Shortfall is a recurring farce - depending on where you sit
It's known among politicians and senior officials as the "annual farce" as a fictional health budget is framed. Everyone knows that the official figures cited are already way off the mark by hundreds of millions of euro.
A supplementary allocation follows that autumn as surely as night follows day. This year is no different.
In January and February 2018 alone the over-spending stood in excess of €101m. By mid-year the health over-spending estimate was speculated at being "between €200m and €300m".
The official figure for the health spending over-run was €168m in the mid-year expenditure report published on July 18. But insider forecasts were that it would be around the €600m mark for the entire 12 months to December 31 next.
There is no shortage of official musings about the need for change and the shelves are groaning under the weight of detailed reform plans. Last June, at the National Economic Dialogue, Taoiseach Leo Varadkar questioned whether Ireland should really be spending more than €15bn per year on health services, noting it was among the highest spend in the developed world.
Could this be the same Leo Varadkar who demanded some €500m extra for the health budget in May 2016? An intriguing new biography of the Taoiseach details how he made this demand to his predecessor, Enda Kenny, as well as sweeping powers to bypass recruitment curbs, as the price of staying as health minister in the new hybrid coalition.
Mr Kenny, who had just pulled together the minority government, could not grant those demands. The biography, entitled 'Leo Varadkar - A Very Modern Taoiseach', notes how he moved to the quieter job of social protection minister, and devoted his time to getting elected as Fine Gael leader.
Clearly, it all depends on where you're sitting when it come to health budgets. Because right now Leo Varadkar is back on side with the Finance Minister, Paschal Donohoe. They are both looking at what was already a very narrow scope for tax cuts, being further eroded by the yearly demand for a big top-up to the health budget.
The current Health Minister, Simon Harris, is the one left holding the rapidly emptying health funds. None of this bodes well for proposals for health reform, which were given a boost a year ago when all parties agreed a new approach to health service provision in the so-called Sláintecare proposals.
The multi-party approach was and is very heartening. But the central plank of the plan, replacing the current iniquitous public-private system with a public only one, would cost money, up to €3bn in fact.
Conservative officials see the funding model to underpin the new regime as being even more ruinous for taxpayers. But continuing the annual farce of a fictional health budget is equally demoralising for everyone involved, and it seriously demeans our system of administration.