Today’s Washington Post reports that the Obama administration has confirmed zero percent of its 20 PAS (presidentially appointed, Senate confirmed) positions at HHS — the lowest percentage of any Cabinet agency. For a team so concerned about health care, this is an inauspicious beginning.

Should Congress manage to pass some kind of comprehensive health-care reform this year, the late-starting team will have trouble implementing and selling the changes. Implementing Medicare Part D, for example, took a full-time effort from Secretary Leavitt and his team, and the program could have gone off the rails at a few crucial moments without those efforts. Implementing a comprehensive health care overhaul would require even more heavy lifting, and the agency is already stressed by the new administration’s initiatives with respect to food safety, electronic health records, and comparative effectiveness. The lack of political leadership at HHS is not going to make this any easier.

— Tevi Troy is the former deputy secretary of health and human services, and author of Intellectuals and the American Presidency.