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...paid through fee-for-service rather than, say, for curing their patients, their primary incentive is to do more stuff. CMS is starting to experiment with pay-for-performance programs that address this concern. But such measures can work only if they are remunerative enough to counter the base incentives that drive excess care. "A few pennies here and there is not going to change what physicians do every day," says Pham. "They're not stupid, and they have business managers...
...there's plenty of reason for cautious optimism. After trying to reinvent the technological wheel with the dangerous and temperamental space shuttle, NASA is returning to what it does best. The hardware and crew for the lunar base will be sent into orbit atop comparatively reliable, disposable boosters, based on the sturdy and powerful engines of the shuttle and long-extinct Saturn boosters. The lunar orbital vehicles will be souped-up Apollo command modules and the landers will be similarly updated lunar excursion modules - the lovable, buglike LEMs. Astronauts on Apollos 15, 16 and 17 already showed that lunar rovers...
Heard anything from America's manned moon base lately? You know, the one that was supposed to have gotten under way in the 1970s, just a handful of years after the Apollo 11 landing? No? What about news on the upcoming Mars landing, the one President George H.W. Bush called for in 1989 and should be deep in development by now? Not a word, right? And you're not likely to hear anything about that either...
...Space watchers could thus be forgiven for being wary Monday, when NASA announced its plans for a manned moon base in the south lunar pole, a settlement that it says should be up and running in 2020 and permanently occupied in 2024. A manned space program that has done nothing but circle the harbor of low-Earth orbit since 1972 - losing 14 astronauts to accidents in the process - hardly seems likely to pull off something so daring, especially when it's got an 18-year deadline in which funding and governmental enthusiasm for the project could easily melt away...
...Even more promising - if far more speculative - is the mission profile for the crews. All of the Apollos landed near the lunar equator, a comparatively easy target for first-time visitors who don't plan to stay too long. A moon base would have to be built in the harder-to-target poles. The perpetual sunshine in most of the extreme north and south means plenty of light for energy-producing solar panels; the perpetual darkness in the shadowed polar regions means a steady supply of water ice, which can be harvested for consumption and fuel manufacture. Currently...