Our health can't depend on Britain's generosity forever
If ever Northern Ireland needed to be part of a United Kingdom it is now. That is not a unionist argument. It is economic reality staring everyone in the face every time we hear another recessionary newsbite and feel the monetary hurt in homes, jobs, wallets, or life in general.
Christmas 2011 is not a good time to be a small, heavily-dependent region or state in Europe. Our neighbours in the Irish Republic can testify to that, like so many other European Community countries living in the shadow of the dominant German economy.
What Northern Ireland is to London, the Irish Republic may soon be to Berlin. Whether we live north or south, we cannot exist without a bailout loan, subsidy or block grant. And call it what you will, such aid comes at a price.
I am not surprised that the Irish government is now considering a referendum. Meanwhile, up at Stormont, the piper sounds and calls the tune from London.
The ramifications for Ireland - both north and south - are vast. Dublin and Belfast are locked into a level of dependency which is re-drawing the political landscape on this island.
What price Irish nationalism in today's Europe, where every euro has to be accounted for to a German Chancellor, the European Central Bank or the International Monetary Fund?
Northern Ireland has been answerable to the British Treasury throughout its 90-year existence. Only now is the level of that dependency starting to dawn on unionist and nationalist alike as we count the cost of maintaining our health service, building new roads and closing down schools.
Earlier this year, I listened to John Compton, the chief executive of the Health and Social Care Board, tell us that the NHS in Northern Ireland was going bust.
His words were a wake-up call, but still many people have ploughed on in their own wee world of economic unreality.
That was no more evident than on November 30, when tens of thousands of people went on strike. For what real gain?
It is taking a long time for the penny to drop here that the days of unquestioned entitlement to state jobs, state grants, state subsidies, state rebates and reliefs, state spending on everything from hospitals to schools, are over.
Let me distil Mr Compton's 240-page findings into a paragraph.
The health service is Northern Ireland's biggest spender. The costs of medical care are soaring. The older we live, the more the bills are mounting.
We have too many hospitals duplicating services in Belfast and elsewhere. In future, the 357 GP practices across this province will need to do more for their money and act less as paper-pushing referral points for patients.
In future, we, the people, will all have to take more responsibility for the health of ourselves and our families.
The message from Berlin, Brussels and London is that every penny and euro must be better accounted for than in the past.
The books are being examined more closely than ever and, in the Republic's and Northern Ireland's cases, such scrutiny will be painful wherever we live.
The Health Minister, Edwin Poots, appears determined to respond positively and promptly to John Compton's revolutionary report.
Changing the health service is the biggest of all tests for Stormont, but can Mr Poots confront effectively the parochial self-interest of some MLAs inside his own party and outside it, who simply act as parish-pump councillors and refuse to see the bigger picture across Northern Ireland?
The evidence to date suggests that he has a battle on his hands. Reform of the health service will lead to arguments and wrangling in the highways and byways over hospital closures and many of Mr Compton's 99 recommendations for reform. Stormont has little, or no, track-record of acting decisively, yet this time it must over health.
The days are gone when we could expect public services around every hole in a hedge, but the mindset of people has not changed, because of a misguided sense of entitlement to public funds and employment.
Nowhere in the UK is that more apparent than in Northern Ireland. We must hope that the people of Britain, who subsidise us to the hilt, don't take a more questioning view of their continued generosity - particularly in the current climate, where they, too, are suffering.