
accepted form of firearms ownership across much of the country, 
one that I enjoy very much.
    When the firearms industry undertook this marketing, it 
came back, and the NRA and the National Shooting Sports 
Foundation said, we have settled on a name that will be 
acceptable to the general public. We are not going to call them 
assault rifles. That is verboden. We are not going to call them 
AR-15s. We are going to call them modern sporting rifles.
    And that is the terminology that is used today. They are 
called modern sporting rifles. Are there some that are used for 
hunting purposes? Yes. A tiny percentage. Most of them are not 
used for sporting.
    The gun that was used by Kyle Rittenhouse was a Smith & 
Wesson M&P Sport. The gun that was used in the Parkland 
shooting was a Smith & Wesson M&P Sport. I could go on and on 
and on. These are not sporting guns.
    Representative Pocan. Okay. Thank you.
    I yield back.
    Chairman Beyer. Thank you, Mr. Pocan.
    I now recognize the gentleman from Arizona, Mr. Schweikert.
    Representative Schweikert. Thank you, Mr. Chairman.
    Okay. Title of our hearing, Economic Toll. And I am trying 
to get my head around, because I have an interesting interest 
on--I keep, you know, sitting here looking at the charts and 
data. Even the doctor actually said something that was sort of 
fascinating, sort of the different categories he ends up 
dealing with.
    And I am going to first do some charts. Ms. Swearer, I am 
going to actually ask couple questions of you, but my goal here 
is not to figure out how many dead animals, though, that is 
actually--being from Scottsdale, that is actually, for us, a 
little creepy. But we have a lot--but we have a dozen indoor 
shooting ranges in my district, and some of them cost a fortune 
to become a member of them.
    But I am looking at the suicide data on the sheets broken 
out by States. And let me do this, just so I can sort of get my 
head--I am one of those people that almost needs a prop. And I 
got to compliment, I believe much of this data is coming from 
Everytown, and it has been quite useful or easy to use.
    Our total firearm bad acts--suicides, homicides--and then 
we have been trying to set up an axis here on restrictions in 
those States. Okay. Good chart, good data.
    But then when we actually started to try to normalize say 
suicides, particularly if I will normalize for functionally 
five Southern States that actually have some very unusual, you 
know, data on their, you know--excuse me.
    If I normalize for suicides, and I pull the suicides out, 
and then I come back and normalize for what I am seeing--and I 
know I am going a little geeky, but if I were to pull those 
five Southern States out, my homicide rates are actually 
distributionally pretty random out there.
    I mean, it is not like I am seeing that the axis of, here 
is States with firearm restrictions, and I am then seeing a 
skewing thing. Those States have dramatically less bad acts, 
other than suicide. It is just--it is not in the data. And that 
lets us sort of understand, we got, in some ways, maybe a 
bigger problem than we understand.
    You know, how do you basically--if our goal here is a safer 
society, more prosperous society, less economic damage, am I 
looking at a world where I need to completely rethink our 
debate on firearms and firearm violence?
    Is it maybe we go back to the 1950s and we are having 
training in school. States like Arizona, 25-plus years ago, we 
legalized concealed carry, but we asked you to go through 
training. And there were predictions we would see substantially 
more bad acts, and that didn't happen in the data.
    Illinois, Florida, dramatically different restriction 
rules, both complex populations, substantially different, you 
know, numbers in some of the bad acts with firearms.
    What can we do as a society to deal with the suicide 
numbers that just--if you look at these suicide numbers, they 
rip your heart out.
    I have an academic article, which is somewhat above my head 
but I have been trying to read it, that is talking about--
trying to analyze these young men who have been involved in 
mass shootings and how many of them have been displaying 
suicidal tendencies.
    I am just--Ms. Swearer, what am I thinking wrong? If this 
were--we were having a truly honest debate and we were white 
boarding this and saying our intention is to make society 
safer, what would we be breaking out? What would we be looking 
at?
    Ms. Swearer. I am sorry, can you--I am not sure I 
understand the question.
    Representative Schweikert. Am I wrong to be thinking that 
suicide prevention is where a bunch of capital goes? Training 
on knowing that, how to use your firearm, how to keep it safe, 
