President Barack Obama’s recess appointment of Dr. Donald Berwick to head the Centers for Medicare and Medicaid Services illustrates — from beginning to end — the utter dysfunction that plagues the U.S. government’s nomination and confirmation process.

Republicans are dead right to complain, as Sen. Orrin Hatch (Utah) did, that “Obama chose to circumvent the Senate and the American people” by the appointment of Berwick “to head one of the most powerful agencies in Washington.”

At the same time, White House Communications Director Dan Pfeiffer was also correct to say that “many Republicans in Congress have made it clear in recent weeks that they were going to stall the nomination as long as they could, solely to score political points. … There’s not time to waste with Washington game-playing.”

The CMS chief oversees one of the biggest agencies in the federal government, dispensing $800 billion a year in benefits and setting rules for the health coverage of 100 million elderly and low-income Americans.

CMS’ programs also present dire fiscal problems for the federal government and the states, and the agency is also responsible for implementing much of the 2010 health care reform law, including $500 billion in Medicare cuts and several pilot programs designed to hold down surging medical costs.

This crucial agency has been without a permanent, Senate-confirmed chief since the fall of 2006.

The dismal trail of dysfunction begins with Obama, who waited 15 months before nominating Berwick in April to head the agency. This post should have been one of the first sub-Cabinet jobs he filled.

Then, the Senate Finance Committee should have moved with dispatch to vet the nomination and schedule hearings.

It’s laughable that Finance Chairman Max Baucus (D-Mont.) pronounced himself “troubled” that “rather than going through the standard nomination process, Dr. Berwick was recess appointed.”

“Senate confirmation of presidential appointees is an essential process prescribed by the Constitution that serves as a check on executive power,” he said, and ensures “that crucial questions are asked of the nominee and answered.”

All true. Then why did Baucus not schedule hearings? By all accounts, Berwick is professionally well-qualified, as head of the Institute for Healthcare Improvement and a professor at Harvard Medical School.

His nomination has been endorsed by, among others, his two predecessors from George W. Bush’s administration.

Yet he has made statements that Republicans had every right to ask about, including endorsements of health care “rationing,” condemnation of free-market medicine and praise for Britain’s system of socialized medicine.

Berwick should have been questioned, but his nomination should not have been used as an opportunity to make endless election-year political points about the Obama health care plan — as, surely, Republicans intended.

Instead of just railing at each other about the Berwick appointment, both the White House and the Senate should use it as a cause for reforming the appointment process. What are the chances of that?