Fourteen years after the health-care policy debacle that she oversaw as first lady, Sen. Hillary Rodham Clinton -- deliberate and mindful of the political minefield she wandered into in that previous foray -- yesterday began an effort to reclaim the issue for her presidential campaign.

Delivering what was billed as a major address on lowering the costs of health care, the Democratic senator from New York introduced a seven-point plan designed to reduce premiums, eliminate inefficiencies in the medical bureaucracy and prevent diseases.

"I believe that equally importantly to having a plan, we have to have a political consensus, and that is what I am trying to develop as I talk about health care and engage in a conversation with the American people, because I think Americans are ready for change," Clinton said before an audience of medical professionals and students at George Washington University.

Clinton did not tackle the familiar issue of health insurance coverage, which an estimated 44.8 million Americans lack. Instead -- in a speech announced just one day earlier, on the heels of reports that Sen. Barack Obama (D-Ill.) will deliver his own health-care address in Iowa next week -- Clinton narrowed her focus to health-care costs, a complex subject but one that resonates among many middle-income Americans.

With a self-deprecating nod to being "overly wonky," Clinton said that, as a battle-scarred participant in the 1993 health-care overhaul failure, she understood the importance of devising workable solutions and building political support at the same time.

Advisers said she will deliver at least two more health-care policy speeches in the months ahead to address the quality of care and insurance coverage. That approach is in keeping with her building-block approach to the "ideas primary" phase of the campaign. Earlier this week, Clinton introduced a proposal to provide pre-kindergarten classes to all children.

Her plan calls for seven steps: a "prevention initiative" to reduce preventable diseases such as diabetes; modernizing health-care records through computerization; overhauling care for the chronically ill, whose costs account for approximately two-thirds of all health-care expenditures; "ending insurance discrimination" by providing care to people with pre-existing conditions, who are currently shut out; creating a "best practices institute," with both government and private participants, to determine standards of care; legalizing prescription-drug importation and requiring Medicare to negotiate lower drug prices; and implementing "common sense" changes to the medical malpractice system.

Health care is certain to be a recurring theme of the campaign and one that former senator John Edwards (D-N.C.) has already sought to make a mainstay of his candidacy.

Advisers said that Obama will present a comprehensive proposal in Iowa City next week and that it will include initiatives for lowering costs and expanding insurance coverage. For Obama, it will be an opportunity to demonstrate his ability to handle substantive policy, as well as to directly challenge Clinton on a signature issue.

Edwards became the first 2008 presidential candidate to map out an extensive health-care plan when he released his blueprint in February. He suggested a path toward insuring all Americans at a cost of about $100 billion per year, making him the only candidate to explicitly say that he would raise taxes to pay for his proposal.

Edwards had criticized his Democratic rivals for not issuing their own detailed plans; after the Clinton speech, his advisers said Clinton was simply following his lead.

"Today's ideas have a familiar ring," Edwards spokesman Mark Kornblau said in a statement. "John Edwards proposed specific steps to make health care affordable three months ago and -- from preventative care to chronic care to paperless records -- Sen. Clinton has followed him down that path. We welcome her support and eagerly await her plan for universal coverage."
But Clinton's political advisers think she has a natural advantage -- particularly among Democratic voters -- that will allow her to tackle health care as she sees fit. Although her 1993 effort to overhaul the system was mocked as "Hillarycare" and rejected for being unwieldy and expensive, voters have since lived with an increasingly expensive system and largely remember the effort as valiant, her supporters say. At least Clinton tried, they add.

"The candidates have different starting positions with the voters on health care," said Drew E. Altman, president of the Henry J. Kaiser Family Foundation, a nonpartisan institution that has done extensive research and polling on health policy.