Health care legislation before Congress takes only modest steps to address a problem that is more deadly than inadequate medical insurance - medical error. Studies show that preventable medical errors - ranging from poor sanitation to mistakes during surgery - kill four times as many people as the lack of medical insurance. In August, a Hearst investigation, "Dead by Mistake," concluded that as many as 200,000 people die each year from medical errors and infections in the United States and that many measures to alleviate the problem have not been adopted 10 years after a landmark federal study, "To Err Is Human." A new Hearst analysis shows that the health care reform bills under consideration by Congress also do not include key recommendations, outlined in the study, that the health care industry has lobbied against ever since. Experts agree that the proposed legislation does not address key aspects of the problem. "We are not seeing a lot about safety, which is interesting, because the nation is acknowledging the 10-year anniversary of 'To Err is Human' and there is a lot of frustration that we have not made more progress," said Jim Conway, senior vice president at the Institute for Healthcare Improvement, a Boston nonprofit that has been pushing hospitals toward safer care. Two major recommendations of the federal study are mandatory reporting of medical errors and, based on those reports, systemic changes to prevent future mistakes. None of the bills include mandatory reporting.