What is the reason for the high costs of medical malpractice cases?

You don't ask questions very well. Protecting doctors is a political question. Legislatures make malpractice hard by requiring doctors to review your file and say in writing that you have a claim and then agreeing to testify. You must pay the doctor who reviews your chart. You must pay him or another dr to testify at a deposition, and possibly at trial. The cost for the medical expert might be 8 to 10 thousand dollars. The lawyer will spend 10 to 30 thousand dollars worth of his time over a 2 year period. The court reporter and the videographer want to be paid in advance and that might be at least a couple or 3 thousand dollars. Everything costs and lawyers don't want to take bad cases or marginal cases because they lose big time if they take it on percentage. Jury verdicts for the plaintiff are very few in number. Jurors like to protect their doctors and hospital. Never know when they might need one. It is all uphill. The public wants the lawyer to absorb all the costs and all the risk. That is absurd. Lawyers cant do that. They have bills to pay just like you do

If you claim that a doctor, hospital, or nurse made a mistake, the burden of proof is on you to prove it. A bad result does NOT mean that someone screwed up, because the human body is not a machine and sometimes bad stuff happens no matter how terrifically the doctor/hospital or nurse acted. So, to prove your case, you will need one or more experts who will charge you for reviewing all of the medical records, for preparing for deposition, and for actually being deposed. They frequently can charge $1,000 or more to do that. The defendant's insurance company will have numerous experts testifying for the defendant, and your lawyer must take their deposition testimony before trial to know what they will say at trial. That also costs a ton of money. It is not unusual for a lawyer representing an injured party to spend $30-$50,000 to take the case to trial. Harry Truman said "If you cannot stand the heat, stay out of the kitchen."

The legislature. Complain to them.

You bring up an important point. Many folks simply don't have the time, or inclination, to be informed on these matters and simply leave it up to their legislators to make the laws about who can sue and for what and what is required to bring such a suit. In Michigan, the legislators have made medical malpractice cases a very onerous and difficult proposition. Subsequently, Michigan judges and juries have made such cases even harder to pursue. Experts are required and are costly. These cases are vigorously defended, probably because the statistics show that they are not easily won by the Plaintiff. Further, one of the tactics of the insurers and defense firms in defending them to the death, is to make them very expensive to pursue. Thus most lawyers will not take these cases unless there is relatively clear malpractice and the damages are serious, for in small damages cases the recovery likely will not even pay for the costs of the litigation. So in my opinion, in Michigan, the "blame" lies with the public in who they elect to the legislature and the bench, and with jurors who routinely side with the doctors and hospitals, such that the climate is that these cases are hard and expensive to pursue. It seems the last thing people care about any more is fairness or justice. Of course, the real bottom line is money and the insurers and doctors and hospitals have lots of it and lobby quite effectively to take away your access to justice.

There are many reasons, some of them legitimate. First, medical science is not an exact science. For example, suppose someone comes into an emergency room clutching his abdomen and says "it hurts, it hurts, it hurts". Well, there could be a hundred reasons and the doctor only has so much he can go on. So, he has to make a judgment call. If it turns out to be the wrong call, he can't be faulted if he followed all of the accepted procedures. So whose to say if he followed the correct procedures? Another doctor. And to hire another doctor to determine whether the first one followed accepted procedures is very expensive, five to ten grand just for starters. Next, doctors own the insurance companies. For real. It was around 30 years ago that doctors decided they were paying so much on premiums that they could use that money to create their own insurance company, so they did. One of the features of that insurance is that the company cannot settle without the permission of the insured. So they fight every case. Now, a car insurance company or a property insurance company will usually settle a case, depending on the liability issues etc. but its just a business decision for them. Medical insurance will pay their lawyers and experts $50,000 to defend a $10,000 case. Why? Because that way, all of the malpractice attorneys know that unless they have a case that will justify the huge time and expense costs, they won't even start a claim. Remember, I said that expert witnesses will cost 5-10 G for starters. Well, that number goes way, way up when cases go to trial. You may need several experts. Plus, if someone is injured that badly that they have a permanent disability and won't be able to work or have the same job as before, then you may need a vocational rehabilitation expert and an economist. More experts, more money. I have had several potential med-mal clients come to me and it seemed to me there were clear cases of malpractice, but if I took the case and won, the verdict would probably be around $25,000 which of course meant that I could not go forward. Add to that, since the medical insurance companies focus on med-mal claims, they have lawyers and their own expert doctors at the ready who handle defense of medical malpractice on a regular basis (sometimes, that's all they do) and so they have serious expertise at defending these claims. As if all that weren't enough, sometimes a jury won't accept there was malpractice no matter how strong the proof. So, unless there is obvious malpractice and severe injury, no lawyer will touch it. The upshot is, a doctor can be as careless as he likes, as long as the injuries he inflicts would not take more than $100,000 to compensate.

You are not asking legal questions but stating policy considerations. This is a matter for the legislature, not this forum.