One of the basic rules of politics these days appears to be if you really want a Health Minister to resign, don't call for their resignation.
This rule seems to particularly apply to James Reilly, who at this stage would be able to wallpaper his office 10 times over with newsprint (remember newsprint?) detailing calls for his resignation, political obituaries and no-confidence debates.
However, James is showing remarkable longevity for someone whose political days have apparently been numbered almost since the moment his term of office began.
Just over a year ago, the obits were being written after the primary care centre 'scandal' (small scandal, nobody died) and Roisin Shortall's resignation.
In recent days Dr Reilly's goose, we are reliably informed, really was cooked this time. Except there is of, course, no basted fowl to tuck into - it's not even in the oven. The usual political step-dance has ensued and colleagues have rowed in behind the health minister.
Most reasonable people deep down would conclude that James Reilly is no worse than most of his predecessors in recent decades.
If Leo Varadkar, or whoever, jumped into Dr Reilly's shoes tomorrow, it would be Groundhog Day again and people would within weeks have begun calling him names, throwing around no-confidence motions like confetti, and perhaps even questioning his diet and exercise regime, none of which of course would make a bit of difference in terms of dealing with the health service's endless problems.
That's not to say there aren't serious faultlines running through how our health service is planned and run, and how health policy is communicated to the people who use the services and who may be afraid that they won't be able to use them for much longer.
But firstly, why was James in trouble this time?
Well, apparently, and we must confess to being shocked when hearing this, the health service is in a mess and doesn't have the funds to look after the increasing number of people who are trying to access services.
Apparently, the fact that the country is still stone broke and that we have to obey the financial diktats of some stern looking foreign gentlemen on how much we can spend on keeping people alive and well has absolutely nothing to do with the fact that the health minister 'can't manage' or 'has no control' over the health budget.
And apparently, (pass the smelling salts) the HSE is going to have a 'budget overrun' at the end of this year, because demand is outstripping the money supply, or else James Reilly is the most incompetent minister ever - whatever you choose to believe.
The Minister should go and collect his significant pension, apparently, because the main opposition party has discovered that the health service is a mess and doesn't have much money to spend.
This apparently, is in stark contrast to the state it was in in February 2011, when the last Government slunk out of office, slaloming among the projectile rotten tomatoes.
Here are some interesting figures: 2006-€349 million; 2008-€345 million; 2009-€254 million; 2010-€595 million.
These are some of the health service overruns that required supplementary bail-outs in the latter years of the Fianna Fail-PD coalition. The 2006 overrun occurred at a time of national largesse.
Eagle eyed readers may note that the overruns, during the current Government (€360 million in 2012, around €150 million this year, are similar or less than less than those of the previous Government.
James Reillly's supporters (there may be some out there somewhere apart from Enda Kenny) would argue that given the unprecedented cuts he has had to cope with, he has worked miracles in keeping the HSE's deficit down to such relatively small proportions.
That's probably going a bit too far in terms of cheerleading, but there is more than a ring of truth to it.
If can certainly be argued that the health service has taken an unfair and disproportionate share of what were largely necessary public service cuts, but one Minister, particularly a political neophyte like Reilly, was never going to buck the will of Government (and the IMF).
That said, it is a bit of a mystery why, if the 2014 health service allocation is to be €360 million less than in 2013, why €666 million plus in cuts are needed. Many of these, notwithstanding the need for 'probity' and to please the IMF, are scaring the bejesus out of vulnerable and sick people who don't know what is in store for them next year.
The Government appears to be insisting that medical cards should take the big hit in 2014 in preference over, for example, hospital services that are at breaking point. Dr Reilly appears to have agreed to this (he probably had had no choice really), assuaged in part by the 'sop' of free GP care for the under fives and the dubious honour of health cuts being monitored inter-departmentally.
Many of the faultlines running through James Reilly's tenure of the health portfolio can be put down to a lack of political adroitness, poor presentation skills, and a tendency to further complicate what are already quite complex healthcare issues - the medical card controversy being a case in point.
James Reilly saying 'let me clarify the matter' are five of the most dreaded words in current political discourse.
In an attempt to try to shed light on matters that were confusing and worrying the public, the Minister told the Oireachtas Health Committee last week that there had been no change in policy on the granting of discretionary medical cards, 'but there had been probity'.
Similar confusing statements been repeated many times by the Minister and the HSE - that the policy regarding medical cards of all types (apparently there is officially only one type but in effect there are at least four types) has not changed.
Some hard facts may indicate otherwise.
A recent Comptroller and Auditor General report state quite clearly: 'in 2013, the HSE introduced a new form for completion by GPs (in relation to discretionary card applications) which requires a GP to specify the normal number of GP visits and the type of medication required.
On the issuing of cards in general , the Comptroller's report also refers to the HSE reviewing eligibility for people who had not accessed GP services with their card in the previous year.
Also, as a result of changes announced in the 2013 Budget, income criteria for medical cards changed and were implemented in the spring.
Whether these represent changes on policy or probity, the fact remains that there has been a tightening up on the issuing of some medical cards, notwithstanding the fact that overall the number of medical cards is growing in line with a sicker and poorer population.
And the so far mysterious but scary €113 million in further medical card cuts next year just adds to public worry about how much further health cuts are going to do, regardless of the technical explanations given.
And, as the dogs in the street will opine if you ask them, if there has been no change in medical card policy, why are all those people ringing up 'Liveline'? They can't all be Fianna Failers and Shinners trying to embarrass the Government.
Notwithstanding his resilience to date, 2014 will be a pivotal year for James Reilly. For how much longer can a health minister preside over incessant health budget cuts which go against his 'reform' promises of greater safety and equity for the health system?
A worrying sign of how bad things are getting with the 'doing more with less' health policy was hospitals indicating last week that continuing cutbacks are limiting their ability to deal effectively with hygiene and patient infection issues.
Far from being run out of office, perhaps if things don't go so well, James Reilly will surprise us all and become that rare breed - a Minister who resigns on a matter of the highest principle - that after over a fifth of the health budget having been lopped off, further significant health cuts are unsustainable.
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