Over at Something not unlike research, Bill Gardner posts a nice piece, poignantly titled Donald Berwick and the lives not saved. Bill notes that Berwick, less encumbered, would have saved many more lives by methodically applying the IHI vision of quality improvement across the American healthcare system.
Bill links to a nice piece I hadn’t seen by conservative health policy expert Tevi Troy. Fixing the Confirmation Process appeared earlier this year in National Affairs. It merits a careful read. Troy was fortunate enough to win Senate confirmation, but he was close enough to the process to appreciate its dangers and its absurdities.
He offers three “modest proposals” to improve the situation:
First, Congress should significantly reduce the number of executive positions that require Senate confirmation…
Troy points out that “The idea of such a reduction has come up in the Senate several times in recent years,” but wait for it: “Committee turf wars have always interfered.”
Second, the Senate needs to reform its own rules:
Lawmakers should, for instance, commit to having the relevant Senate committee hold a confirmation hearing for each presidential nominee within two months of his nomination. And to enforce this rule, the Senate should create a new Committee on Confirmations. This new body would be structured like the Ethics Committee, which has equal bipartisan representation and comes together to act only as events warrant. It would be convened only if a nominee were held up for longer than two months… In that event, the new confirmations committee would review the nominee in question and determine if any obvious disqualifying factors should prevent his confirmation…
The full Senate, moreover, should commit to holding an up-or-down vote within one month of a positive committee vote… In addition, the Senate should prohibit the placement of anonymous holds on executive-branch appointees. Ending this practice would recognize the need for lawmakers to show at least some modest deference to the president in his personnel choices, and also the need for senators to offer clear, public arguments for rejecting nominees…
Third, “the White House should dramatically streamline nominee paperwork requirements and allow vetting to be carried out more transparently and efficiently.” This is a huge deterrent to many people.
Troy goes on to argue that “improvement of the confirmation process would require major attitude adjustments on Capitol Hill and in the White House.” I don’t actually agree. Individual and collective responsibility almost entirely resides within the United States Senate, whose members have damaged American government by turning the confirmation process into such a sclerotic mess. And although Republicans are severe current malefactors here, the problem is ultimately structural rather than ideological.
If the Senate doesn’t fix this process, I hope the next administration—Democrat or Republican—is less deferential than the Obama administration has been. A few hundred recess appointments might be a decent place to start.
