My AEI colleague Scott Gottlieb’s new book about the COVID-19 pandemic, Uncontrolled Spread, is out this week, and I would recommend it to you very highly. The book is full of insights and lessons from the pandemic response, and argues for some important changes to our public-health system to help the United States be better prepared for future outbreaks.
But one theme that really stood out to me in the book has to do with a more fundamental question of governance, and of the relation between professional expertise and political leadership at the federal level.
Gottlieb points to some extremely serious failures and lapses on the part of the Centers for Disease Control and Prevention — the federal government’s lead public-health agency. Anyone who has worked with the CDC for any length of time could tell you stories of shocking incompetence. I certainly have some myself. And some of the particular failures of the agency in dealing with COVID-19 were prefigured by prior failures — around testing, for instance, and around data collection and other key issues.
But in searching for explanations for the CDC’s failures, some observers and journalists incline carelessly to blame political interference in the agency’s work, and to imagine that the CDC might be more effective if it were more independent. Michael Lewis points this way in his own recent book about the pandemic — which I found to be an engaging and fast-paced but ultimately wrongheaded book.
Gottlieb, who has a lot of experience with the federal public-health agencies going back two decades, comes to an entirely different conclusion. Federal agencies, Gottlieb writes, “have politically appointed leadership that are subject to Senate confirmation for a reason. The role of a politically appointed chief is to help align an agency with the objectives of Congress and the executive branch, and to be accountable to both. However, there’s a mutual concession in this arrangement. A politically appointed agency head has a twin obligation to educate political leaders about an agency’s prerogatives and to maintain the delicate line between an agency’s core mission and the political goals of elected officials.”
In other words, political appointees in federal agencies aren’t just compliance czars for the president, nor are they, in Alexander Hamilton’s memorable phrase, “obsequious instruments of his pleasure.” They do keep the agency connected to the priorities of the country’s elected leaders, but they also keep those leaders connected to the priorities of the agency. And a big part of the CDC’s weakness for decades now has been the absence of political appointees who might help keep it both grounded and connected.
The CDC rarely has more than three or four political appointees, while its career staff consists of roughly 20,000 people. None of its appointees, not even its director, is confirmed by the Senate, unlike the leaders of all the other HHS sub-agencies. There is no obvious reason for this. The agency is also based in Atlanta, and so is routinely left out of policymaking discussions in which its leaders should have a role. Even in the age of videoconferencing there is no substitute for being in the room. And the net effect of all this is not independence but weakness, and ultimately also incompetence. The CDC lacks people internally who will hold it to account, and who will speak up for it in intra-administration debates. The absence of political appointees renders it insular, defensive, and disconnected.
The past two years should lead to a wholesale transformation of the CDC, and Gottlieb offers a lot of ideas about what that should involve. But among other things, such a process should aim for the greater integration of the CDC into the structure of our system of government, not its greater isolation.
Political distortion of the technical work of administrative agencies is real, and can be a serious problem. But the usual clichéd story of bureaucratic independence and political interference — a story particularly in fashion when Republicans are president of course, but which persists even in Democratic administrations — gets the character of that problem wrong, and often miscasts the basic function of political appointees in government agencies.