Tort reform for medical malpractice is a tough sell to lawmakers. Just look at all the failed attempts at getting bills through the state Capitol.

This year — with reports of doctors leaving Hawai'i over skyrocketing insurance premiums, among other causes — there was every reason to expect change.

Unfortunately, a House bill that would cap the amount of money awarded in one category of malpractice lawsuits was rejected Thursday.

But there's still time to act.

A Senate medical liability bill, SB 813, could be amended to include key tort reform provisions. Success will take a concerted push from businesses and everyday folks who understand how much the state risks by its inaction.

Neighbor Island residents understand, after witnessing many of their doctors packing up, leaving rural communities seriously underserved. People with traumatic injuries and those requiring specialty services often are flown to Honolulu for what should be available to them locally.

That's a bleak picture, particularly for a state that's always prided itself on taking care of its own.

The real tragedy here is that our leaders are voting emotionally rather than rationally. Compelling testimony from victims who endured catastrophic damage due to poor medical treatment can't be dismissed, nor should it be.

Families spoke movingly of expenses caused by malpractice. Indeed, there should be exemptions for the most egregious cases of negligence and malpractice.

And virtually all the damages discussed at Thursday's hearing could be compensated fully as economic damages. What would be capped at $500,000 are "non-economic" damages, the incalculable "pain and suffering" claim.

Too often, says insurance commissioner J.P. Schmidt, half the award is lumped into this undefined category, resulting in a legal system that's simply untenable.

Malpractice premiums are regulated, Schmidt said, so windfall profits by insurance companies could be avoided. Tort reform also would expand the tiny pool of insurance providers, stimulating competition and reducing costs. That's been the experience in states where medical tort reform is a success.

The proposed cap is no panacea. But it would signal the state's determination to deal with the problem. Hawai'i's dreams for the future, attracting new business and jobs, can't be achieved without quality healthcare in the mix.