The question that dominates the Illinois gubernatorial race this cycle is a huge one: What will each candidate do to fix the state's budget deficit? Because the shortfall is so large, righting the ship will require comprehensive changes both in the way the state generates and spends revenue. We've already seen plenty of Republicans ignore reality when it comes to the obvious need for additional revenue.  But equally frustrating are their vague suggestions for how the state should lower its expenditures.

Take the results of a survey published today by the Peoria Journal-Star. Asked how they planned to "lower or contain the state's health care costs," the GOP candidates threw out numerous ideas that won't make a real dent in the deficit or improve the lives of Illinois citizens. State Sen. Bill Brady (R-Bloomington) called for "improved management of the Medicaid program" without identifying where management can be improved. DuPage County Board Chairman Bob Schillerstrom wants to "move Medicaid recipients into a managed-care system." (If he's referring to a private managed care system, than this is a radical and problematic plan for a number of reasons.) Former Attorney General Jim Ryan supports increasing home- and community-based services, which is sound policy but will only save $70 million. Finally, we get this suggestion -- common on the national stage -- from State Sen. Kirk Dillard (R-Hinsdale) and former Republican Party Chairman Andy McKenna:

McKenna and state Sen. Kirk Dillard called for reforming the state's tort system. Dillard said that would "reduce frivolous lawsuits which are driving up the cost of health care in Illinois."

Here's the question for McKenna and Dillard: What exactly don't they like about the state's current tort reform statutes? In 2005, the General Assembly passed a relatively stringent medical malpractice package, which capped non-economic damages at $500,000 for physicians and $1 million for hospitals. The bill also strengthened the state's certificate-of-merit clause, which now requires the plaintiff of a medical malpractice suit to obtain a certificate from a physician declaring that he or she has reviewed the case and believes the suit has merit, along with setting standards for expert witness testimony. It's true that a Cook County Circuit Court ruled that the law was unconstitutional in 2007, but the law has remained in effect as the Illinois Supreme Court continues to examine it.  At the time it was passed, the president of the Illinois State Medical Society called it a "significant step in the right direction."

So if Illinois already has pretty strict laws on the books, why are medical costs rising here just as fast as in other parts of the country? Probably because very few health economists think tort reform alone significantly reduces insurance premiums. It can limit the growth of malpractice premiums for providers, but those premiums make up a tiny proportion (about 2 percent) of health care costs across the board. Doctors also claim that defensive medicine is a big driver of over-utilization, but data shows that doctors' prescriptions are much more influenced by the prevailing medical culture in their region.

It's worth noting that only one Republican candidate, Dan Proft, actually offered a concrete proposal. He wants to reverse the expansion of Medicaid eligibility guidelines that occurred under Rod Blagojevich's administration and tighten income-eligibility criteria for the state's largely successful All Kids program. Eliminating coverage for many of the state's most vulnerable during one of the worst recessions in memory is wrong-headed and callous, but at least it's a real plan. Proft's competitors aren't offering anything nearly as specific.