Last year, House Speaker Michael Madigan sent a clear message to Governor Rod Blagojevich when he brought all of the governor's highly unpopular tax and fee hikes to the floor for up-or-down votes. The governor's bills all lost by overwhelming margins, and Blagojevich was forced to back down from his demand that Madigan pass his proposals. Madigan's message was received.

Madigan appeared to be sending a similar message to the all-powerful trial lawyers last week when he allowed an amendment to the floor that would place a "cap" on non-economic damages in medical-malpractice suits at $1 million for doctors and $2 million for hospitals.

The amendment was far more agreeable to the trial lawyers than the bill it was supposed to be attached to. The underlying bill would cap the damages at $250,000 for docs and $500,000 for hospitals.

But Madigan, the trial lawyers' top ally in Springfield, had muscled that very tough caps bill out of committee the same morning. The bill didn't have enough votes on the committee, so Madigan substituted three Democratic members for three other Democrats who favored malpractice caps. The Democrats, mostly Downstaters, believe the caps will help ease what they consider to be a health-care crisis. Doctors are abandoning their Illinois practices for other states, particularly in the Metro East area near St. Louis and in southern Illinois.

The docs say damage caps would lower their ever-increasing malpractice-insurance premiums, and their voices are being heard. Last year, the medical-malpractice-crisis issue defeated a Democratic Supreme Court candidate who, on paper, should have won in a walk. Instead, Gordon Maag not only lost his high-court race, but he also lost his retention bid for the appellate bench, an almost unheard-of result.

Politicians notice when things like that happen, and Speaker Madigan, the trial lawyers' greatest friend, finally decided that something needed to be done.

So, Madigan brought the rather extreme cap bill to the floor. And to send a message to the trial lawyers that they were on the losing side of this battle, he allowed a vote on the lawyer-friendly amendment.

When it came time to vote, most of Madigan's Democrats sided with the doctors and against the trial lawyers, including Democratic state Representative Jay Hoffman, who works for one of the top trial-law firms in the Metro East area. Message sent.

The trial lawyers have responded to all of this as any attorney would, with well-reasoned arguments and plenty of studies, facts and constitutional arguments that back up their positions. But the General Assembly is not a courtroom, and legislators are not judges.

The legislators' object here is not to get at the ultimate truth and pass a bill on its "merits," but to get their hometown doctors off their backs and out of politics.

A politician cannot win an argument with a constituent's godlike physician who dispenses free samples of tort-reform advice along with packets of the latest wonder drug. Democrats believe that once rank-and-file doctors are placated with caps, they'll focus their ire where the Dems believe it really belongs: on their malpractice-insurance companies and, especially, the Illinois State Medical Society's insurance company, which has been driving the Springfield med-mal debate for years while it was driving up premiums on its own doctors.

Besides, the lawyers are about two years too late. They relied so much on Madigan to bottle up any hostile proposals for so long that they never thought they needed to justify their positions. In the meantime, they became arrogant and sloppy, and the public debate completely got away from them. And now all the briefing books in the world haven't been able to stop the doctors' momentum. There's still no guarantee that a caps bill will ever reach the governor's desk, but it's a lot closer now than it has ever been under Democratic rule.

There's also another twist to this tale. Madigan is allowing other amendments to the floor that might be politically difficult for the Republicans to defend in next year's campaign season. The amendments - all of which have been defeated so far - are intended to create loopholes in the law, like taking a doctor's license away after three state sanctions. It's the price the Republicans will have to pay to get this bill, which they've been trying to pass for years, to the Senate.

Seems like a fair trade to me.

Rich Miller also publishes Capitol Fax, a daily political newsletter. He can be reached at (

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