Inside Politics:Mary Harney's decision to confront the hospital consultants on the eve of an election is a brave decision, full of risks but also of political possibilities. Having put it up to the hospital consultants, the Minister for Health is now putting it up to her Cabinet colleagues to take a stand on an issue of fundamental national importance.
The battle with the consultants has the potential to be a defining issue for the Progressive Democrats going into the election campaign.
Michael McDowell showed nerve when he faced down the Garda representative bodies on the question of the Garda Reserve. If Ms Harney can do the same on a vastly more important issue, with an even more powerful vested interest group, the PDs will have grounds for claiming that they really do make a difference in government.
The question is whether Fianna Fáil has the stomach for a bloody battle with a body which has the capacity to do real damage to the party's election prospects if hostilities get out of hand.
Taking on powerful interest groups in open combat is certainly not the Taoiseach's style and the timing is not exactly suitable for a political leader with his cautious approach.
Ms Harney, though, has picked the time for battle with her eyes wide open. The consultants' contract has been a festering problem in the health service since Charles Haughey signed the deal in 1979. Any minister for health over the past two decades could have taken the stand that Ms Harney is now adopting, but none of them chose to do it because the consequences of defeat were too terrible to contemplate.
What Mary Harney is doing is comparable in political terms to what Margaret Thatcher did at the time of the miners' strike. If she doesn't win, the Government's entire health strategy will be left in a shambles, the HSE will have its authority undermined and the PDs as a party - and the Government as an entity - will suffer a loss of credibility.
On the other hand, if she wins, one major reform of the health service in the interests of consumers can truly begin, because the stranglehold the consultants have had over any change will finally be broken.
In political terms not only will the PDs win, but the entire Government will be able to bask in the reflected glory of having taken a decisive stand in the public interest.
While it can point to many successes, this Government has shown a weakness in recent years for dithering in the face of big decisions. Going into the election, both Government parties will be claiming the credit for the country's prosperity and progress. However, the Opposition has already begun to focus on the failure to take tough decisions and deliver on them. Victory over the hospital consultants would certainly do a lot to bury that image of indecision.
When the matter comes before the Cabinet on Wednesday week, Ms Harney's Fianna Fáil colleagues can be expected to back her. They are all utterly fed up with the consultants for dragging the issue out for so long and for contributing to the air of crisis in the health service.
From his current vantage point in finance, and in the light of his own experience in health, Brian Cowen will certainly be in Mary Harney's corner. He has made no secret of his own complete frustration with the consultants.
It is one thing to make the big decision. The question is whether the Government will be able hold its nerve when the going gets tough, as it undoubtedly will. Once she gets Government approval, Ms Harney will want to press ahead with the appointment of more than 1,000 new public hospital consultants, against the wishes of the IHCA (Irish Hospital Consultants' Association).
The mood will be soured even further since she is also proposing to curtail some of the privileges currently available to consultants in the use of public hospital facilities for their private patients. If the international recruiting campaign gets under way immediately, as planned, and new public hospital consultants are being appointed by the time the election takes place, then the Minister will be in a position to claim victory.
The IHCA has said that it will block new appointments by refusing to participate in the interview process, but it appears that a new system of recruitment which does not require their assent will be put in place to get around that problem.
A potentially complicating factor is that action in support of a €1.5 billion pay claim by nurses is also coming down the tracks. While the Labour Court rejected the nurses' claim because it would ultimately add billions of euro to the annual public service pay bill in knock-on claims, the Irish Nurses' Organisation is proposing industrial action next month.
If Ms Harney can face down the consultants, she will be on stronger ground to deal with the nurses, but the other side of the coin is that the nurses and consultants together could make the health service unworkable.
The natural inclination of the Opposition would be to try and exploit Ms Harney's difficulties but Fine Gael's health spokesman Liam Twomey has wisely backed her against the consultants.
With the political consensus on her side the Minister's hand has been strengthened.
Battle will be joined quickly once the Minister gets Government approval for her plans.
Ms Harney will either go down in political history as the first Minister for Health to vanquish the consultants or she will join a long list of predecessors, from Noel Browne to Brendan Corish, who were defeated by one of the most powerful vested interests in the land.