I am glad that an issue that we discussed in the working group may now see the light of day. The idea was to use the states as laboratories of democracy, by encouraging them to experiment with alternative forms of dispute resolution. If any of the experiments were particularly effective, proponents of reform could highlight them and use them as models for a broader type of fix. But in reality, this small demonstration project is not going to solve the problem of medical-malpractice lawsuits, or the high malpractice insurance premiums and expensive defensive-medicine practices that stem from the lawsuits. It was a small holding action, designed to keep the flame of malpractice reform alive after it was stopped by impassable legislative roadblocks.

I challenge long-standing Republican (and, perhaps, even conservative) doctrine, Congress has no business passing med-mal reform. I'm a med-mal hawk: I compile an annual publication, the U.S. Index of Health Ownership, that uses inputs from my colleagues Lawrence McQuillan and Hovannes Abramyan to measure states' success in passing good med-mal legislation.

Many states still need med-mal reform, but they should do it on their own. Federalism demands it. Plus, the trend is our friend: States that neglect med-mal reform will face serious shortages of physicians. When Texas enacted effective med-mal reform, the number of physicians applying for licenses jumped up by 57 percent from 2003 to 2008. They didn't spring out of the ground, but migrated from other states.