It goes deeper than the pixel. In fact, I could care less about visual design. I think that's an over-emphasized aspect of design.
It goes to philosophy. Anyone can make pretty things, but it takes a damn intransigent defiance to do whatever it takes to make great experiences.
I mean experience design. And experience design isn't about making everyone happy. It's about firing people when they get in your way, and breaking down fiefdoms that make products crap.
A thousand people all compromising will result in a product or service that dies the death of a thousand paper cuts. This is starting to sound Ayn Randian, but sadly this may be an important aspect to the creation of great things.
There's a reason why it takes a single auteur to craft a masterpiece, whether a movie, a website, or the experience of flying. Too many cooks DO spoil the broth. And it takes a person with the authority to cut things to one's vision to make great consumer experiences a reality.
What people call Dustin's hubris and arrogance is merely his gall to point out the things that someone in control should do. It's something that is not exercised enough, and I think rather than cut down someone who aspires to the best, perhaps we should look to see what really sucks in our lives and focus on ways to make it better.