that you don't grab a firearm and start cleaning it until you 
have gone through the proper procedures.
    I mean, those of us that grew up with this, we have rules, 
and how many young people are out there running around with a 
firearm that have no blanking idea how it works.
    I mean, if I were to come and say, here is a dozen things, 
what makes society--what are you seeing out there in literature 
that would make us safer?
    Ms. Swearer. I think I understand the question a little bit 
better. I am going to pull off of some of the things you have 
already mentioned.
    So you talked about mass shootings in particular and 
suicide prevention. I think you are correct, to a large extent, 
mass shooters are suicidal and they are showing signs of being 
a danger to themselves or others. While mass shootings are 
considerably a small part of the problem, they have an outsized 
effect on both the--sort of the national conversation and the 
way we feel about public safety, so it does matter.
    But what that tells us for prevention is that a lot of 
these individuals are showing signs of being a danger to 
themselves or others, that there are methods for targeted 
intervention or even just generalized suicide prevention that 
are more likely to lower those rates and to allow for 
intervention, you know, other than just broad gun control 
measures.
    Representative Schweikert. And, look, I know I spoke too 
long, and thank you for your patience, Mr. Chairman, but there 
is also some fascinating discussion here on both the homicide 
rates but also if we could understand why does a State like 
Massachusetts have such a amazing low number on suicides but 
also some other States that actually have very open firearm 
laws also have terrific--it turns out there is complexity here. 
And if we are going to be intellectually honest, we need to 
bathe into that complexity.
    I yield back.
    Chairman Beyer. Thank you, Mr. Schweikert, very much.
    Let me introduce the winner of yesterday's primary in 
Maryland, the distinguished gentleman from Maryland, Mr. Trone.
    Representative Trone. Thank you very much.
    Mr. Chairman and Senator Lee, thank you for holding this 
hearing today. We appreciate it very much.
    I would like to start off with a question for Ms. Swearer, 
our Republican witness. And I have been a gun owner--shotguns, 
rifles--grew up on a farm, hunted all my life, taking gun 
safety courses, and certainly would be supportive of owning a 
firearm.
    Could you tell me how many times in America an AR-15 has 
been used in self-defense of someone's home?
    Ms. Swearer. Do I know the exact number? No, not off the 
top of my head.
    Representative Trone. Any number you have at all?
    Ms. Swearer. I know that it happens. I would refer you to--
--
    Representative Trone. It happens? Where does that number 
come from.
    Ms. Swearer. Our Defensive Gun Use Database in my research 
and experience researching defensive gun uses. Though I would 
say, to a large extent, a lot of defensive gun uses happen in 
public where people are generally not carrying around AR-15s. 
So you will probably see--and you should expect to see the same 
distribution in terms of types of firearms----
    Representative Trone. But we really don't see anywhere ever 
where someone is using an AR-15 to defend their home. That 
hasn't happened, has it, really.
    Ms. Swearer. Yes, it has.
    Representative Trone. Maybe that guy was a narco. Maybe he 
was a narco. Maybe he was fighting other narcos, but----
    Ms. Swearer. No, sir. I can think of a time, actually, 
within the last couple of weeks from Largo, Florida, where an 
individual used an AK-47 to defend his home, lawfully, as he is 
not facing charges, the sheriff has said he is not facing 
charges, against multiple intruders. So this does happen and I 
think far more often than individuals realize.
    Representative Trone. We are going to find out. And we have 
asked for a study to be made on that, because I don't think it 
happens too doggone often.
    And the AR-15 is for human hunting. That is what it is for, 
human hunting. And as Dr. Busse said, it's about sports 
rifles----
    Ms. Swearer. Then why do law enforcement officers generally 
have them? Are they going around hunting humans?
    Representative Trone. Because they are law officers who are 
taking care of humans that are going down a wrong path. So I 
take my time back. We are all finished, you and I. Human 
hunting.
    Now, Mr. Busse, you spoke about working for a prominent, 
you know, gun company, and what has happened behind closed 
doors and financial gain, and companies that did the right 
thing for many, many years, and then they said, hey, there is 
easy profit here, and we hit our quarterly numbers.
