Politicians and commentators share a fondness for subjects which can be summed up in a slogan and lend themselves to tidy conclusions. The trouble with the health service, especially for politicians, is that it's all too easily understood - especially by those who have most need of it - but impossible to tidy up for popular consumption.
No one is too old, too young or too remote from everyday life to be unaware of the truth that health cuts hurt the old, the sick and the handicapped. It makes the undeniable connection between health and public funding: that's why Fianna Fβil once chose it as an election slogan.
Of course politicians of all shades also acknowledge the truism that you can't solve the problems of health, or any other service, simply by throwing money at them. Not that that was ever likely, even in the richest little country in Europe.
Still, the richest country with the poorest health service in the European Union was a shameful record that must somehow be erased. And until the other day friends, foes and commentators were convinced that this was the Government with the means and the incentive to do it.
The Fianna Fβil-Progressive Democrats coalition had spent 41/2 years living with the issue. It had been told time and again what was wrong with the service - not only by political opponents like Liz McManus, Gay Mitchell and John Gormley, but by nurses, doctors and civil servants.
So it knew what was wrong and what might be done to change it. The remedy it chose was the most cautious on offer, its presentation by Micheβl Martin the glossiest that could be devised by numerous advisers and public relations consultants, not to mention the political skills of some of the wiliest in the business.
Then, in an act of deliberate meanness it postponed until 2003 the extension of the medical card scheme to 200,000 people cruelly trapped above the present income limit of around £5,000 (€6,348) a year.
Suddenly it was clear that what the Coalition was trying to do was not to reform the health service - certainly not to attempt anything radical - but to win the next general election. After all, not only the estimable Jack Jones of MRBI (whose book In Your Opinion has just been published) but every researcher in the field had identified health as the outstanding issue for the electorate. The issue to be tackled if the election was to be won.
Health, however, does not stand alone: it's inextricably bound to other issues, not least the yawning gaps between rich and poor.
You don't need a procession of researchers to tell you that the poor live shorter and less comfortable lives than the rest of the population. You don't need to be reminded by the Economic and Social Research Institute, the Combat Poverty Agency, the Conference of Religious in Ireland and the St Vincent de Paul Society that the poor suffer most from inadequate education, housing and public transport.
(On housing alone, there were messages this week from Sister Stanislaus Kennedy of Focus - calling on 40,000 people to sign cards representing the shortfall in local authority and voluntary housing - and from a group of artists and activists in Bray with their exhibition, no fixed abode.) As Ray Dooley of the Children's Rights Alliance said: "Study after study has shown the link between poverty and health." The doctors know. The nurses know. The officials of the Department of Health who famously met ministers at Ballymascanlon seemed to know. How the hell could members of the Government not know?
How many shared the rage of James O'Reilly of the Irish Medical Organisation when he heard that the Government was either unaware of the link between health and poverty or coldly ignoring it? I remembered how, many years ago, I listened to a poor man tell his wife to sell the last of their cattle to pay for his stay in a nursing home and the injury that cost him the sight of one eye. When the time came, they left Ennis on the West Clare train and, from Miltown Malbay, sick as he was, trudged the last few miles home.
They told us then that we couldn't afford a decent service. And now? Reading the report of the task force set up as a result of Jamie Sinnott's case, I am reminded of the official response to the report on equal citizenship (and disability) published in December 1999.
It said: "The Department of Finance cannot accept these recommendations which imply the underpinning by law of access to and provision of services for people with disability as a right.
"This right, if given a statutory basis, would be prohibitively expensive for the Exchequer and could lead to requests from other persons seeking access to health and other services without regard to the eventual cost of providing these services."
To hell with your rights. The Exchequer comes first.
dwalsh@irish-times.ie