One in four voters puts health top of the list of issues on which the next election should be fought. The electorate wants to know why our wealth has failed to deliver high-quality healthcare accessible to all.
Low health spending, doctors' resistance to change and politicians' refusal to rationalise small rural hospitals all contribute to that failure. But even if rises in health spending took precedence over tax cuts, the hospital consultants' contract was changed and the hospital network was reorganised, fundamental questions would remain about how we structure our health system.
It would remain a two-tier system, in which "the public caste perceives its care as largesse, while the private caste perceives its care as service," as Dr Sean Conroy, a regional manager with the Western Health Board, puts it.
It would remain a system with nominally free hospital services, but where fear of public hospital waiting lists has driven 45 per cent of the population into private healthcare. It would still be a system which charges 70 per cent of the population for GP visits.
This is not how it has to be. In many developed countries free and equitable access to health care is taken for granted. Waiting lists may exist, but queue-jumping is not institutionalised as it is in Ireland.
Countries fund comprehensive healthcare either from general taxation, as in Britain, or by social insurance, as in many continental European countries. If this second model was applied to Ireland, our PRSI system, with contributions from employers and employees, could fund health care.
Today 75 per cent of the £4,000 million which funds the health services comes from the Exchequer, chiefly from general taxation. The remainder comes from private insurance and private payments. Relatively poor households contribute significantly to health spending in their payments to GPs and purchase of medicines. Private health insurance contributes only £350 million, less than 9 per cent of all health spending. Yet it totally distorts access to services.
Since private health insurance contributes so little, and general taxation so much, to Ireland's health spending, why do we permit private insurance to distort the health services by allowing the 45 per cent of the population who have it to enjoy preferential access? Why not fund the entire health service from general taxation and offer it free to all?
"It is a myth that the only, or the main, reason for the existence of the public-private mix in healthcare is the unaffordability of universally free, taxation-based access," according to Dr Conroy.
However, Ireland has now gone so far down the path to private medicine that not even the Labour Party is proposing a British NHS-style system. Its proposals for reform of the health service, published last April, were a variant of continental-style universal health insurance.
Ms Liz McManus, Labour's health spokeswoman, explains: "With up to 45 per cent of the population now covered by private insurance, they would appear to like what they get. It does create a different relationship between the patient and the health services."
So Labour has proposed extending insurance to cover everyone, with the State paying premiums for those who cannot afford them. Labour takes a market approach with both not-for-profit and private insurance companies competing for patients; hospitals, including private hospitals, competing to supply services; and, crucially, all hospitals and consultants in this State-supported "universal hospital system" treating all patients equally no matter who is paying their premiums.
Doctors and patients who would opt instead to go for a "super-private" system would not be permitted to work in the State system, and would not receive State subventions. In effect, private practice would be removed from public hospitals.
Current VHI subscribers might question what they would get for their money if they could no longer jump queues. Labour proposes investment and reform to ensure that waiting lists cease to be a problem. Labour also proposes a free GP service.
The Commission on Health Funding in 1989 proposed another route to equitable access, the introduction of common waiting lists for public and private patients in public hospitals. This would remove the chief incentive to take out private insurance, which would also cost more because of abolition of tax relief for VHI premiums and the proposal to charge insurance companies the full cost of private beds in public hospitals.
Prof Brian Nolan of the ESRI forecasts that implementing these proposals would bring about a situation similar to the UK, where 12 per cent of the population now have private health insurance and its main attraction is access to private hospitals.
Bringing more people back into a better-funded and better-run public health system could revolutionise it, generating the kind of loyalty which the British traditionally had to the NHS.
If a government was elected here with a mandate to bring equitable healthcare to Ireland, it would therefore have two local models to consider - the Labour Party's, or the one advanced by the Commission on Health Funding. It could also consider a wholly taxation-funded system.
Surprisingly, the commission did not recommend that GP visits should be free, arguing: "It is desirable for people to take some responsibility for their own health."
One commission member dissented, the trade unionist, Mr Phil Flynn, who said: "Many middle- and low-income families are deterred by price from utilising GP services which they need."
The Minister for Health, Mr Martin, responded to the Labour Party's proposals by dismissing the German health system as inefficient, and he promised more spending. He chose to beat the local hospital drum by suggesting that to have hospitals compete would bring closures. Labour countered that hospitals would change the services they offer.
The Government's White Paper on private insurance rejected arguments for a European-style social-insurance-based system, suggesting that European countries have problems, too; there is no evidence of a consensus for radical change; and "concerns about equity" could be met by "targeted initiatives and general improvements in the public health system".
This approach fails to address the schism at the centre of our system between the treatment of public and private patients, a schism which does not exist in much of Europe.