MY GRANDMA TAIT saved fabric. Remnants, scraps and half-used yardage were in every drawer and closet when she died. And although she did not discriminate when it came to hoarding (we poured pounds of rock-hard sugar down the sink), it is the fabric I remember.

Quite early, I picked up the point that she had been a child of the Depression, so there was a just-in-case quality to her accumulations. Were we going to sew up a storm and sell our handiwork if things turned bad? Time would tell.

Only now does it seem obvious. All that cloth was going to help pay for health care.

As topics go, health care bores the socks off of most people. There is just nothing fun about it. Dinner parties at which the subject is broached break up early. Yet the health-care problem is taking us over the falls. Health-care spending consumes a steadily growing percentage of the gross domestic product, even as the percentage of people who lack health insurance also ticks upward. Some 50 million Americans, roughly a sixth of us, are currently going without.

According to the nonpartisan Center for Studying Health System Change, nearly 1 in 5 families reported trouble paying medical bills last year. Many borrowed or considered declaring bankruptcy as a result. Those struggling included 43 million insured people.

Ever since the early ’90s, when Bill Clinton’s plan for national coverage was throttled, our leaders have let the problem fester, even as they vowed something must be done. It still must be, even as we face the worst financial crisis since the Great Depression.

Both presidential candidates have health-care reform plans. But can either, if elected, afford to proceed?

Barack Obama’s plan would cover the most people, and go far toward paring the ranks of the uninsured. Because both candidates’ plans lack details, calculations are difficult. But the nonpartisan Tax Policy Center recently estimated that Obama’s plan would cost about $1.6 trillion over a decade, and insure an additional 34 million people. (It retains employer-based plans but adds a publicly subsidized option.)

John McCain’s plan would cost almost as much. But it would encourage employers to drop coverage and push workers to buy insurance on the open market. The Tax Policy Center forecasts that this would result in a net gain of only about 1 million insured. As noted by The Wall Street Journal, studies reported in the policy journal Health Affairs reached the same conclusion.

McCain, then, would spend more than a trillion dollars to barely move the ball off the 50-yard line. His plan would also make it harder for the sickest people to get coverage. Because it relies heavily on private insurers, which would be working overtime to screen applicants, administrative costs would soar. Economist Paul Krugman estimates that the bureaucrats would soak up about 29 percent of premiums. (Medicare, the government’s plan for the elderly, only spends 3 percent on administrative costs.)

McCain has said he would like to deregulate the insurance market in much the way the banking industry was deregulated. Any takers, my friends?

Since the Clinton plan bombed, we have been hearing mostly about incremental change. Cover the kids first. Or cover just certain procedures. Cover the people with red hair, or the ones whose last names begin M through O.

But even the incrementalists cannot seem to get anywhere. Last fall, George W. Bush vetoed an expansion of S-CHIP, the children’s health-insurance program administered by the states. John McCain stood with him.

Still, under the right leadership, some helpful changes could be made right away.

S-CHIP can and should be expanded. By pulling another 5 million into the system, it would get us to almost full coverage of American youngsters.

Other modest steps could begin to attack costs. One is to start studying the effectiveness of various treatments, and make that information public. Too many Americans have had the experience of reporting some elusive symptom and being tested to the max, charged for the privilege and left wondering what it was all about. (The offending doctors know who they are; their fellow doctors really know who they are.)

Substantial reform is unlikely until the nation gets its financial house in order. Yet out-of-control medical costs are one reason the house is such a mess. Insurance companies and others invested in the current setup are counting on us to despair before we begin. They are hoping the proposed solutions bore us stiff.

All we have to remember is that the cost of doing nothing gets worse and worse. We have the most expensive health-care system in the world. Yet more and more Americans are afraid it will not be there for them when the chips are down, and are turning out to be right. It is a kind of drama we do not need. Give us the dull details. In the meantime, I’ll be whipping up a tea cozy for my doctor.

M.J. Andersen is a member of The Journal’s editorial board.