Everything about the U.S. health care system is big and, as Commonwealth Fund President David Blumenthal, M.D., reminds us in his latest blog post, reforming it is a really big job. With this in mind, he considers recent signs of progress: the estimated 20 million who have gained insurance under the law, a leveling off in the pace of health care spending, and a 1.5 percent drop in the rate of hospital readmissions.