Dr. Orszag reveals in his critique of PCORI the very conceit the Institute was designed to avoid – a research agenda designed by “the experts” to cut costs, instead of an agenda shaped by patients and doctors to improve care. Rather than pursue a research agenda as defined by an insular group of experts in Washington, PCORI was set up to engage patients, caregivers and the publicly directly, and give them a real voice in decision-making, in order to ensure that the Institute was studying the questions that matter most.