I have been writing in The Irish Times for almost 34 years, but so far as I can recall I have never written about health policy. My reticence on this subject has been because this is a very complex policy area, and while over the decades I gradually gained sufficient insight to write with reasonable authority on other matters, I felt that I would be over-extending myself if I tried also to cover the very technical area of health.
Why, then, abandon at this stage such prolonged, and one might think prudent, journalistic restraint? Quite simply because of mounting frustration with what, even to an outsider like myself, seems to be the emergence of potentially disastrous health policies.
In 1987-1989 the new minister for finance, Ray MacSharry, was very effective in completing the process that our government had initiated of reducing the excessive share of national resources absorbed by current public spending.
Unfortunately, however, Ray MacSharry failed to appreciate that one area where our government had effectively completed this process was in relation to the health service, where during our term of office a dedicated and skilful minister, Barry Desmond, had in fact succeeded in reducing the proportion of public spending devoted to health by over one-quarter - without damage to the fabric of the service.
As a result, McSharry's otherwise successful programme of additional spending cuts was marred by one fundamental mistake: the cutting out of a further 3,000 beds. This has left the health service ever since unable to cater for the needs of a population which in the meantime has risen by one-fifth. Unhappily a stubborn refusal by this Government to admit to and rectify that mistake within the public health system lies at the root of many of our health service problems today.
So far as salaries in the health service are concerned, I have no difficulty about those engaged in the practice of medicine, nursing and so on within the public sector being remunerated adequately, at rates of pay comparable to those available in other countries at a similar stage of development - indeed that is clearly necessary to ensure the good health of our people. However, if consultants are in fact paid significantly higher salaries here than in neighbouring countries, that would be another matter.
At the same time I also have an instinctive concern at the idea of businesses making money out of caring for people who are ill. Doctors and nurses and others engaged in medical care are motivated and guided by a strong ethic of very long standing, and this is also true of people with a caring vocation who choose to fulfil that vocation by, for example, running a nursing home - or even perhaps a hospital established by committed doctors.
But ought the Government promote investments in nursing homes, and now in hospitals, by business people from outside the caring professions who have no reason to share this vocational commitment, and whose interest lies in profit maximisation?
Profit maximisation under competitive conditions is of course a perfectly normal feature of our capitalist system outside the caring area. But in this sector, as we have already seen in relation to some nursing homes, such a development may have negative effects on the quality of care offered to those who are ill - effects that may be very difficult to control externally by means of a public inspection system.
It is, of course, true that in the past even within the public system, and also among religious institutions with a presumed vocational commitment, the quality of care has sometimes been found to have been grossly inadequate, especially when governments offered totally inadequate finance to non-profit-making caring bodies, to which in most cases they delegated such work.
But past failures of this kind, which within a reformed public sector we should in future be able to prevent, do not justify the handing over of caring functions to profit-motivated private interests - however attractive this might be to some politicians whose motivation may be an ideological commitment to cutting public services so as further to reduce taxes.
A key defect of the health system that we have inherited from the past is the method by which healthcare is financed. In the face of grossly inadequate financial provision for public services - shortfalls that now involve huge, and sometimes fatal, delays in treatment - the better-off half of the population can and do buy priority for prompt treatment by means of private health insurance.
Now I see no great problem with people being able to secure more privacy - a private or semi-private room in hospital - through private health insurance, and I have the impression that in the early stages of the VHI, that was in fact what people paid for and secured.
But, over time, governments allowed a serious erosion of the capacity of the public health system to serve adequately and in a timely way a population that in recent decades has been increasing more rapidly than anywhere else in Europe.
Except in one special area, those with private health insurance were thus exempted from the impact of this deterioration in service - because they could, and did, jump the queue. That special area where the better-off have also been adversely affected is Accident and Emergency, and it cannot be without significance that so much attention has recently been directed at this particular shortcoming of the system, rather than at the waiting-list problem that affects only the less well-off.
If we had an adequately resourced single-tier health system, like that of France, through which all of us passed, there would of course be irresistible pressure from the better-off half of the population for adequate facilities, as well as tolerance for any additional revenue-raising measures needed to finance these, whether from the exchequer or by means of national health insurance contributions.
What is happening at present is that the unleashing of investment in private health facilities is about to create new and powerful vested interests that will be concerned to block the future creation of such a single-tier health service, financed by a national health insurance system.
The unseemly haste with which the Minister for Health is currently pushing for the signature of contracts for the construction of private hospitals in the grounds of public hospitals reflects a powerful ideological commitment to the eventual blocking of any future attempt to end the socially divisive nature of our health system.
The commitment of Fine Gael and Labour to work towards ending this anti-social rift in our health system is an important difference that has emerged between the programmes of the alternative governments on offer in the forthcoming election.