Tort-lawsuits-plus-liability-coverage cost only about $25 billion in 2002, and extra defensive medicine probably added a bit more. These small fractions of a $1.5-trillion medical economy would be a bargain if they actually bought the compensation, injury deterrence, and justice that advocates claim. They do not. Few sue and fewer collect, slowly and with high overhead; high rates of preventable error and injury persist; and justice is ill served by omitting most injuries, resolving them slowly, and paying out hugely variable amounts. Better systems would make practitioners more willing to disclose problems, feed back improvements in real time, and compensate consistently. (Health Affairs 23(5):277, September/October 2004.)