Here is something to know: just as Congress is about to pass legislation to restructure the Medicare program, the person who will arguably be the most important effectuator of that policy -- the head of the Centers for Medicare and Medicaid Services at the Department of Health and Human Services -- has not been confirmed by Congress. That's because he or she has not been nominated by the administration. (Norm Ornstein pointed this out to me.)
There are many reasons for this, but one of them is, I think, a serious administrative challenge that the Obama administration has yet to master: getting the government to work -- to getting departments to work together, to getting nominees nominated and confirmed, to prioritizing. Implementing health care reform without a CMS director is like leaving your broken car at a mechanic-less garage.
One reason why Gregory Craig fell into disfavor at the White House was his shop's inability to master the nomination and confirmation process. It is hoped that Robert Bauer, with a better feel for the broad politics of administering government, will facilitate the confirmation process.
Surely, an obstruction-obsessed GOP deserves a share of the blame, but the White House hasn't seemed to fight for its nominees. And when it has, its leverage has been lacking. No one's afraid of a White House that doesn't knock heads together. (The chief of staff might curse, but his bark is worse than his bite. That is Obama's way.) Ornstein advises the administration to appoint a deputy chief of staff whose job it is, essentially, to run the government -- someone akin to the head of Britain's civil service -- someone who can identify problems in advance and make sure that policy goals are advanced expeditiously. Figuring this out will be most critical as Obama advances two pieces of domestic policy later in the year: immigration reform and an education overhaul. Immigration reform will require a half a dozen departments to work closely together. Education reform will be killed in the cradle unless the administration works -- ahead of time -- to incorporate state and local bureaucracies.
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