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

This responsiblity for legal fees is exactly the tort reform that is needed and resisted by the trial lawyers lobby. Lawyers enroll plaintiffs by assuring them they are at no risk. Of course the law firm risks their own costs, but given the propensity to settle nuisance suits there is little risk.

And it is very hard for a doctor or hospital to comfort themselves that if they are completely broke they won't get sued. It may be true that a law firm cannot bankrupt a hospital twice, but that is like saying a cheetah won't eat a gazelle because that means he can't eat it again.

I just don't see how our health care system will ever get costs under control without legal reform and I don't see that happening when the legislative system is run for and by lawyers and one of our major parties is completely in the pocket of trial lawyers. (and if they resisted the lawyers would just buy more Replbicans to make up the deficit.)

Reform of our tax codes faces similar obstacles. Only a system of our Byzantine complexity can be gamed as skillfully as those with the resources game the tax code written by their lobbyists.