Last year, Jack Bleed cut through the bone of his ring finger while working. The 31-year-old resident of North Little Rock, Arkansas, waited for about six hours at a nearby medical center while the medical staff there called all over town -- even as far away as Dallas and Memphis -- to find a hand surgeon to reattach his finger. Finally, a willing doctor was located in Louisville, Kentucky. But even though Bleed had insurance , he would have to hire a private plane to get himself there, at a cost of $4,300. In the end, he charged the cost to two credit cards, and his finger was saved. His insurance company eventually covered the cost of the plane, but his experience makes people aware of the fact that trauma  care in the United States is not only geographically limited, but in many places, non-existent. Only eight states -- New York, New Jersey, Maryland, Illinois, New Mexico, California, Oregon, and Washington -- have local, fully functional trauma systems. The remaining states have partial systems, and 12 -- including Arkansas -- have no trauma system at all. Although the President has signed a bill of $12 million for the purpose of supporting trauma care systems nationwide, many in Congress  are unwilling to spend government money for a service they think should be paid for by states, says Wayne Meredith, medical director for trauma programs at the American College of Surgeons. Meanwhile, many states have also failed to find the dollars to support trauma systems. To make matters worse, many people without insurance depend heavily on the emergency care services, placing a huge financial burden on the medical centers that serve them. For the same reason, doctors, too, often go unpaid. They are unwilling to perform emergency care, worsening critical shortages of neurosurgeons, orthopedists, and hand surgeons -- the very types of specialists Bleed needed at short notice. Supporting a trauma care system doesn't take much. A half-penny sales tax in Miami-Dade County makes its outstanding system work. In Arkansas alone, says Wayne Meredith, a well-funded trauma system would possibly prevent 200 to 600 deaths each year. If trauma care systems were to work well across the nation, experts say, many thousands of lives each year could be saved. "You don't get much better return on your investment than that," Meredith says. The example of Miami-Dade County shows that    _   .
its tax policy is admirable running a trauma system is profitable a trauma system is not expensive sales tax is not heavy in small counties