    Why don't you just give us a quick--real quick--a couple of 
quick steps that we should be doing here to help take back the 
industry from the lobbyists, et cetera, that are supporting the 
other party, as you talked about, who are just there, not for 
protecting hunters. And, certainly, the idea of a 
constitutional protection, that has no utility now in today's 
world. There is no utility of a constitutional protection for 
having an AK-47 in your home. That is a zero. And that is a 
farce.
    So talk about exactly how we can hold the gun industry and 
those who stand to benefit from it accountable.
    Mr. Busse. I appreciate the question. And like you, I grew 
up on the farm. I appreciate the guns I own. I want to keep 
owning them. I think things that we can do--people like you and 
I who grew up understand that guns are a very serious thing, 
very serious. We should not treat them--we should not regulate 
them as if they are cans of Coke or some other consumable thing 
in a grocery store. These things are much more serious. They--
as my father taught me, as he handed me a gun, this can cause 
death in an instant.
    So we need to start regulating them as if they are serious, 
not--over the last 15 or 18 years across much of the country, 
we have reduced regulations. We haven't increased them.
    And I know people tire of this example, but if you were to 
take the same population and triple the amount of cars on the 
highway, you would not reduce regulation to make society 
function better with triple the amount of cars. Yet something 
as serious as a gun--which I appreciate and own and want to 
continue to own--I consider my plea for responsible regulation 
to be the pro-gun position, because responsible gun owners who 
want to maintain their rights, want to do these sorts of things 
to hold other gun owners and the industry accountable so that 
we can maintain those rights.
    Representative Trone. I feel the same way. I am pro-gun. 
There is no question about it. But I am not pro-gun human 
hunting guns. That is a different type of gun for a different 
mission.
    I would like to ask, the legislation we have done recently 
on guns, which is really mental health legislation, and we are 
very pleased that that happened, that is going to make major 
differences, I believe, in our mental health and our schools in 
particular.
    And, Doctor--let's have Ms. Burd-Sharps speak to us a quick 
second. What else do we need to add to that to help us on the 
mental health and our schools? Ma'am?
    Ms. Burd-Sharps. I think that the Bipartisan Safer 
Communities Act is tremendous, and support to schools is really 
important. I think that--you know, But there are many other 
things that we need to do, including more accountability for 
secure storage so that, you know, people can't get access to--
that people are storing this gun securely; that we are having 
awareness campaigns so that everybody knows to secure their 
guns securely; and that people, gun owners are held accountable 
when, for instance, a child gets access to a gun. Those are 
beyond the mental health realm, but that is incredibly 
important, particularly for young people in this country.
    Representative Trone. Thank you. I yield back.
    Chairman Beyer. Mr. Trone, thank you very much.
    Now let me move on to our distinguished gentleman from 
Kansas, Mr. Estes.
    Representative Estes. Well, thank you, Mr. Chairman. And 
thank you for our witnesses for being here today.
    You know, over the past two years, we have seen violence 
spiral out of control across the country, both in major 
metropolitan areas as well as along the southern border. This 
is a serious problem and it must be addressed.
    But this rise in violent crime is not because of a sudden 
increase in firearms. For almost 30 years, crime rate was 
trending down while gun ownership was increasing.
    2020 marks the recent rise in violence and homicides across 
the Nation. I don't think it is a coincidence that this rise 
followed the repeated slogans like defund the police and open 
borders.
    Today, violent crime is up more than 40 percent from last 
year in New York City. And in L.A., murders are on track to top 
a 15-year record. Defunding the police has been a disaster for 
Americans living in our largest cities.
    And the corresponding wave of drug-related crimes caused by 
open border policies from the Biden administration are making a 
bad problem much worse. In 2021, drug overdose deaths in the 
United States reached an all-time high up 17 percent from the 
prior year. And Fentanyl, which continues to pour across the 
border, is now the leading cause of death for Americans 18 to 
45.
    We urgently need to address the underlying causes of 
