WASHINGTON — Hillary Clinton says she still has scars from her failed effort to overhaul the nation's health care system. She doesn't want to get burned again.
Chastened by her disastrous debut as a health-care crusader 14 years ago, the former first lady is taking a more cautious approach as she seeks the Democratic presidential nomination. While other candidates tout ambitious plans to provide health insurance to every American, she stresses the need for a national consensus on the issue.
Clinton hasn't offered any detailed plan for dealing with the 47 million Americans who don't have health insurance, although she says she remains committed to the goal of universal coverage.
"It's a problem for her, given her history," said Robert Blendon, director of the Program on Public Opinion and Health and Social Policy at Harvard University. "She wants people to think about her experience as a U.S. senator and not go back to relive the details of her health-care reform plan and her task force and all the problems they had."
Some Republicans are already reviving attack lines from the 1990s, warning Americans to be on guard against "Hillarycare" and calling any increase in government regulation a step toward socialized medicine.
The two parties are miles apart on health-care issues.
Democrats describe the escalating cost of health insurance and the rising number of uninsured Americans as "a crisis." All say they want universal coverage.
Republicans rarely mention health care, except when asked about it. Former New York Mayor Rudy Giuliani and Sen. John McCain of Arizona don't list health care in the "issues" section of their campaign Web sites. Former Massachusetts Gov. Mitt Romney rarely talks about his successful effort to make health insurance mandatory for Massachusetts residents.
"You're looking at candidates who live in parallel universes," said Robert Moffit, director of the Center for Health Policy Studies at the Heritage Foundation, a conservative think tank. "I've never seen such an intense ideological divide."
The fissure became apparent more than 60 years ago, when President Harry Truman's plan for national health insurance died in Congress. The gap between the parties widened considerably during the bitter fight over Clinton's ambitious plan in 1993-94.
The plan, delivered to Congress in a complex 1,342-page bill, would have required employers to provide health insurance and called for a much bigger government role in the health-care system. President Bill Clinton, who put his wife in charge of the effort, abandoned it after a draining year-long battle.
"We knew we had alienated a wide assortment of health-care industry experts and professionals, as well as some of our own legislative allies," Hillary Clinton wrote in "Living History," her best-selling memoir. "I knew I had contributed to the failure, both because of my own missteps and because I underestimated the resistance I would meet as a first lady with a policy initiative."
That failure is now a point of pride on the campaign trail. By drawing attention to her "scars," Clinton establishes her credentials as a fighter for health care. By withholding the details of her current plan, she avoids comparisons with her previous proposal.
"She's put together things that don't look at all like '93-94," Blendon said. "She's been very cautious and very establishment-oriented about what she's proposing."
Campaign spokesman Phil Singer said Clinton will produce a detailed plan for universal coverage, but he declined to say when. The candidate's first major health-care speech, delivered in Washington last month, focused on non-controversial ideas for reducing medical costs.
"She's learned from the mistakes that were made," Singer said, referring to Clinton's 1993-94 effort to overhaul health care. "What sets her apart now is the passion, experience and knowledge that she brings to the table."
Clinton signaled her intentions for dealing with the uninsured at a health-care forum with other Democratic candidates in March.
"Every employer is going to have to provide insurance or pay into a pool where that money can be used to help people," she said. The New York senator said she would also consider a Massachusetts-style plan requiring individuals to get health insurance if they're not otherwise covered.
"I know probably better than anybody how hard this will be," she said. "We're all going to have plans. That's not in doubt. We need a movement. We need people to make this the number one voting issue in the '08 election."
Some health policy experts think the odds of sweeping change are low, no matter who wins the next presidential election.
"People have fundamentally different ideas about the health-care system," said Moffit, of Heritage. "Do you honestly believe that you could have a comprehensive health-care program that would literally affect one-sixth of the entire economy, that you would be able to get it through the House and Senate and signed by the president? I don't think that's possible."
Others are more hopeful. Blendon said the next presidential election could set the direction for changes in the health-care system.
"I think what most people who are interested in this are saying is, 'We have a problem; I'd like a leader to figure out something to do about it,"" he said. "The country has a choice. Do you want to try something big that's not an all-government plan, or would you rather play around with modest changes?"
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