A consensus has emerged across the political divide that there is a high level of dissatisfaction among the public with the state of the health service, and that this will be a key issue in the next, possibly looming, election.
While the Budget announced significant increases in Government spending across a range of areas, health won the jackpot. In 2001, current and capital health spending is to increase to more than £5 billion.
This comes on top of substantial increases over the past few years, so that spending next year will be almost twice what it was in 1997. The central question is: will this be enough?
The rapid rise in the numbers purchasing health insurance suggests that dissatisfaction with the public health service is indeed widespread. Whereas one person in five had health insurance 20 years ago, we are now approaching the situation where half the population has cover.
As shown in a study by Ms Miriam Wiley and myself, recently published by the ESRI, the most important factor seems to be unhappiness with the hospital care available to public patients. Health insurance buys "private" care, allowing the insured to avoid the waiting lists that may face public patients and also to feel happier about the quality of the care they receive.
Curiously, that private care is often received in public hospitals. One-fifth of the beds in Irish public hospitals are reserved for private patients, who pay a per-night charge for that bed and their consultant's fee, with that consultant often treating public patients in the same hospital, on salary from the State.
Since the early 1990s the Department of Health has drawn a sharp distinction between beds designated for private and public use, because private patients were thought to be gaining speedier access through public wards on occasion. While some private patients still end up in beds intended for public patients, mostly when admitted through casualty, the numbers are relatively small.
The more fundamental issue in terms of equity in access for public versus private patients arises from the nature of the public-private mix itself. The State now has a two-tier system with a divide that is much more pronounced than in most other European Union countries.
In other countries the rich can buy private care, but we have allowed a structure to evolve whereby the public health services themselves incorporate faster access and arguably better care for half the population, the half with more resources.
On the face of it, an appealing way to extract ourselves from this situation would be to extend health insurance to everyone, "make everyone a private patient". This notion is at the core of proposals put forward by the Labour Party, and more recently by Fine Gael, and looks set to be hotly debated in the run-up to the next election.
It is likely to be a confused debate because this general notion can in practice mean many different things, so it is worth trying to disentangle the core components.
The Labour Party proposal, for example, would see the entire population being insured with private competing health insurance companies, with those on low income having their premiums paid by the State.
That insurance would entitle everyone to a basic package, which they would receive in public hospitals. Anyone who chose to add to their basic package could buy "super-private" insurance, covering private care delivered in private hospitals.
The three distinct elements, then, are the nature of people's entitlements to healthcare, how that care is delivered and how it is funded. Taking these in turn, the entire Irish population is already entitled to comprehensive public hospital care, subject to some relatively modest per-night charges for those without medical card cover.
The problem for hospital care is not the entitlement structure (though that is an issue for primary care) but that what is available to the public patient is seen as unsatisfactory and that some people are facilitated in bypassing it.
We could change the label to everyone being "insured" rather than "entitled", but that on its own would, of course, change nothing: the challenge is to ensure that an acceptable "basic package" is available to everyone. Defining what is in that package would certainly be a step forward, but making it available depends on delivery and funding structures.
One aspect of the Labour proposal, little remarked on, is that the basic package would be delivered in public hospitals, and consultants working in those hospitals could not also work in private hospitals. Rather than the current intricate public-private mix, there would in effect be a complete split between the two.
There are strong arguments in favour of such a radical redirection, both from an equity and efficiency perspective. At a minimum, seriously debating this option should shift the burden of proof more on to those who argue without much concrete evidence that the current system has major benefits for public patients.
It is its reliance on funding via competing private insurers that is the most problematic aspect of the proposal. Experience elsewhere suggests that this can be a recipe for (even greater) cost inflation and leaves the State picking up the tab for all the bad risks.
That is why this option was rejected by the Commission on Health Funding in the mid-1980s. Crucially, there are other ways of ensuring universal coverage which do not share these drawbacks - either via social insurance or direct State funding - which could be perfectly compatible with the other elements of the proposal.
The need to distinguish between these different elements - the central point being made here - applies with equal force to the recent, less-detailed Fine Gael proposals, and to the examination of structures currently being carried out for the Minister for Health.
Finally, what about what the Minister for Finance described as "the extraordinary rate of increase in health spending", rebutting in his view claims that the health service suffers from underfunding?
The recent increase in spending has indeed been so rapid that the system will probably have some difficulty absorbing it. In the longer term, though, it will not make the structural issues go away.
The British government recently announced it would raise health spending as a proportion of national income to the European Union average: there seems little reason to believe we can attain the quality of health services consistent with our new-found higher-income status without doing the same.
Prof Brian Nolan works for the Economic and Social Research Institute