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To clamp down on health care costs, a growing number of employers and insurers are putting limits on how much they'll pay for certain medical services such as knee replacements, lab tests and complex imaging.

A recent study found that savings from such moves may be modest, however, and some analysts question whether "reference pricing," as it's called, is good for consumers.

The California Public Employees' Retirement System (CalPERS), which administers the health insurance benefits for 1.4 million state workers, retirees and their families, has one of the more established reference pricing systems.

More than three years ago, CalPERS began using reference pricing for elective knee and hip replacements, two common procedures for which hospital prices varied widely without discernible differences in quality, says Ann Boynton, who helps set benefits policies at CalPERS.

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Working with Anthem Blue Cross, the CalPERS set $30,000 as the reference price for those two surgeries in its preferred provider organization plan.

Members who get surgery at one of the 52 hospitals that charge $30,000 or less pay only their plan's regular cost-sharing. If member choose to use an in-network hospital that charges more than the reference price, however, they're on the hook for the entire amount over $30,000, and the extra spending doesn't count toward their annual maximum out-of-pocket limit, Boynton says.

"We're not worried about people not getting the care they need," says Boynton. "They have access to good hospitals; they're just getting it at a reasonable price."

In two years, CalPERS saved nearly $6 million on those two procedures, and members saved $600,000 in lower cost sharing, according to research published last year by James C. Robinson, a professor of health economics at the University of California, Berkeley, and director of the Berkeley Center for Health Technology. Most of the savings came from price reductions at expensive hospitals.

The agency recently set caps on how much it would spend for cataract surgery, colonoscopies and arthroscopic surgery, Boynton says.

Those who have studied reference pricing say it is most appropriate for common, non-emergency procedures or tests that vary widely in price but are generally comparable in quality. Research has generally shown that higher prices for medical services don't mean their quality is higher. Setting a reference price steers consumers to high-quality doctors, hospitals, labs and imaging centers that perform well for the price, proponents say.

Others point out that reference pricing doesn't necessarily save employers a lot of money, however. A study released earlier this month by the National Institute for Health Care Reform examined the 2011 claims data for 528,000 autoworkers and their dependents, both active and retired. It analyzed roughly 350 high-volume and/or high-priced inpatient and ambulatory medical services that reference pricing might reasonably be applied to.

The overall potential savings was 5 percent, the study found.

"It was surprising that even with all that pricing variation, reference pricing doesn't have a more dramatic impact on spending," says Chapin White, a senior policy researcher at RAND and lead author of the study.

Even though the results may be modest, a growing number of very large companies are incorporating reference pricing, according to benefits consultant Mercer's annual employer health insurance survey. The percentage of employers with 10,000 or more employees that used reference pricing grew from 10 percent in 2012 to 15 percent in 2013, the survey found. Thirty percent said they were considering adding reference pricing, the survey found. Among employers with 500 or fewer workers, adoption was flat at 10 percent in 2013, compared with 11 percent in 2012.

This spring, the Obama administration said that large group and self-insured health plans could use reference pricing.

The health law sets limits on how much consumers have to pay out of pocket annually for in-network care before insurance picks up the whole tab — in 2015, it's $6,600 for an individual and $13,200 for a family plan. But if consumers choose providers whose prices are higher than a plan's reference price, those amounts don't count toward the out-of-pocket maximum, the administration guidance said.

Leaving consumers on the hook for amounts over the reference price needlessly drags them into the battle between providers and health plans over prices, says White.

"You expect the health plan to do a few things: negotiate reasonable prices with providers, and not to enter into network contracts with providers who provide bad quality care," White says. "Reference pricing is kind of an admission that health plans have failed on one or both of those fronts."

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The holiday season is approaching, a time for sales and Santa and, now, credit card data breaches.

Though cyberthieves have stolen millions of card numbers this year, shoppers are heading into the heavy-spending season with no new credit safeguards in place.

When you hear about a data breach, Bryan Sartin is one of the guys who go in to investigate.

"I've seen my own personal information in those lots of stolen data many, many, many, many, many times," Sartin says.

Sartin heads a team of forensic computer techs for Verizon — good-guy hackers, basically. For a while he and his deskmate had a running joke.

"How frequently, in our cases, we would find his credit cards?" he explains. "And I remember, back to back, it was like two out of three cases. And there was a third [case], and it's not here, and he's kind of laughing — and then all of a sudden we found his wife's."

