Note:  The original included a cartoon and a picture of Molly Ivins.

AUSTIN, Texas -- Have you noticed  that the health care system is not working?  In fact, it is falling apart.  And the most curious thing about that is how few people for whom the system really works -- and the ones who make the decisions -- are aware of it.
 
It's like the old story about frogs and hot water. If you drop a frog into boiling water, it will leap to get out but if you drop a frog
into cool water and then gradually heat it up, the beast doesn't  notice, so they say.
 
Another factor is the now-constant cognitive dissonance we have in this country as a result of the ever-widening gap between most people and the people who run things. If you have health insurance, the system is a pain in the behind but it works. If you don't have health insurance, you are flat out of luck. And in case you hadn't noticed, more and more employers are deciding not to offer health insurance. or using "temporary" workers or out-sourcing various tasks so they won't have to cover the workers.
 
If you don't have health insurance, the system is an insane nightmare. A new book by Dr. Rudolph Mueller, "As Sick As It Gets The Shocking Reality of America's Healthcare" lays out the problems as well as any I've read. But the book is just one more grain of sand in the beaches of evidence we already have that the system is breaking up.
 
At South by Southwest, the Austin music festival, a panel on health care for musicians -- who are largely uninsured -- produced this nugget:  Did you know there more than 1,000 concerts given every  week by musicians for other musicians to raise enough money for an operation or medical treatment of some kind? It's a beautiful tradition, but it doesn't work. All the generosity of all the musicians in the country -- and so many of them are endlessly generous with their time and talent -- doesn't begin to cover the cost or medical treatment for even a few.
 
As they say in bridge circles, let's review the play. Ten years ago, we  knew the system was a mess and Bill Clinton was elected in large part by promising to do something about it. Hillary Clinton got the assignment and conventional wisdom in the political world is that she blew it. She did make political mistakes, but the far more important reason the attempt at reform failed is that the insurance industry spent $10 million to defeat the bill. Remember Harry and Louise?
 
Since then, the politicians have been afraid to try reform. The smartest of them, including Bill Clinton and Sen. Ted Kennedy,  have been trying to move the ball incrementally -- tinkering with Medicare and Medicaid, starting a program to insure poor children. But the system is falling apart faster than they can move to fix it. A Patients' Bill of Rights is not the answer. It won't provide health insurance for a single additional individual.
 
The most maddening thing about the sheer stupidity of America's health care system is that the far better alternative is perfectly
clear. Every other industrialized nation manages to do this better than we do. The answer is universal health insurance, a single-payer system.

Every time we start to get serious about reform, the right wing starts screaming, "Socialized medicine, socialized medicine." And then we're all supposed to run screaming with horror.
 
But if you want to see horror in action, try the emergency room of any large public hospital in this country. And for a truly hilarious experience, try to get emergency medical help on Christmas Eve.
 
Look, this should not be a for-profit system. We need to phase out all for-profit or investor-owned provider and insurance organizations. Mueller suggests a one-time fair buy out of all such organizations.  The good news is that doctors are no longer impeding, serious reform -- in fact, doctors are having such a hard time under the current system that they've been radicalized on the subject and can now be counted on to help with reform.
 
Conservatives reflexively start moaning about the cost of a "big, new government program." Actually, what's costly is the system we have now. Americans already spend 58 percent more than the weighted average of similar nations for health care.
 
"It is a system wasteful beyond belief and manipulated by a lobby focused on providing the highest profits for their self-interest and investors, and mammoth cash flows to companies that should not exist or not be involved in health care. The system is also paying for an extremely large number of sick people who would not be sick under any decent universal health care system," writes Mueller.
 
Sitting around deploring the current system will not fix it -- there are citizen action groups all over the country working on this problem. It is easy to find them and get involved. You don't have to be on the Internet; the phone book works fine. We can't wait for the political system to get round to doing something about this: We need to help ourselves now.

Molly Ivins is a syndicated columnist based in Austin, Texas.