Former Federal Official Examines U.S. Reform Law

Three new entities created by the Affordable Care Act (ACA)-the Patient-Centered Outcomes Research Institute, the Center for Medicare and Medicaid Innovation and the Independent Payment Advisory Board (IPAB)-offer “a powerful constellation in theory,” according to Peter Orszag, Vice Chair of Global Banking at Citigroup and former Director of the White House’s Office of Management and Budget. Writing in the July/August issue of Foreign Affairs, Orszag argues that the IPAB is the most promising of the new institutions created by the reform law-the IPAB has the power to force reductions in Medicare spending when projected growth exceeds a specified target. The only way to prevent such reductions will be for Congress to pass special legislation to block an IPAB action. Orszag argues that the “biggest substantive shortcoming” in the ACA is in the area of tort reform. He proposes safe harbors from malpractice litigation for physicians who follow evidence-based practice guidelines. For a copy of “How Health Care Can Save or Sink America,” visit