The Center for Medicare & Medicaid Services is the federal government's largest agency. It runs on a budget of nearly 1 trillion taxpayer dollars and oversees the two programs largely considered to pose the greatest long-term threat to the federal budget. But for nearly a decade now, this hulking agency has been without a confirmed director. Last week, Tom Scully, who ran Medicare under President George W. Bush, decided it was time to break a seven-year streak with no confirmed Medicare head. He joined up with six other former Medicare heads—three Republicans, three Democrats—to plead with top senators to confirm the White House's newest nominee, Marilyn Tavenner.