What drives the defensive/excessive medicine? Second guessing, especially when there is an adverse outcome, must have some effect. The lack of cost/benefit calculation. I certainly would have declined the x-rays in the case of the minor injury of my son. There was nothing to justify their cost. The humane tendency to show that one is an excellent doctor.

Since claims of malpractice are mostly wrong, the plaintiff bar does not help matters. “Perhaps that extra test saved a life” is the claim, but the lawyer who makes the claim can base it only on conjecture, as there is almost never a suit when treatment is effective.

http://www.chicagotribune.com/news/nationworld/chi-somalia_20nov20,0,4913179.story

In response to (1), merchant vessels could legally arm themselves, but they probably would not want to. The reason shipping and hence the cost of imported goods is so cheap is that a crew of 15-20 can run a modern cargo ship transporting millions of dollars of merchandise. These ships, even if armed, would stand no chance against an attack by pirates.

If the various navys and other military were allowed to go after these pirates in earnest, the problem would be solved.