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HL20: Peter Orszag— Developing Social Norms

Philip Betbeze, for HealthLeaders Media, December 13, 2011

In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is the story of Peter Orszag.

This profile was published in the December, 2011 issue of HealthLeaders magazine.

 "In these high-cost cases, the healthcare delivered is what the doctor recommends. Therefore, you won't move toward value unless you're affecting what those doctors recommend."

Peter Orszag is part of the executive team at one of the world's largest banks now, far removed from his time as director of the Congressional Budget Office and White House Budget director. But his thoughts are never too far away from healthcare. In fact, his Bloomberg View column often explores healthcare topics, and he recently was appointed to the board of The Mount Sinai Medical Center in New York.

Orszag, you might remember, was one of the chief proponents of the individual mandate being included in the legislation that became the Patient Protection and Affordable Care Act of 2010. Whether you love or hate the law, Orszag's contention that the individual mandate is the linchpin of the success or failure of the legislation has gained traction on both sides of the political aisle.

The legal ground shifts regularly under the mandate as appeals court after appeals court determines questions of its constitutionality (and reaches diametrically opposed decisions). The press breathlessly awaits and reports each decision as we now wait for the Supreme Court to decide.

Behind the scenes, Orszag and a team of advisers quietly influenced the law, especially in areas where they thought behavioral economics could play a key role. In fact, his team included Cass R. Sunstein, administrator of the White House Office of Information and Regulatory Affairs and a co-author of Nudge: Improving Decisions about Health, Wealth, and Happiness. The underpinning of that book, and much of the law, is essentially that people can be gently "nudged" into making beneficial choices for themselves and society based on the ways the choices are presented to them.

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