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Peter Orszag, Director of the Office of Management and Budget, speaks with Edward Luce, the FT's Washington bureau chief. He says the creation of a new Medicare Commission will have as big an impact on the US healthcare sector as the creation of the US Federal Reserve almost a century ago had on US monetary policy. He also discusses whether it would be at all possible, given the mood of the Republican Party right now, for Mr Obama's administration to create a bipartisan effort to tackle America's looming debt crisis.