Why does the appointments clause matter? Because other than the president (and, sort of, the VP), there are no other elected officials in our largest branch of government. The ONLY granular control we have of the individuals running agencies and carrying out our laws and policies is through the senate confirmation (and impeachment) process. It can be something of a rubber stamp (when the president and senate are of the same party), but it's all we've got, and at least provides some transparency.