violence. That starts with giving our law enforcement the 
proper respect they deserve for keeping the peace and by making 
sure that violent criminals are sentenced properly by district 
attorneys.
    The recent attacks on police officers have been horrific. 
Over 141 officers shot, 27 of those being ambush-style attacks 
so far in 2022. It is no wonder why more than 2,100 cops have 
resigned or retired this year in New York City. Over 500 of 
those occurring just in June.
    We can't reverse the past two year trend in shooting and 
homicides if we don't have any police. If we are going to have 
a real conversation about ways to reduce violence within our 
communities, we have got to include ending anti-cop hostility. 
It is time we get back to law and order in the country. We must 
prosecute violent criminals and we must secure the border.
    Ms. Swearer, in a hearing earlier this year before the 
Senate, you were cutoff before--while discussing some data 
about rogue prosecutors. What role do they have to play in 
reducing violent crime in Chicago and other cities that may 
have seen a spike in crime?
    Ms. Swearer. Thank you, sir. I think it is two things. So, 
first of all, whenever you are not prosecuting crimes, when you 
are not entering that--those small minority of individuals who 
are responsible for a majority of violent crime are 
incarcerated or meaningfully punished and are off the streets, 
they continue to be rereleased, they continue to be out there 
facilitating a lot of these same violent crimes over and over 
again. And at the same time, when they are not being punished, 
it at the very least does not disincentivize them and often 
incentivizes them to commit violence because they understand 
that there is not going to be a serious punishment for those 
offenses.
    So it is problematic both from a very practical standpoint, 
but also from the theoretical standpoint of signaling to them 
that their offenses are not going to be taken seriously.
    Representative Estes. How do firearms help women protect 
themselves from violent attacks?
    Ms. Swearer. They, in many respects, equalize their--excuse 
me--their ability against their assailants. So women especially 
compared to male attackers--and I say this as a fairly athletic 
woman myself--you know, we tend to be a little bit undersized 
and less physically capable against larger opponents.
    You know, firearms--again, whether it is a woman, whether 
it is anybody, whether it is a man, someone who is suffering 
from, you know, some sort of physical handicap, it greatly 
increases their ability to defend themselves, and a lot of 
times to do so at a distance and often without even having to 
fire that gun. Just the mere threat of it is enough to, you 
know, deter and to back people off. But it is, you know, 
capable of being used for when that is not sufficient.
    Representative Estes. Right, right. Yes. I mean, as we have 
talked about, you know, and the whole context of this hearing 
was talking about the economic impact of violence. And, 
obviously, we need to address the gun violence issue. But I 
think a lot of that allows people to have weapons for their 
self-defense; make sure that we support the police in their 
role in helping protect our communities, protecting our 
country. So I appreciate your time.
    And I will yield back, Mr. Chairman.
    Chairman Beyer. Mr. Estes, thank you very much. I want to 
point out, by the way, the open borders is a Republican slogan, 
not a Democratic one.
    I want to thank all of you for joining me in this important 
conversation about the staggering economic cost that gun 
violence imposes on our Nation and for pointing out that it is 
complex.
    While the total losses caused by gun violence are 
incalculable, the economic cost of gun violence cascades 
through our economy in real and measurable ways. We all agreed 
on that. As we heard today, no one is left unaffected by this 
epidemic. While Americans feel the pain of these losses, gun 
manufacturers exploit fear and prejudice to capitalize on these 
tragedies, earning record profits at the expense of human 
lives.
    Congress has recently taken an important step toward gun 
reform, but this alone is not nearly enough. There is much more 
work to be done so that--keep Americans safe from gun violence 
and its economic toll.
    Thanks to each of our panelists for their contribution to 
this critical and outgoing discussion. As you do this important 
work, we rely on your expertise.
    And thank you as well to my colleagues for being part of 
this discussion and sharing your wisdom. The record will remain 
open for three business days.
    This hearing is adjourned.
    [Whereupon, at 3:44 p.m., Wednesday, July 20, 2022, the 
hearing was adjourned.]

