On the same token, the state of chaos also provides an extraordinary opportunity to fix things, Daschle said. He would like to see the NQF become “the gold standard” of measures. Along with that, a dose of tough love and accepting that “you can’t please everyone all the time,” America could make some real headway, he said. “We might not be able to tame the Wild West, but we could bring some urgently needed law and order."

The two leaders agreed on the big gear theory and the need for taming chaotic measurements, but true to their political outlooks, they also diverged. Daschle was very optimistic about the infrastructure laid down by the Affordable Care Act, with its emphasis on well care.

Leavitt said America shouldn’t be so quick to attribute ACA with changes to the U.S. healthcare system. Improvement is being brought about more by the will of the consumer. The free market is driving change in healthcare.

America’s healthcare crisis is an economic crisis, Leavitt said. And he feels optimistic that that crisis will drive citizens to come up with a uniquely American solution to healthcare. “The economic pressure is driving people to do the hard things,” he said.

[See also: Health IT experts brainstorm with ONC on clinical quality measures.]

As far as ACA goes, “you can implement just about any system in time,” Leavitt said. “We’ve been going through a complicated, labored implementation. But you have to ask the question now, `is it working, and how can we make it better where it’s not working?’”

This will move the U.S. to an entirely different level of reform discussions, Leavitt said. That discussion will focus on refinement, rather than repeal and replace of ACA. 

To borrow from Leavitt’s analogy, Daschle said the ACA is starting to turn the three big gears of insurance, payment, and care delivery reform. The launch of ACA has begun to bring insurance reform. Payment reform, still to come, will center on bundled payments, while care delivery will focus more on wellness care than it ever has before.

[See also: Big data to assess CMS quality measures.]