The Irish health system is the product of decades of conflict between church, State and the medical profession. The defeat of Dr Noel Browne's mother-and-child scheme in 1951 was no isolated incident. Church and doctors blocked reform over and over again.
Health systems in other countries tend to be financed in one of three ways: by the state from general taxation, as in Britain; by the state from compulsory social insurance, as in much of continental Europe; or by private finance based on voluntary insurance, as in the United States.
In Ireland powerful opposition prevented the State from achieving either of the first two systems. Today's Irish health system is the hybrid consequence combining British and American elements in a unique mixture.
In the 1951 mother-and-child scheme controversy, Dr Browne provoked the opposition of the Catholic Church and the medical profession to a scheme to provide free GP care for children and free ante-natal and post-natal care for mothers of infants up to six weeks after birth. He lost.
Today, some 50 years later, Ireland remains highly unusual in charging for GP care for the majority of children .
The Archbishop of Dublin, Dr John Charles McQuaid, objected to the scheme on the grounds that it conflicted with Catholic social teaching; interfered between parents, children and doctors; and the consequent burden of taxation would compel parents to avail of it.
The Catholic bishops said the State was not entitled to relieve the "10 per cent of necessitous or negligent parents" by infringeing the rights of the other 90 per cent of parents to provide for the health of their children. The poorest third of the population was already receiving free care from dispensary doctors.
The Irish Medical Association objected that it would lead to a full-time State medical service in which doctors would become civil servants.
The Taoiseach, Mr John A. Costello, famously told Dr Browne that "whatever about fighting the doctors, I am not going to fight the bishops, and whatever about fighting the bishops, I am not going to fight the doctors and the bishops".
But this battle had started long before Dr Browne became a minister.
1911
Before Irish independence the Catholic Church and the medical profession opposed Lloyd George's introduction of a health system funded by social insurance. The bishops said it would be an undue burden on farmers and small Irish businesses. Doctors were opposed because it would reduce private practice. Social insurance-based medical benefit, the standard system in continental Europe and in Britain until the 1940s, was not introduced in Ireland.
1940s
In the 1940s, influenced by the Beveridge Report which laid the foundation for Britain's National Health Service (NHS), Fianna Fail governments and the Department of Health began to aspire to the goal of a free national health service. GPs would be district medical officers, specialists would be employed by hospitals, and private fees would be eliminated.
The 1947 Health Act containing the same proposals as the mother-and-child scheme met a storm of opposition from the medical profession and the hierarchy, who argued against allowing health authorities to educate women about motherhood and children about health.
In Health, Medicine and Politics in Ireland 1900-1970, Dr Ruth Barrington wrote that with the mobilising of opposition to the Act "the conditions for a powerful alliance between the [medical] profession and the church against radical changes in the health services had been fulfilled".
1950s
The government led by Mr Eamon de Valera lost the 1948 general election and a five-party coalition appointed Dr Noel Browne as Minister for Health. After the defeat of the mother-and-child scheme - as outlined above - health issues dominated the 1951 general election and Fianna Fail was returned to power, having promised to implement the 1947 Act.
The 1953 Health Bill also proposed a major extension of entitlements to hospital services - the biggest threat yet to the private income of hospital consultants. It provoked strong opposition from the medical profession and the Catholic Church.
The IMA argued for a voluntary health insurance scheme - the germ of the private health insurance industry which we have today.
The hierarchy said the Bill infringed the rights of fathers to provide for the health of their families. Extending free hospital services would "seriously weaken the moral fibre of the people".
The eventual Health Act of 1953 achieved the kernel of the mother-and-child scheme - the provision of free ante-natal care for women. However, it left GP services unchanged, free medical care for children was limited to infants up to six weeks, and treatment in health clinics up to six years. Free hospital services would only be available to people on lower and middle incomes. Consultants had protected their private fee income.
A bruised and battered Fianna Fail gradually abandoned its radical ambition of a free health service for all. In 1957 the VHI was established.
1960s
By 1966 Mr Sean Flanagan as Minister for Health saw no reason why it was the duty of the State to provide health services for all the people any more than it had a duty to organise free transport or free bread for all.
1970s
The GMS gave medical cards to a third of the population. Mr Charles Haughey, as Minister for Health, began discussions which led to the first common contract in 1981, giving consultants in public hospitals an unlimited right to private practice.
1980s
The public health system came under multiple assault. Health cutbacks closed public wards. Heavily subsidised by the State and funded by private health insurance - the medical profession's preferred system - a booming private sector gradually emerged. The Blackrock Clinic and the Mater Private Hospital opened in Dublin in the early 1980s, the first purely profit-driven hospitals in the Irish system.
1990s
In 1991, free hospital care was extended to the entire population subject to overnight charges, but resource-starved public services continued to drive patients into private insurance. In 1994 the Health Insurance Act opened the Irish health insurance market to competition.