At some point, the political debate will return to health care, a burning issue for many Americans, and an economic drain. Soaring health-care costs continue to push companies to raise their employees’ contributions or drop their coverage altogether. Close to 50 million Americans are now medically uninsured. American businesses, meanwhile, strain to compete with companies from countries that have created rational health-care systems.

In the presidential race, Democrat Barack Obama and Republican John McCain have very different plans. Both need work, but Senator Obama’s vision is closer to what must be done.

Mr. Obama would increase the number of insured by several means: Extend subsidies to individuals and small businesses to buy coverage. Expand eligibility for the Medicaid and the State Children’s Health Insurance Program. Create a National Health Insurance Exchange for uninsured people not covered by an employer or one of the public programs. The exchange would offer a choice of private-insurance plans and a government-run plan, known as the National Health Plan. Mr. Obama would leave intact the employer-based system that still covers most American workers.

The National Health Plan has drawn fire from conservatives, who see it as the seed that will grow and eventually replace the private insurance market.

How to pay for it? Mr. Obama would charge businesses that do not make a meaningful contribution to their workers’ coverage a certain percentage of their payroll. (Small businesses would be exempt from this requirement.) Mr. Obama also offers some vaguer sources of funding.

Mr. McCain’s stated goal is to make health coverage less dependent on employers, encourage personal responsibility and preserve choice of health insurance. To do so, he would provide one large new tax subsidy and remove another.

Under the McCain plan, every family would get a $5,000 refundable tax credit and use it to buy health coverage. Meanwhile, it would tax workers’ premiums that are paid for by employers.

One danger in the McCain proposal is that the loss of the tax deduction might prompt more companies to drop their coverage. Another is that low-risk workers would have less incentive to stay in the employer’s plan and leave the insurance pool full of sicker people. There is wisdom in doing away with our workplace-based system of health coverage, but a sudden overhaul of related tax policy could lead to a collapse of the current setup that, while very flawed, is still insuring the majority of workers. One may also question whether $5,000 is enough to insure a family these days.

The plans have some common features. Both would subsidize the insurance of people who are “high risk” — that is, have expensive medical conditions that would make private insurers avoid them. And they both offer vague sources for savings, such as greater use of information technology and improved disease management.

Critics say the Obama plan extends the control of the federal government over health care, to which we answer: It’s about time. The crazy-quilt of public (local, state and federal) and private coverage by companies with sky-high profit margins has created a variety of cross subsidies and wasteful spending (including gigantic payments to insurance-company executives) that threaten to bankrupt our country.

Mr. Obama’s proposal does need to devote more attention to cost savings. And it would need mandated coverage for everyone, not just children.

But if at the end of the day it leads to a national health-care system in which the federal government provides basic coverage and people can buy private insurance for the extras, then fine. That sounds a lot like Medicare, and although Medicare spending must be better controlled, it is a program that the American people like.