                       SUBMISSIONS FOR THE RECORD

         Prepared statement of Hon. Donald Beyer Jr., Chairman,
                        Joint Economic Committee
                              recognitions
    This hearing will come to order. I would like to welcome everyone 
to the Joint Economic Committee's hearing titled ``The Economic Toll of 
Gun Violence: How Our Nation Bears the Costs.''
    I want to thank each of our distinguished witnesses for sharing 
their expertise today.
    Now, I will turn to my opening statement.
                           opening statement
    It is abundantly clear that the United States is facing a gun 
violence crisis that is unique in its deadliness and scale.
    While mass shootings capture international attention, the use of 
guns in homicides, suicides and accidental shootings imposes widespread 
and long-lasting costs.
    Loss or injury to gun violence is immeasurable, but the economy-
wide harms are real and calculable.
    According to new estimates from Everytown for Gun Safety, gun 
violence costs our economy more than half a trillion dollars every 
year.
    This is a staggering figure, one that is both gut-wrenching and 
entirely avoidable.
    To put it in context, at more than half a trillion dollars, gun 
violence costs our economy more than the national GDP of nearly 90 
percent of countries in the world.
    From health care to education, business development to housing, the 
toll of gun violence is borne by survivors, their families and our 
entire economy.

    Each year, gun violence costs survivors and their families more 
than $1 billion in just initial hospital care.
    It contributes to worse mental health outcomes, including higher 
rates of diagnosed psychiatric disorders in both survivors and their 
families.
    For children exposed to a fatal school shooting in their local 
area, antidepressant use increases significantly for years following an 
incident.
    Gun violence burdens our broader health system, stretching its 
capacity and taxing our frontline health care workers.
    And because treatment for firearm injuries costs more than double 
that of other types of hospital care, this epidemic further stretches 
our public insurance programs.

    Gun violence has also been shown to negatively impact the 
educational and life outcomes of children, particularly in instances of 
school shootings.
    Students that experience these incidents experience more frequent 
school absences and have a greater chance of repeating a grade, and 
they are less likely to graduate from high school or attend college.

    Gun violence reduces new businesses development and directly hurts 
jobs growth.
    Areas that experience gun violence are more likely to see 
businesses scale back and fewer new businesses form. Research has shown 
that one additional gun homicide in a neighborhood resulted in 80 fewer 
jobs the following year.

    Just gunshots being fired--even if there are no injuries--reduces 
home values.
    Because homeownership is the primary way to build wealth in this 
country, this has the power to reduce economic opportunities for 
generations.

    Tragically, we know that the economic toll of gun violence is 
rising.
    As firearm deaths, gun injuries and mass shootings have increased 
in recent years, the gun industry has made money hand over fist.
    During the worst of the pandemic, gun sales spiked, leading to 
record-high profits for the two top gunmakers.
    As sales have surged, so too, has gun violence.
    The Bureau of Alcohol, Tobacco, Firearms and Explosives documented 
a connection between pandemic gun sales and increased violence: It 
found that guns sold in 2020 were more likely to wind up at crime 
scenes within a year of purchase than in any previous period.
    And like a storm creating its own weather, increased gun violence 
spurs a corresponding increase in gun sales.
    For example, it is a well-documented trend that gun sales rise 
after mass shootings.
    Investors also anticipate this effect, which drives up the share 
prices of gun and ammunition companies. For example, shares of the two 
largest gun companies rose more than the market average in the 
immediate aftermath of the massacres in Sandy Hook, Connecticut; San 
Bernardino, California and Parkland, Florida.

    This self-perpetuating cycle is not an accident.
    After gun purchases plateaued in the early 2000s, the gun industry 
took action to revive sales, lobbying for the successful passage of 
legislation that granted gun manufacturers and sellers immunity from 
legal accountability for the harms caused by their product.
    The immunity provided by the Protection of Lawful Commerce in Arms 
Act is markedly different from the treatment of nearly all other 
industries. While other industries can be held accountable for products 
or practices that result in harm to consumers, gun manufacturers 
cannot.
    For example, tobacco companies were famously held accountable for 
the harms caused by smoking, which led directly to changes in the way 
tobacco products are marketed and sold.

