Word: payments
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...basis points last fall, according to data-tracker HSH Associates - but has since settled down to about 100. Still, that's a big added expense. Plus, consider that for houses worth more than $1.5 million or so, banks are likely to look for a down payment in the 30% range. (See 10 things to buy during the recession...
Undoing these waste-promoting incentives - the "fee-for-service" payment system that awards more fees to doctors and hospitals for providing more services, and the regulated electricity rates that reward utilities for selling more power and building more plants - would not solve all our health-care and energy problems. But it would be a major step in the right direction. President Obama has pledged to pass massive overhauls of both sectors this year, but if Congress lacks the stomach for comprehensive reforms - and these days it's looking like Kate Moss in the stomach department - a more modest effort...
...quality structure, the same interest-group politics that have distorted and ultimately paralyzed the current system could dominate the new system; that's why Obama has proposed to depoliticize those decisions through an independent agency similar to the military-base-closing commission. Still, changing the dysfunctional payment system while safeguarding patient rights (and perhaps protecting doctors who practice evidence-based medicine from frivolous malpractice suits) would be easier than expanding coverage to the uninsured, transforming the insurance market and figuring out how to pay for it all during a crippling recession. "It's become conventional wisdom that...
...even mild reimbursement reforms; former Health and Human Services Secretary Donna Shalala recalls a futile effort to reduce overpayments and promote competition among oxygen providers. "Congress stops anything that's going to gore anybody's ox," Shalala says. "If Congress is going to be involved in the nitty-gritty payment details, reform is dead." Obama wants to let another independent agency, similar to the military-base-closing commission, recommend how to pay for quality, which would limit political haggling. But even if such a panel focused on clinical effectiveness rather than cost-effectiveness - so that taxpayers would cover vastly more...
...Unfortunately, micropayments in the past have failed to live up to lofty expectations. Over the last 10 years, several companies including U.S.-based Peppercoin and CyberCash offered online payment systems that didn't catch on. PlaySpan CEO Karl Mehta says this is because "there was not enough digital content to consume." That's changing. Mehta predicts that micropayment services will over the next few years become available on a wide range of gaming and social websites - adding that there's no reason they can't be used to buy newspaper and magazine articles, too. "The newspaper industry is now crying...