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More than a decade after her first attempt at universal coverage crumbled, Democratic presidential candidate Hillary Clinton re-entered the health care debate yesterday. Her second stab at a health care overhaul would extend coverage to all Americans and lower the cost of care, Clinton said.

"I believe everyone - every man, woman and child - should have quality, affordable health care in America," Clinton said in Des Moines, Iowa, where she detailed her $110 billion plan. "We should do it because it is the right thing to do, because we can no longer tolerate the injustice of a system that shuts out nearly one in six Americans."

Saying that "the only way to guarantee affordable coverage for everyone is to cover everyone," Clinton proposed making insurance mandatory. But her plan stresses consumer choice, as evidenced by its title, "The American Health Choices Plan." People could continue their coverage or buy into one of the private insurance plans available to federal employees. A plan modeled on the federal Medicare program would also be an option.

Ending some of the President Bush-backed tax breaks for people earning more than $250,000 annually would help pay for the overhaul, said Clinton, a New York senator. Outlining a series of cost-cutting measures, Clinton also proposed allowing Medicare to negotiate for lower drug prices and creating electronic medical records. At least $120 billion in annual savings would come from modernizing the health care system and focusing on disease prevention, according to Clinton's plan.

Clinton's plan comes several months after several of her Democratic opponents, including former North Carolina senator John Edwards and Illinois Sen. Barack Obama, outlined their proposals. Edwards criticized what he described as Clinton's ties to lobbyists yesterday.

"The only way to bring real health care reform is to end the Washington influence game once and for all," Edwards said, according to prepared remarks.

Edwards's plan has a public health insurance system competing for market share with private insurers.

The Democrats' plans differ slightly, although each aims to expand coverage to the estimated 47 million uninsured Americans and drive down costs. Clinton and Edwards would both require all Americans to obtain coverage, while Obama would only make insurance mandatory for children, health care experts said.

But voters are interested in larger issues of universal coverage and health care costs, not policy specifics, political observers said yesterday.

"It's difficult to imagine voters choosing between one of the front-runners and another based on the health care proposals that are out there," said Dante Scala, a professor of political science at the University of New Hampshire. Voters "are listening to who's paying the most attention to it, as opposed to who has the most details."

Clinton sought yesterday to pre-empt the type of criticism that helped derail her first health care plan, which she worked on during her time as first lady.

"I know my Republican opponents will try to equate health care for all Americans with government-run health care. Well, don't let them fool us again," Clinton said. "This is not government-run. There will be no new bureaucracies. You can keep the doctors you know and trust. You can keep the insurance you have, if you like it."

The plan reflects a shift in emphasis from Clinton's first proposal. In the 1990s, the Health Insurance Association of America created the "Harry and Louise" television advertisements, which described the plan as creating an expensive new bureaucracy and limiting consumer choice.

"One of the things that scared middle-income people was that her old proposal, you had to enroll and get your insurance from these new things called alliances," said Robert Blendon, a professor at the Harvard School of Public Health. Clinton's first plan would have required most companies to pay for 80 percent of their employees' health insurance. Small businesses would have received subsidies. The bill also directed people to join insurance-purchasing groups, known as alliances. (next page »)