You cannot tell how much malpractice and "defensive medicine" costs our society, simply by adding malpractice insurance costs and litigation costs. That would be analogous to measuring the cost of a war by counting the shell casings on the battlefield. This mentality completely ignores the billions and billions of dollars that are spent on testing to "CYA", the tremendous infrastructure that has been put in place for "risk avoidance", JCAHO, NCQA & HEDIS measures, practice guidelines, etc. Studies that have been done comparing a state with tort reform to one without, are also based on a false premise, since physicians often train in one state & practice in another, plus all of the aforementioned influences are not really based on state, but rather national trends and norms. There have been studies of physician ordering habits that have placed estimates of all of this increasing costs by as much as 30%. I suspect that is rather high, but lets say it is half that. Why wouldn't we want to do something to reduce health care costs by 15%? Yes, malpractice costs and claims are down, but this is due to a lot of the above costly "prevention" measures, plus the fact that numerous states have instituted tort reform on their own.

As someone with an administrative as well as clinical background, I am very interested in quality measures. One "good" thing that has come from all of the excessive (often frivolous) lawsuits has been the greater attention to quality measures and better clinical documentation. You can even hear talks about the "six sigma" approach to health care at management seminars. I am all for improved quality of care with maximum efficiency.

What we need now is a tort system that allows for appropriate compensation to those damaged by negligence, not a system that settles almost every claim out of court to avoid a lengthy and expensive court battle. I believe that medicine is still more art than science. You can do everything "by the book" and still have a bad outcome. Is that malpractice? Right now that depends on what state you practice in. I seriously doubt that we will have any meaningful federal tort reform as long as the vast majority of our federal legislators are lawyers.