How The System Is Vulnerable

Sartin says data breaches happen all the time. In fact, though, only about a third of them are ever made public. In Midtown Manhattan, that fact surprises many shoppers, like Alexandra Goodell.

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"It's upsetting; it gets me angry," she says. "I work really hard and I don't want to go out of my way to cancel my card and to nail down what happened."

One reason U.S. credit card numbers are stolen so often has to do with the way we process them after the swipe, says Sartin.

"That transaction, in a text format of some kind, is sent to a server there at the store that all of the cash registers speak to," he says.

Your credit card number then flies through the Internet to the merchant's main national computer, then to the processor, then to the bank, and then back again.

"It returns in .06 seconds with a yes or no," he says.

You walk out of the store while the transaction continues to ricochet across the country — using technology from the 1970s, says Jason Oxman, CEO of the Electronic Transaction Association.

"What we need to do in the U.S. is completely replace an architecture that has been deployed over the course of the last 40 years," Oxman says. "That's how long mag stripe cards have been on the market."

The Next Step: Tokenization

He says the magnetic stripe worked fine until the '90s. Then came personal computers, which could counterfeit hundreds of credit cards. Because the U.S. had a strong telecom network, retailers went to an online system to verify credit cards' authenticity. Countries where the Internet wasn't so great adopted so-called chip cards or smart cards.

"So that's one reason that we haven't used the chip cards," Oxman says. "We haven't needed to because our online system of authorization has been a replacement for that offline chip."

But by this time next year, you are likely to be using the new chip cards. What slowed them down is the chicken-or-the-egg conundrum: Banks didn't want to issue chip cards if retailers didn't have the readers, and retailers weren't going to buy readers if banks weren't issuing the cards.

"There are more than 10,000 financial institutions that issue credit cards and debit cards in the U.S.," Oxman says. "There are 8 million merchants that accept credit and debit cards in the U.S. "

But the new chip cards are expected to cut out only about 60 percent of the fraud, which frustrates merchants. Mallory Duncan, general counsel at the National Retail Federation, fears the credit card hacks will continue because at the core, the system's backbone is still the same — 16-digit account numbers flying across the Internet.

"Unfortunately all we're going to get in the near future is the not-quite-so-smart card," Duncan says. "The problem is that the product itself is fundamentally flawed. You cannot secure a house of straw."

Duncan says retailers are hoping to move toward a system called tokenization, which replaces a card number with a one-time-only, randomly generated number. Google Wallet and Apple Pay use tokenization.

"All of those potentially are much more secure for consumers than would be partially secure chip cards," he says.

Tokenization is in use now, but not yet for credit cards. Because it requires significant system upgrades for both retailers and the banks, it's that same chicken-and-egg problem: Who spends the money first?

At any big-box store, you can find the annual holiday mash-up now on garish display: Halloween costumes are stacked next to the decorative turkey napkins and pre-lit Christmas trees.

It's time to celebrate the Halloween-Thanksgiving-Hanukkah-Christmas-New-Year season!

This year, most merchants are optimistic, predicting strong sales throughout the peak shopping period. Let's start with Halloween, with its sales of costumes, candy, cards and pumpkins. This year, the National Retail Federation predicts Halloween revenues will hit $7.4 billion, up from last year's $6.9 billion.

Decorations will drive much of that spending, up to $2 billion, the trade group says. A generation ago, Dad might carve a pumpkin into a jack-o'-lantern, and that was that. Today, front yards are filled with electronic bubbling cauldrons, animated jumping spiders and talking witches.

Another positive factor for retailers is that Oct. 31 falls on a Friday, which allows for more Halloween parties. And this is good news for party-throwers: Candy will cost, at most, just a few pennies more than last year.

"Halloween candy price inflation has slowed tremendously over the past couple of years, thanks to depressed raw sugar and refined sugar beet prices," IHS Global Insight U.S. economist Chris Christopher said in his analysis of the holiday.

Icing on your pumpkin cake: It will be cheaper to drive to those Halloween parties because gasoline prices have dropped dramatically in recent weeks to around $3 a gallon.

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Need one more reason for optimism? Congress is not in session. "Last year's federal government shutdown in the first half of October put a damper on consumer mood in the run-up to Halloween, and more importantly to the holiday retail sales season," Christopher said.

And that's what merchants are really looking for: signs that a good Halloween will lead to an even stronger holiday season. The retail group is predicting a robust increase in spending in the year's final two months.

