Double standards exist in Ireland today; if one pays for health care, one will live longer and in less pain while those on low incomes will suffer. This is unjust, unacceptable and untenable. There must be a comprehensive, high quality health service available to all based on fair criteria, not the size of a person's bank balance. Citizens cannot be confident of appropriate treatment when they are ill. Major health care service providers have not justified the trust placed in them by citizens. The poor, elderly and many others suffer second-class treatment or no treatment at all.