> Playing devil's advocate here: what's bigger than an overhaul of an entire nation's healthcare system?

High-level leadership positions in offices whose scope is the entire executive branch not just the healthcare piece: his position for the entirety of the Obama Administration has been Chief Performance Officer and Deputy Director for Management of the Office of Management and Budget (and about a year and a quarter of that he spent as Acting Director of OMB, as well).

Or, being responsible for leadership on the entirety of the nations economic policy -- he's scheduled to move into a position as Director of the National Economic Council on Jan. 1, 2014.