Remember how Obamacare was going to "Bend the cost curve" for health care spending? That was OMB director Peter Orszag, back when Obamacare was being debated. There were a number of theories about how it would accomplish this. There were electronic medical records, which would cut down paperwork and medical errors. And ACOs, which would finally bring America to the promised land of "bundled payments", which was supposed to radically change treatment incentives. Medicare pilot projects were going to open up new, more efficient ways to do things. If all those failed, the legislation contained an Independent Payment Advisory Board which will recommend a panel of automatic cuts unless health care cost inflation stays below a fairly low target level.