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Health is of central importance to well-being. The standard and reach of health services have improved in Ireland over recent decades as indeed have health outcomes. However, not all of this progress has been experienced equally by all sections of the population. In particular, there are significant and persistent disparities in healthcare outcomes adjusted for socio-economic status. Similar disparities in the level of access to healthcare and the scope of healthcare provision point to a systemic problem. This paper considers a policy approach that could deliver a single, universal, comprehensive and integrated health service fit for purpose and one to which all people can have access on the basis of need and not ability to pay. Our costing exercise demonstrates that health system transition and reform will entail additional demands on public resources with implications for fiscal policy.