Consensus is emerging about the need to curb the costs of medical malpractice litigation. Though the Clinton health plan proposes several useful reforms, it hangs back from other needed remedies.

The problem demanding redress is the unconscionable waste through defensive medicine, exorbitant malpractice-insurance costs and legal proceedings forced upon the health-care system by patients suing their doctors and sometimes winning large awards.It should go without saying that true victims of incompetent care must have recourse to the courts - and that egregious perpetrators of malpractice should face criminal charges and professional disqualification.

But these days, simple victims of bad luck quite often sue. Most cases are settled out of court; when they go to trial, doctors usually win. Even so, huge reserves of time, money and civility are drained out of a system once sustained by doctors' sense of duty and their patients' trust.

The Clinton administration has endorsed two essential changes. Who could oppose eliminating "double recovery" - patients collecting compensation both from their health insurer and from a jury award for the same injury? About half the states have banned this abuse - as any national health reform should.

Likewise, what could be more sensible than payment of awards in installments rather than lump sums? The purpose of damages is to cover victims' expenses, not to hand them a windfall - or tempt the unscrupulous to fraud.

Beyond this, however, the Clinton plan neglects two reforms urged by House Republicans: a cap on non-economic damages and "loser pays."

Non-economic damages are awards for pain and suffering - over and above the injured party's compensation for medical expenses, lost income, necessary home help, and so on. There is no rational way of putting a dollar value on suffering; any sum a jury names is equally arbitrary. Yet these awards account for half of total payments in malpractice cases and help make damages unpredictable and inconsistent.

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Scripps Howard News Service reports that half the states have limited non-economic damages. The congressional Office of Technology Assessment recently found such caps to be "the one reform consistently shown to reduce malpractice costs." The $250,000 national cap proposed by House Republicans is, if anything, too high.

Finally, requiring the loser in a malpractice suit to pay the winner's legal fees is a powerful deterrent to frivolous suits.

The House Republicans would impose this rule on parties who reject a mediated settlement, then lose in court - a reasonable place to start.

Who knows when Congress will actually get down to passing malpractice reforms. When it does, it must go well beyond the administration's current proposals.

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