The effort to overhaul the nation's health care system has so far skirted the issue of tort reform, intensifying debate over the role malpractice lawsuits play in increasing premiums.

Many critics of the new law say it doesn't adequately address the cost of lawsuits.

But numerous academic studies say malpractice lawsuits are not among the largest drivers of medical costs - which have increased more than 800 percent since 1980 - and that the solutions to skyrocketing medical costs are much more complex.

Blaming soaring health costs on lawsuits "is at best naive and at worst dishonest," said Amitabh Chandra, a health care economist at Harvard University.

That hasn't changed the sentiment of local Republican members of Congress, who argue the savings from reducing medical lawsuits would be significant.

"National medical-malpractice reform should have been an integral part of the health care law in order to reduce costs without limiting access to or compromising quality of care," said Rep. David Dreier, R-San Dimas. "California is a state that has implemented medical-liability reform and, as a result, the medical malpractice rates for California physicians are some of the lowest in the country.

"In fact, the Congressional Budget Office told Congress that the federal government could save up to $54 billion over 10 years by implementing California-style medical malpractice reform. If it had built on this example, the health care law could have had an impact on costs nationwide," Dreier said.

Rep. Jerry Lewis, R-Redlands, agreed.

"We cannot have true health care reform unless we end frivolous and expensive lawsuits," he said. "I support a national law based on California's 30-year-old Medical Injury Compensation Reform Act law, which has proven fair to patients and stabilized the medical-liability system in our state.

"It would help eliminate unnecessary tests and procedures that are being imposed on patients by doctors afraid of lawsuits, which is estimated to add $126 billion a year to health care costs."

Chandra pegs the real costs of malpractice judgments, including costs of fighting lawsuits and administrative costs, at less than $10 billion.

That's a drop in the bucket compared with the nation's $2.5 trillion annual health care budget, he said.

But defensive medicine - tests and procedures ordered to protect against medical-malpractice lawsuits - can also add to costs.

"As a resident, the first thing you learn is that your license is on the line," said Dr. Faisal Qazi, an Upland neurologist.

Newly graduated doctors learn that if they don't do an extra test and something goes wrong, it would at the very least result in a hassle and loss of productivity and income.

"We do our best to avoid them," said Qazi, who is also an assistant professor of neurology at Western University of Health Sciences in Pomona.

But Chandra, a professor of public policy at Harvard's John F. Kennedy School of Government who has researched defensive medicine, said he believes many of those purported expenses are actually because of the way insurance and government payments are structured.

"The way the system is set up, the more you test, the more imaging you have done, the more you get paid," he said. "But don't just blame the doctors. It's the perverse reimbursement system we have."

Although detractors of the legal system decry frivolous lawsuits, less than 10 percent of patients with a legitimate claim end up suing, Chandra said.

"There are many more who suffered and get nothing," he said.

According to a report released last year, technology is the biggest driver of health care costs.

Wellpoint Institute of Health Care Knowledge released a study last year titled "What's Really Driving the Increase in Health Care Premiums?" The study compiles research from sources that include PricewaterhouseCoopers, the Robert Wood Johnson Foundation, the Kaiser Family Foundation and several federal agencies. 

Top on this list of key drivers of health care costs are advances in medical technology and subsequent increases in their use.

"Newer technologies tend to increase prices because they are generally more expensive than the technologies they replace," the report said. While newer technologies can yield better results for some patients, "these diagnostic tests can be used inappropriately in some situations where existing, older technologies are more effective and accurate ... The wise applications of these new expensive therapies will result in more affordable health care for all Americans."

Wellpoint is the nation's largest health care benefits company.

Rep. Joe Baca, D-San Bernardino, said that despite the criticism, the health care legislation "takes some positive steps in the area of medical-liability reform by authorizing the secretary of Health and Human Services to award five-year demonstration grants to develop, implement and evaluate alternative medical liability reform initiatives, such as health courts and early offer programs, beginning in 2011.

"The law also extends medical liability protections under the Federal Tort Claims Act to officers, governing board members, employees and contractors of free clinics," Baca said.

But Lisa Rickard, president of U.S. Chamber Institute for Legal Reform, said the state demonstration projects are "watered down" reform efforts because they allow the plaintiffs to opt out at any time.

Gerald Kominski, associate director of the UCLA Center for Health Policy Research, said there is room for tort reform but that it wouldn't dramatically drive down costs.

Instead, Kominski points to quality control as an important avenue toward cost reduction.

Credible reports estimate that 100,000 American die each year from medical errors. The public would not tolerate hundreds of commercial plane crashes a year claiming that number of lives each year, he said.

As the threat of malpractice lawsuits has not improved medical error rates, other mechanisms are needed, Kominski said.

When it comes to health care, Americans want two conflicting things at the same time, he said.

"We don't want to pay for other people to have health care," Kominski said, "but we want spending without limits when it comes to ourselves."