When John Kitzhaber packed out of the governor's office in 2002, he famously grumbled that Oregon had become "ungovernable."

Since then, the Oregon Democrat, a former emergency room physician, has returned to his passion - health care. And it may well be the most ungovernable policy issue of all.

The American health care system, he told the McMinnville City Club on Tuesday, is already in crisis. And that crisis has the potential to get much worse as aging baby boomers add to the strain.

Meanwhile, the sheer number of stakeholders has made genuine debate virtually impossible.

With his PowerPoint casting the image of a giant waterfall on the screen, he asked the large audience to imagine all the key players aboard a raft floating toward the watery abyss.

Paddling madly, they all derive a "perverse sense of security from the fact that the people on the other end are going to go over before they do," he said. "That is exactly what we're doing here in this country, and we can do better."

For the 61-year-old Kitzhaber - himself a baby boomer - doing better meant launching a group called the Archimedes Movement, a grassroots nonprofit aimed at creating "a new space for civic engagement outside our traditional legislative and governance structures."

Kitzhaber regards the decline of fossil fuels and the state of public education in the United States as two issues that ought to command everyone's attention. But he feels health care is the most urgent of all.

It's not as if evidence is wanting.

On Wednesday, a study by Oregon Health & Science University in Portland confirmed something those in the industry have long known or suspected - emergency room visits have jumped 36 percent since 2003, when tens of thousands of low-income residents were dropped from the Oregon Health Plan.

That plan, the state version of Medicaid, was authored by Kitzhaber in the 1990s. So it's close to his heart.

Social Security presents a $5 trillion long-term problem, Kitzhaber said. But that's nothing compared to Medicare, where the unfunded entitlement is expected to exceed $67 trillion by the time boomers start becoming eligible - in about three years.

"We're paying for that by borrowing money from Japan and China and other countries that are still willing to lend it to us," Kitzhaber said. "What do you think is going to happen the day China, for example, says they're no longer willing to underwrite U.S. deficit spending in the face of a falling dollar? That's why we have a staggering currency crisis."

And that's without taking into account the war in Iraq, which is also being effectively financed by the Chinese, with an ultimate price tag estimated in the trillions.

In 2007, Kitzhaber presented an ambitious plan to pool virtually all public money spent on health care in Oregon - Medicare, Medicaid and the federal deductions employers get for providing health coverage - and use it to provide "core" health service to all Oregonians.

Dubbed the Oregon Better Health Act, it was intended to jump-start a national debate on health care. It enjoyed bipartisan sponsorship in the Oregon Legislature, but remained bottled up in committee when the Legislature adjourned.

He took another run at the issue last fall, campaigning for Measure 50, a legislatively referred cigarette tax increase intended to boost health coverage for children.

The tobacco industry spent millions fighting it, and it took a drubbing at the polls. In Yamhill County, the measure was rejected 66 percent to 34 percent.

The thrust of Kitzhaber's argument is that the system is beyond fixing - that it needs a radical overhaul.

"Fixing the U.S. health care system, or fixing the U.S. energy system requires transformational change," he said. "You can't do it by playing around at the edges of what we have right now.

"It's like trying to turn a Piper Cub into a 747 on a flight between New York and Los Angeles. You can't do it."

Among those who can't do it - at least based on the plans they've put forth, Kitzhaber said - are presidential candidates Barack Obama, Hillary Clinton, both Democrats, and John McCain, a Republican.

Kitzhaber said those plans erroneously define the issue as a financing problem, a question of who will pay for insurance so everyone has access to the system.

"The problem is the system," he said. "The poor performance and inefficiency of the U.S. health care system is built into the system itself.

"It's a function of the system, and it's not going to change just by changing who pays for it. So somehow, we've got to shift this debate from how we pay for something, to what we're actually buying, how it's organized and delivered."

Around 70 percent of all health care costs are due to chronic diseases - diabetes, congestive heart failure, coronary artery disease, and asthma, Kitzhaber said. Those are conditions where prevention can play a huge role, and if caught early and acted upon immediately, gargantuan hospital bills can be avoided.

One of the problems with health care in America, he said, was that the system is only designed to deal with those problems when they've reached the crises stage.

Citing the accomplishments of the so-called "Greatest Generation," the one that, having fought and won World War II, returned to the United States and built the U.S. Highway system, cured polio and went to the moon, Kitzhaber called for an equally momentous leap forward in the realm of health care.

"Our apparent inability to address any of those issues raises a serious question about whether we still have the will and courage as a society to reconcile the growing contradiction between what we say we want to leave our children, and the world we're actually building through the choices and the decisions that we're making today," he said. "If we fail to address this, if we fail to act, this will be our legacy."