In a year in which the U.S. House and Senate have tackled many difficult health care issues, one critical issue that has not been addressed by both chambers is the near-national crisis of skyrocketing medical malpractice rates.

Across America, frivolous lawsuits are driving malpractice insurance costs so high that doctors are leaving the profession, or relocating to urban areas where costs tend to be lower. This crisis was recently highlighted in a Time magazine cover story, "The Doctor is Out," which described how rising malpractice insurance costs combined with low reimbursement rates paid by the Medicare program are dramatically reducing health care access across America.

In an effort to secure their own survival, doctors across the country are going on strike, threatening walk-outs or ceasing service because their malpractice insurance costs have become so extreme.

In South Carolina, malpractice insurance rates for obstetricians have increased 665 percent since 1998, according to the South Carolina Medical Association. Doctors who can not afford to work end up moving to a different state or retiring early. Other doctors are refusing to perform potentially life-saving procedures because of the heavy liability risk. Finally, many of the best and brightest medical students are avoiding high-risk fields such as surgery, where malpractice insurance rates are higher. The number of medical students applying to general surgery residency programs declined by 30 percent in the 1990s.

No group of patients illustrates this problem more dramatically than pregnant women living in rural areas. As obstetricians have left these areas, women are more likely than ever to deliver a baby en route to a hospital that might be an hour or more away. This problem is so severe in New Jersey that one doctor has held seminars to train toll-booth operators in emergency delivery, according to The Wall Street Journal.

While South Carolina has avoided a full-blown malpractice crisis, it is one of 32 states exhibiting "problem signs," according to the American Medical Association. Our own congressional delegation is deeply divided about how to proceed. The House passed a bill in March designed to limit the damage caused by frivolous lawsuits, but the Senate has refused to act on the measure.

What both chambers should agree on is that the real problem is reduced access for patients. I have long argued that the root problem in our health care system is that the third-party payer system has severed the doctor-patient relationship. The third-party payer, command-and-control health care system, in which government and health insurance bureaucrats -- not doctors and patients -- make too many decisions, creates perverse incentives that drive up costs and reduce access to quality care.

Skyrocketing malpractice insurance costs that force doctors out of the profession is a secondary problem compared to the third-party payer system, but it is a clear and present danger Congress has to address. And while it is reasonable to debate the point of whether frivolous lawsuits are the primary cause for rising malpractice costs, there should be no mistaking the fact that runaway litigation is a major factor.

In California, whose law capping jury awards is Congress' model, malpractice insurance rates have grown much slower than the rest of the nation.

Before the 1960s, only one physician in seven had ever been sued in his entire lifetime, whereas today's rate is about one in seven every year. The American people understand that we can never sue our way to health care security, which is why a recent Gallup poll found that 72 percent of Americans favor capping pain and suffering awards in medical liability cases.

Our neighbors North Carolina and Georgia are among 18 states experiencing a full-blown medical liability crisis. While South Carolina has not yet experienced doctor walkouts, we should not wait until that day arrives.

Congress needs to act now to cap punitive non-economic "pain and suffering" damages at $250,000 while protecting the right of patients to recover unlimited actual economic damages. In other words, Congress should make sure that patients who are harmed by a doctor's negligence receive compensation that is in proportion to their injury without creating a lawsuit lottery that enriches a handful of trial attorneys at the expense of all doctors and patients.

The stalemate in the Senate on this issue is not likely to be broken before the 2004 elections, and the S.C. Legislature would be wise to continue its work on this issue. Still, Congress should avoid the temptation to play politics and focus on writing legislation, not bumper sticker slogans. Otherwise, one bumper sticker we may see in the near future is "Drive Carefully: Baby Being Delivered."