A major roadblock in healthcare reform is the issue of malpractice insurance. High malpractice insurance premiums are believed to be a major driver of healthcare services costs. Specious arguments are made that the cost of malpractice insurance reflects the costs of "out of control" or frivolous litigation. However, malpractice insurance companies do not follow a simple cash-in cash-out formula. Research has shown malpractice premiums going up while litigation costs go down, and indicated the performance of the stock market as the main driver of premiums rather than litigation. I suggest replacing the malpractice insurance industry with federal non-profit malpractice insurance. Tort reform could be triggered automatically if this fails to reduce premiums enough to lower the cost of care.