    Protection from accountability has facilitated the launch of a new 
and booming market for increasingly lethal weapons.
    In the past, gun companies focused their marketing efforts almost 
exclusively on the sale of guns for hunting and recreational shooting 
purposes.
    Yet their marketing tactics have shifted in recent years. 
Manufacturers now push guns for personal protection, self-defense and 
concealed carry.
    This has created a new civilian market for products that had 
previously been seen exclusively as weapons of war. The firearm 
industry has met the growing demand by flooding the market with more 
lethal weapons.

    The human toll of gun violence is unbearable. So, too, is the 
economic one.
    Today, the United States will spend $49.3 million on just the 
medical care, first responders, ambulances, police and criminal justice 
services related to gun violence.
    We will pay this price tomorrow, the next day, and every day 
thereafter until we, as a Nation, decide to address this epidemic.
    Last month, for the first time in nearly 30 years, Congress took 
action to curb gun violence. This is an important step, but more is 
needed.
    To address the growing violence and its significant costs, we must 
work together to pave a more peaceful path forward.
    Now, I would like to turn it over to Senator Lee for his opening 
statement.
                               __________

          Prepared statement of Hon. Mike Lee, Ranking Member,
                        Joint Economic Committee
    Violent crime is on the rise in communities across America. 
Suicides and other deaths of despair are at record highs, homicides are 
climbing again, and police officers are retiring at unprecedented 
rates. Meanwhile, mass public shootings in Uvalde, Texas and Highland 
Park, Illinois have renewed the national conversation about how we can 
stop the evil perpetrated in these horrific events.
    Mass shooters who carry out highly visible acts of violence are 
fueled by an evil desire to inflict on others the despair and isolation 
they suffer themselves. It is our collective responsibility to 
understand why deadly violence is increasing and how to address its 
root causes.
    Research from my staff on the Joint Economic Committee shows that 
most mass public shooters are suicidal, and they are less likely to 
have connections to family or work. They tend to live in communities 
where violence is concentrated, and where their support systems have 
unraveled.
    Similar trends are true for the less talked about--but more 
prevalent--violence that is reflected in the 29 percent increase in the 
homicide rate in 2020, and the decades-long rise in suicide and other 
deaths of despair.
    These findings on the role of supportive families and communities 
suggest that the circumstances that lead to violence go far beyond the 
simple presence of a firearm.
    Nonetheless, every time a horrific event occurs, like the shootings 
in Uvalde and Highland Park, we immediately hear demands for the same 
one-size-fits-all gun control mandates from Washington that many have 
pushed for decades. Yet policies to stop violent crime must be faithful 
to the Constitution and must not inadvertently harm the very citizens 
we are trying to protect.
    At its core, the Second Amendment guarantees the right to keep and 
bear arms, to defend one's family and community. My staff estimates 
that defensive gun use helped avoid more than $120 billion in crime 
last year alone. Limiting our fundamental rights under the Second 
Amendment makes us less secure, not more.
    Addressing our violence epidemic will not be achieved with top-down 
rules from Washington, but with the much harder work of reversing the 
decline in social capital in communities across America. We should look 
to community-led solutions focused on cultivating stable, two-parent 
families, strengthening employment opportunities, boosting 
institutional trust, enforcing laws already on the books, and 
supporting local programs that help those at highest risk for violence.
    While far more daunting than proposals to simply restrict access to 
firearms, these solutions would be far more effective at preventing 
violence and providing support to struggling individuals in our 
communities.
    The decades-long decline in violent crime has ended. Deaths of 
despair are increasing, and mass public shootings continue to scar our 
communities. Understanding the causes of increased violence is more 
urgent than ever.
    I hope that our conversation today considers how we might alleviate 
the childhood trauma, isolation, lack of stable employment, and low 
levels of community trust that contribute to increased acts of 
violence.
    Family and civil society breakdown come with dangerous 
consequences. Confronting the underlying causes of violent crime must 
play a key role in our efforts to keep American communities safe and 
prosperous.
    Thank you.

