Efforts to reform our medical malpractice system in this country have been stalled for decades in large part because medical malpractice has never been connected to broader issues in American health policy. Notably, the Medicare and Medicaid programs—which have shaped the way that much of our health care system operates—are invisible where malpractice is concerned. A promising avenue for integrating malpractice policy with health policy, thereby focusing medical liability on patient safety while taking account of cost and access, is for the federal government to pioneer a program of administrative compensation applicable to Medicare patients, which would set the standard for the rest of the health care system. Under such a program, Medicare would establish a system of “medical courts” and link them to other quality-related initiatives involving patient safety, consumer information, and provider payment. The resulting regulatory system would transform what would have been private malpractice claims into an effective administrative mechanism to assure compensation for avoidable injury and encourage performance improvement. In this year’s Rome Lecture, Professor William Sage, MD, JD, will discuss having Medicare lead medical malpractice reform in the United States.