As President Bush travels the country pushing for limits on pain and suffering awards for Americans who win medical malpractice, he should remember that these cases often begin with an incompetent doctor.

Bush aides are aware of that. An administration study recently demonstrated that one of the major factors in medical malpractice is the medical industry's unwillingness to discipline incompetent doctors.

Repeated studies have shown that a great share of the nation's medical-malpractice awards stem from the incompetence of a small percentage of doctors. Yet the state medical-review boards authorized to discipline these doctors often do not.

In the war between defendant doctors and plaintiffs' lawyers, Bush has been unabashedly on the side of the doctors. Speaking in Illinois on Wednesday, he argued that a shortage of obstetricians and gynecologists is due to high insurance premiums and that those premiums are exclusively a result of high and unwarranted pain and suffering awards.

The facts do not support the president. High insurance rates are just as much the result of insurance-company investment policies and legitimate claims by those who have been injured by a doctor's mistakes. The president doesn't appear ready to hear the silence coming from the insurance industry whenever the question is asked: Will hard caps bring about lower rates? The industry won't promise that, and if it can't, then the hard caps won't solve the problems of doctors leaving fields such as obstetrics and gynecology.

Bush could help solve the core problem: Americans being injured by incompetent doctors, suing and, in the process, driving up insurance costs for all doctors. He could include a proposal to significantly strengthen the medical-review system in this country, thus sparing Americans from the relatively small number of incompetent doctors who are creating the majority of the problems.

According to The New York Times, the administration commissioned the study from the University of Iowa and the Urban Institute. The researchers who wrote the final report offer great hope of significantly reducing the number of malpractice injuries through better disciplining of doctors.

The Times quoted Bush's press secretary, Scott McClellan, recently as saying that the federal government may take medical-malpractice governance away from the states. If that happens, then it would appear that a strong national law on disciplining doctors would also be in order.

Tort reform that punishes only the victims of medical malpractice without reducing insurance rates or getting rid of incompetent doctors is no reform at all.

The president must first act to eliminate the problem at its source, the rare incompetent doctor who creates the problem. Bush now has a study that shows him what to do toward that end.