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
    
    
    Response from Ms. Sarah Burd-Sharps to Questions for the Record
                     submitted by Senator Klobuchar
    You noted that gun violence costs the American taxpayers $12.6 
billion, which could be used for community violence intervention 
programs to address the root causes of gun violence. The Bipartisan 
Safer Communities Act included $250 million to fund community-based 
violence prevention programs.

      What are the long-term expenses cities face each year 
related to gun violence?

    Gun violence takes a toll not only on its victims but also on 
government budgets. The presence of significant gun violence in a city 
means more money spent on hospitals, first responders, rehab and 
institutional care, and criminal justice costs. Spending large amounts 
of money on the response to gun violence can prevent spending on the 
types of social services that can prevent it from occurring in the 
first place, including quality education and health care, mental health 
services, and more.

    An Everytown analysis of the Nation's 20 largest US cities found 
that each city has an average of 186 gun homicides per year. These 
homicides add up to an average cost of $2.2 billion per city, $132 
million of which come from government programs and services and is 
borne by taxpayers. Combining the cost in all 20 cities yields a total 
of $45 billion, $2.6 billion of which is paid by taxpayers. This amount 
is a very conservative estimate. It does not include the cost of 
suicides or gun injuries. It also does not include the negative impact 
gun violence has on businesses and property values in the hardest hit 
communities.

      How does investing in violence prevention help to save 
resources that would otherwise be spent addressing the long-term 
effects of gun violence?

    Violence prevention through local violence intervention programs 
can significantly reduce costs related to gun violence by preventing 
hospitalizations, decreasing police and court expenditures, and 
improving quality of life. A 2015 cost-effectiveness analysis of San 
Francisco's Hospital Violence Intervention Program, the Wraparound 
Project, found that by reducing re-injury and hospitalizations, the 
program saved both money and quality-adjusted life years, compared to 
doing nothing. A 2016 study of abandoned building and lot remediation 
in Philadelphia (``cleaning and greening activities'') found that these 
efforts reduced firearm violence, saving taxpayers an estimated $5 per 
dollar invested in remediating buildings and $26 per dollar invested in 
remediating lots. Initial results from a 2022 randomized control trial 
of READI Chicago--a program that offers cognitive behavioral therapy 
and employment to young men at the greatest personal and geographic 
risk of gun violence in the city--found that while the program cost an 
estimated $60,000 per participant, $185,000 was saved in societal 
harms.
                               __________

      Response from Dr. Chethan Sathya to Question for the Record
                     submitted by Senator Klobuchar
    You noted in your testimony that the United States spends over $1 
billion per year on medical costs associated with gun violence and that 
the costs of treating gunshot related injuries are substantially more 
expensive than treating other type of injury such as stab wounds or car 
accidents. Do you expect communities will see a decrease in medical 
costs associated with gun violence if they make an upfront investment 
in gun violence prevention initiatives, such as those run by your 
organization?

    Early gun violence intervention programs can effectively reduce the 
number of firearm-related injuries--even without adequate funding for 
gun violence research, we know that. Investing in those programs, 
including community violence intervention and hospital-based violence 
intervention, can lower rates of gun violence and therefore the 
subsequent treatment costs. At the same time, we would benefit from 
more rigorous research that tracks community-based and hospital 
interventions with the costs of treating gun violence in the short and 
long term.

    It's important for these investments to be part of a broader public 
health strategy that involves data collection, analysis, and 
appropriate adjustments based on that analysis. To tackle the cost of 
gun violence, we need to recognize and address its complex causes and 
invest in a public health approach that addresses each of them. Similar 
public health crisis, such as motor vehicle collisions and smoking, 
have all seen a significant reduction in their healthcare associated 
costs and economic toll as a result of successful public health 
strategies.

    At Northwell, we're piloting an NIH-funded universal screening 
protocol that asks our patients about their risk of firearm injury--
whether that's suicide, unintentional shooting, or an assault. Our hope 
is that by identifying those risks early, we can both save lives and 
reduce the medical costs associated with gun violence.
  

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