White House budget director Peter Orszag pushed back against the notion that the healthcare overhaul will add to the deficit. Orszag said that the healthcare overhaul needs four main pillars that will put the system on a more sustainable path: (1) deficit neutrality, (2) an excise tax on high-cost insurance plans, (3) an independent Medicare commission, and (4) delivery system reforms. The budget chief said that the four main issues will underpin a better system, but "execution is crucially important to success," the Wall Street Journal reports.