, ▁not ▁a ▁health ▁policy . ▁And ▁his ▁reasoning ▁explains ▁why , ▁year ▁in ▁year ▁out , ▁Congress ▁has ▁rejected ▁econom ically ▁sensible ▁propos als ▁to ▁att ain ▁greater ▁efficiency ▁in ▁the ▁Medic are ▁program ." ▁Rein hardt ▁comp ares ▁the ▁IP AB ▁to ▁a ▁similar ▁board ▁in ▁Germany , ▁which ▁he ▁says ▁is ▁efficient , ▁effective ▁and ▁civil ized . ▁ ▁Form er ▁C BO ▁direct ors ▁Peter ▁Or sz ag , ▁who ▁directed ▁the ▁C BO ▁and ▁O MB ▁in ▁the ▁Ob ama ▁administration , ▁said ▁the ▁IP AB ▁may ▁have ▁been ▁the ▁most ▁important ▁aspect ▁of ▁the ▁Aff ord able ▁Care ▁Act . ▁He ▁said ▁the ▁board ▁was ▁" created ▁to ▁help ▁address ▁our ▁long - term ▁fis cal ▁im bal ance ▁while ▁boost ing ▁quality ▁in ▁health ▁care ". ▁" It ' s ▁a ▁very ▁prom ising ▁structure ," ▁said ▁Or sz ag , ▁but ▁he ▁ca ution ed ▁that ▁" wh ether ▁it ▁real izes ▁its ▁potential ▁depends ▁on ▁how ▁it ' s ▁implemented ." ▁ ▁Douglas ▁Hol tz - E ak in , ▁a ▁former ▁C BO ▁director ▁and ▁an ▁econom ist ▁who ▁is ▁currently ▁president ▁of ▁a ▁conserv ative ▁political ▁organization , ▁thought ▁that ▁despite ▁" require ments ▁that ▁would ▁force ▁Congress ▁to ▁adopt ▁the ▁recommend ations ▁or ▁find ▁compar able ▁sav ings ," ▁" cut s ▁will ▁be ▁polit ically ▁in fe as ible , ▁as ▁Congress ▁is ▁likely ▁to ▁continue ▁regularly ▁to ▁override ▁scheduled ▁redu ctions ." ▁In ▁the ▁words ▁of ▁Susan ▁D ent