President Obama’s controversial recess appointment of Donald Berwick to head the Centers for Medicare and Medicaid Services marked the 18th recess appointment he’s made since taking office—more than President George W. Bush at this point in his presidency.

There’s a big distinction, however. Obama had 60 senators caucusing with Democrats for nearly seven months of his White House tenure. He’s had 58 or 59 at other times.

Contrast that with Bush, who took office in 2001 with the Senate split 50-50 and Vice President Dick Cheney casting the tie-breaking vote. That lasted less than six months. When former Sen. Jim Jeffords of Vermont stopped caucusing with Republicans, Democrats took control of the Senate. Bush made 15 recess appointments through July 7, 2002.

Obama, who once called recess appointees “damaged goods,” hasn’t shied away from using his presidential power to fill vacancies for important federal posts. And despite large Democratic majorities in the Senate, he’s blamed Republicans for holding up confirmation of his nominees.

“The United States Senate has the responsibility to approve or disapprove of my nominees,” Obama said on March 27 when announcing 15 recess appointments. “But if, in the interest of scoring political points, Republicans in the Senate refuse to exercise that responsibility, I must act in the interest of the American people and exercise my authority to fill these positions on an interim basis.”

Obama wasn’t as pointed in his criticism of the GOP when he announced three new recess appointments Wednesday. In fact, he blamed the Senate as a whole, without citing Republicans.

That could be because Democrats were at fault for delaying Berwick’s confirmation. In fact, Senate Finance Chairman Max Baucus (D.-Mont.) never scheduled a hearing for Berwick despite a request from Sen. Charles Grassley (R.-Iowa), the committee’s ranking Republican.

Republicans wanted to question Berwick about his controversial statements on rationing healthcare. Those statements made him a lightening rod from the moment Obama nominated him. That’s also what prompted a litany of Republican complaints about the man who will oversee the Medicare and Medicaid programs, controlling a budget that exceeds $1 trillion.

Berwick’s job is even more significant following passage of Obamacare—a point the administration acknowledged last week in its defense of its latest recess appointment.

“We have—whether everyone likes it or not, we’ve passed a very important Affordable Care Act, many things of which have to be implemented by the beginning of next year,” White House spokesman Robert Gibbs said. “Whether it’s Medicare and Medicaid innovation, whether it’s increased investment in health IT technology to ensure greater cost savings and greater quality of care, so we need somebody on the job now.”

Even congressional Democrats were unwilling to concede that point to Obama. Baucus blasted the White House for making the recess appointment without congressional approval.

"Senate confirmation of presidential appointees is an essential process prescribed by the Constitution that serves as a check on executive power and protects Montanans and all Americans by ensuring that crucial questions are asked of the nominee—and answered," Baucus said.

The White House doesn’t seem sympathetic. With 189 nominees still pending before the Senate—including 49 who have been waiting more than six months—Obama’s former Democratic colleagues can’t escape blame. They do, after all, run the place.

Without a major breakthrough before the August recess, Obama could continue his trend of recess appointments, especially if electoral trends indicate diminished Democratic ranks next year. Bush made a total of 20 recess appointments in his first two years; Obama is already on pace to exceed that.

“The president is going to install people that need to be installed for this government to run effective [sic] and efficiently,” Gibbs said in defense of Obama’s decision. “In this case, because the appointments process is clearly broken, he did so through a recess appointment.”

Mr. Bluey, a contributing editor to Human Events, is director of the Center for Media & Public Policy at The Heritage Foundation.