The ongoing Illinois drama over the medical malpractice reform debate intensified last week when President George W. Bush paid a visit to Madison County.

Yes, THAT Madison County – the favored courtroom home to many of the nation’s wealthiest trial lawyers, made universally infamous by the multi-billion-dollar class action lawsuits filed over asbestos and Marlboro Lights, and the focus of a multi-million-dollar Supreme Court race last year that featured both candidates accusing each other of being soft on child molesters in front of a backdrop of stories about small-town hospitals closing their doors and doctors fleeing to neighboring states, and ending with the trial lawyers’ hand-picked Democratic candidate losing both the campaign and his appellate court seat, which then spun off a bizarre sequel when the loser immediately filed a nine-figure defamation lawsuit against his opponent’s financial backers.

"Madison County" has become a shorthand epithet among an ever-widening circle of those who believe that the trial lawyers have gone too far. It was labeled the nation’s Number 1 "Judicial Hellhole" by the American Tort Reform Association (neighboring St. Clair County was Number 2), but even bastions of liberalism like the St. Louis Post-Dispatch have gotten into the act. The paper bellowed last fall that the county’s judicial system "stinks," and then promptly buried a poll result which showed "well over half" of Illinoisans believe that medical malpractice damages should not be capped.

The situation is so weird that even some Metro East Democratic legislators openly worked with the Illinois State Medical Society on a solution last spring – which two years earlier might have resulted in their excommunication from the local party.

Even Governor Blagojevich, who campaigned as a friend of the trial lawyers and placed sole blame on the insurance industry for the med-mal insurance "crisis" during his first year in office, has at least partially changed his tune. The guv revealed last year that his wife’s obstetrician had fled to Wisconsin to avoid her outrageously high med-mal rates, then later appointed a task force to come up with a comprehensive solution.

And now, just a week before the spring session is set to begin, in walked the president.

President Bush promoted his own, federal tort reform package while in Madison County, and used the plight of the region’s physicians as the "tip of the spear" in his fight to persuade Congress to pass his much broader legislation.

But, other than causing Illinois more embarrassment in the national media and giving the minority Republicans more political ammunition, will the president’s visit make much of a difference at the Statehouse?

There was much speculation during the Veto Session that the governor, who most likely covets that big pile of trial lawyer re-election cash, would only kinda sorta support his own commission’s recommendations and then promptly toss the hot potato at the General Assembly. This would set up yet another showdown with trial lawyer friend House Speaker Michael Madigan, who would demand that the governor come out and say exactly where he stood before the House would vote on the proposal.

If that’s the scenario, a Bush visit might help force the governor’s hand. But we’re talking about a very skillful evader here, not some run-of-the-mill politico.

Others believe that nothing at all will happen, with or without a high-profile presidential visit. Up until now, they point out, both sides have simply used the issue as a partisan battering ram and purposely avoided coming to any agreement so they can keep the political game alive. According to this argument, as long as the Democrats believe they can win elections without changing the status quo too much, they won’t do much of anything. And as long as the Republicans believe they can use the issue to pick off some Democratic seats, they won’t agree to any compromises. The absence of high-minded, bipartisan legislative compromises in the past decade or two seems to support this theory.

But even some of the trial lawyers’ best legislative friends admit something has to be done, and the trial lawyers’ willingness to give on several major points during the spring session makes it appear that a reasonable solution could be found.

What’s needed, obviously, is real leadership. The governor’s commission report will collect dust alongside all of the other blue ribbon recommendations from bygone years if there is no one at the top pulling all the parties in a single direction. Important, complicated and delicate legislation like this doesn’t magically become law by itself.

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