Welcome, Mary Harney, to the vilest job in the world. It's worse than being a New York cop directing traffic in Falluja or a Jesuit missionary in Sadr City, or a rabbi in Mecca. Indeed, there are many jobs across the Middle East which you might happily apply for once you have passed through the seventh circle of hell that is the Department of Health.
The Taoiseach had it in his power to show his mettle on the issue of health, when the Hanly report recommended the closure of Nenagh Accident and Emergency unit. Since Hanly was party policy, Bertram instructed Fianna Fáil members to accept its recommendations. The local Fianna Fáil stalwart Marie Hoctor, TD bit her trembling lip and, loyal and true, did so. Michael Smith, Minister of Defence, paused for a moment and dissented. Why was he doing this? Why, minding his seat, the snake.
That was the moment when Bertram should have called the Minister in, taken the car-keys away and told ex-Minister Smith to walk back to Nenagh in sackcloth and ashes. He didn't, of course, which only goes to show that our political culture instinctively regards the creature comically known as our "health service" primarily as a political football. For health is a vote-catcher, and within the institutional idiocy of the multi-seat constituency, it is one over which one TD will happily slip the scalpel into the ribs of a party colleague, and without anaesthetic.
Mary Harney will certainly be told by the opposition and the media to spend vastly more on the health service, to improve its quality, to employ more people at every level, and then to multiply it all by the number she first thought of. Wrong advice.
She shouldn't expand the health service. She shouldn't even reduce it. She should simply close it down, put herself out of a job, and apply to the government in Baghdad for a job as a teacher of Christian hymns to deserving Mujahadeen in Kut al Mara.
"Onward Christian Soldiers" will be a doddle after what lies ahead over the next two years.
Like the Army, most hospitals run themselves. Yet, like the Army, they are administered by a vast civil service, which in the case of the Department of Health, exceeds the medical personnel being administered. Like soldiers, doctors and nurses are among the most dedicated and selfless people in Irish life, yet for all their heroic efforts, wards remain closed while patients sleep on outdoor window-sills, where they are kept in place with a few bits of sticking plaster and a tent-peg.
This isn't because money isn't being spent on health. Charlie McCreevy disbelievingly watched gold vanish from Finance's coffers like children exiting from Hamelin, and like the children, without any subsequent trace. Wards and clinics remained empty, while doctors operated with Swiss army knives and performed open-heart surgery with can-openers. Now Charlie lies on his Brussels bed, staring at the ceiling, wondering - Jesus: Where did it all go? For we could have desalinated the Mediterranean with the money that was poured into Health; and we could irrigate the African dust-belt with the money that we're going to spend on it again if the usual babble of pious populism has its way.
At bottom, there is one basic lesson. It is impossible for a modern state to provide the health-care which its citizens expect. Health-care is an addiction, which, like compulsive gambling, cannot be satisfied. There is no limit to the money that electorates want spent on health - though of course, there is a limit to the amount of tax they are prepared to pay to get it, or which is economically feasible.
Germany and France have run smack into the unyielding wall of ruin raised by high health expectations. They each have a health-care service which will, at the merest hint of a pre-sneeze intake of breath, have a thermometer sticking out of your every orifice, while a state-subsidised pharmacopoeia will hose you down with both orthodox and alternative medicines. The result? Both countries have almost zero economic growth - Germany actually has minus growth - and 250,000 French people now work in London.
The days of the terrifying Irish mother-superior hospital matron - who breakfasted on the heads of young housemen, which she idly snapped off and ate as she passed through the wards - are over. Nonetheless, the old religious hospitals were largely free from state intervention, and they worked. To be sure, women who sought sterilisation were choked at dawn with rosary beads, and men who asked for vasectomies were (very properly) thrown off the Cliffs of Moher - but generally speaking, the independent hospitals functioned at a higher level of competence and efficiency than was evident almost anywhere else in Irish life.
They can be made work again. Like the European Bank, the Fed or the Bank of England, they should be made immune to political interference and beyond the grasp of the civil service. The only way to guarantee that is to return our hospitals to the private sector (in which some - such as Clane - are already operating very successfully) to be supervised by some autonomous regulatory authority.
Yes, yes, yes, my Tánaiste, some people will with unanalytical sanctimony talk about your resorting to "right-wing" or "Thatcherite" methods. Does it matter what the solutions - or you - are called if they work? Ideological purists prefer death and ideological perfection to better health care. Ignore them. Do yourself out of a job, Mary. See you in Baghdad.