>>My understanding here is that the largest expenses are in settling claims just to make them go away.

I agree with everything you say. But the man with no $ will not settle to avoid a court case. He has nothing to fear from litigation, because any awards against him simply get added to the pile of unlucky creditors who never will be paid. The legal model depends on the fleas not sucking the dog to death. In this case the dog is hit by a car and it doesn't matter what the flea does now.

Re physicians on other countries: they carry insurance, but not to the same extent. There are a number of reasons, but a big difference is that in other jurisdictions if you lose a court case you are liable for the costs *including legal costs* of the other party. This contrasts with the US in which each party is responsible for its own legal costs except in "extraordinary" circumstances that judges are reluctant to declare. Being liable for your target's legal fees has a sobering effect on frivolous litigation and makes it worthwhile to defend rather than trying to settle.