collaborative, robust system for evaluating the health care system that would incorporate existing department and external research, stimulate new studies as needed, synthesize findings, and provide actionable feedback for policy makers, purchasers, payers, providers, health care professionals, and the public (Recommendation 3).

• Strengthen the HHS and U.S. public health and health care workforces. The secretary should place a high priority on developing a strategy and tools for workforce improvement within (1) HHS, (2) the public health and health care professions nationwide, and (3) the biosciences (Recommendation 4).

• Improve accountability and decision making. A “new compact” between Congress and the department is essential as HHS works toward achieving its vision for a healthy nation, departmental mission, and key health goals. Under this compact, the secretary would provide Congress and the nation regular, rigorous reports about departmental activities and assume greater accountability for improving performance and obtaining results; in return, Congress should allow the department greater flexibility in its internal operations and decision making (Recommendation 5).

The last recommendation, which the committee believes would enable development of a more effective working relationship—a new compact—between Congress and HHS, is essential to the implementation of all of these recommendations. This new compact would require a rigorous decision-making process and strengthened accountability, so that Congress is well informed of the department’s goals and can measure its progress, while giving HHS the necessary flexibility and renewed management authority to fulfill its mission. Splintered congressional oversight and appropriations, increasingly prescriptive laws, and earmarked appropriations cause the department to be risk averse and slow to change. A new compact could enhance its ability to innovate and operate coordinated, productive programs that improve the quality of life for all Americans.