The NRF's annual Consumer Spending Survey found the average person celebrating Christmas, Kwanzaa and/or Hanukkah will spend $804.42 this year, up nearly 5 percent over last year's actual $767.27.

"Overall, consumers feel better about where they stand compared to a year ago, and as such could find themselves stretching their dollars to give their loved ones a holiday season to remember," Prosper's principal analyst Pam Goodfellow said in a statement.

That prediction feels right to Antoine Kent, who was visiting New York City and shopping for a ninja costume for his godson. He believes the economy is strengthening enough to allow for more spending through the holidays.

"It seems like it's getting a little better each year," Kent said.

For the moment, he only needs to focus on Halloween because his 8-year-old godson was clear: "He said, 'Find me a ninja.' "

In case you are wondering: Yahoo says this year's most searched-for Halloween costumes include Teenage Mutant Ninja Turtles and Frozen princesses.

By Christmas, most shopping lists will shift to electronics. Analysts are predicting the hottest gifts will include iPhones, digital fitness products and video games.

NPR Business Desk intern Robert Szypko contributed to this report.

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The dustiest portion of my home library includes the 1980s books — about how Japan's economy would dominate the world.

And then there are the 1990s books — about how the Y2K computer glitch would end the modern era.

Go up one more shelf for the late 2000s books — about oil "peaking." The authors claimed global oil production was reaching a peak and would soon decline, causing economic chaos.

The titles include Peak Oil and the Second Great Depression, Peak Oil Survival and When Oil Peaked.

When those books were written, worldwide oil drillers were producing about 85 million barrels a day. Now they are pumping about 93 million barrels.

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Despite growing violence in the Middle East, oil supplies just keep rising.

At the same time, the growth rate for demand has been shrinking. This week, the International Energy Agency cut its forecast for oil-demand growth for this year and next. Turns out, oil demand growth — not production — is what appears to have peaked.

Now prices are plunging, down around 25 percent since June.

What did the forecasters get so wrong? In large measure, their mistake was in failing to appreciate the impact of a relatively new technology, hydraulic fracturing, or fracking.

Because of fracking, oil is being extracted from shale formations in Texas and North Dakota. Production has shot up so quickly in those areas that the United States is now the world's largest source of oil and natural gas liquids, overtaking Saudi Arabia and Russia.

This new competition has shocked OPEC. Members say they want to maintain their current market share, so they are keeping up production and even boosting it.

Bottom line: The peak of production is nowhere on the horizon.

So are the authors of "peaking" books now slapping themselves in the head and admitting they had it all wrong?

Some are, at least a bit.

Energy analyst Chris Nelder wrote a book in 2008 titled Profit from the Peak. The cover's inside flap said: "There is no doubt that oil production will peak, if it hasn't already, and that all other fossil fuels will peak soon after."

In a phone discussion about his prediction, Nelder said "my expectation has not materialized."

The surge in oil production in Texas and North Dakota "has really surprised everyone," he said. "If you had told me five years ago we'd be producing more oil today, I would have said, 'No way.' I did not believe at all that this would happen."

But while he acknowledges that oil has not peaked yet, he says it might soon because "oil is trapped on a narrow ledge" where it must stand on stable prices. Holding the price of a barrel steady around $110 for years allows energy companies to invest in fracking operations.

Over the past three years, those are exactly the conditions drillers have enjoyed. Oil was sitting pretty on a stable plateau of roughly $110 a barrel. But now, as global growth slows, the price is plunging, down to around $83 per barrel.

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"China is cooling off quite a bit. Much of Europe is slipping back towards recession," Nelder said. If oil prices stay low for long, frackers may need to stand down. "There is a lower level [in price] where they just can't make money," he said.

And with OPEC pumping so much oil now to hold down prices, maybe they are using up their supplies more quickly. "Depletion never sleeps," he said.

So perhaps Nelder has been wrong so far, but could be right before too long.

That's what Kenneth Worth thinks. He's the author of Peak Oil and the Second Great Depression, a 2010 book. He says the fracking boom has been so frenzied in this decade that drillers may have extracted the cheapest oil already. With fracking, oil supplies "deplete very rapidly. You have to keep drilling really fast," he said.

With prices now so low, the money to keep up the frenzy may not be there.

So maybe the "peaking" predictions weren't wrong, just premature. Then again, at some point, any forecast can turn out to be right, he says. "If you take enough of a timeline, eventually we're all dead," Worth noted.

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