Even these "bad apples" in the medical profession don't significantly increase malpractice insurance premiums for the rest of the doctors. The truth is that insurance companies do not make their money from premiums, but from investing those premiums. When interest rates and returns are high, the companies prosper and often reduce premiums in competition with one another. When interest rates are low (as they are now), the companies' returns suffer, and they must raise premiums to make up for the loss of investment income. In June 2003, the General Accounting Office issued a report to Congress (GAO-03-702, available at www.gao.gov) which found that insurers' pricing decisions were affected not only by their losses on malpractice claims, but also by their loss of income from investments, prior premium history and other market conditions such as market share and the level of competition.

The bottom line on tort reform is this: Research has shown that there is no evidence of rising jury awards or the so-called high cost of litigation, and that the economy is the key to rising malpractice insurance premiums.

As unfortunate as they are, high-profile litigants like Linda McDougal (the woman whose doctor conducted an unwarranted double-mastectomy) and Jessica Santillan (the 17-year-old whose doctors failed to match her organ donor) may help to educate the public. The tragedy is that the healthcare system can disfigure or kill someone and still have the nerve to ask for a cap on damages, a concept that in effect frees these paid professionals and for-profit institutions from personal accountability. Try explaining that to the injured person and their family.

As long as the healthcare industry fails to police itself, there will be plenty of work for all of us.