Back in 1994, Hillary Clinton’s 1342-page plan to restructure radically the one-seventh of the American economy devoted to health care was scary enough that it led to the election of a Republican Congress for the first time in 42 years. Now she’s trying again, and the way we read it, it may yet be enough to elect Mayor Bloomberg, Mayor Giuliani, Governor Romney, or just about anyone other than her to the White House.

It’s not that Mrs. Clinton, now a senator, hasn’t learned anything from her experience the last time around. The plan she released yesterday was 14 pages long, not 1342. One of its seven elements was investing in health information technology, which is such a matter of bipartisan consensus that it has been a pet project of Karl Rove. Another is “common-sense medical malpractice reform,” which Republicans have been pressing for years.

Delve into the details, however, and it becomes clear that, 13 years after her health care plan failed, Mrs. Clinton hasn’t lost her instinct for socialized medicine. Her version of medical malpractice “reform” doesn’t cap punitive damages. It doesn’t create specialized medical courts, and it doesn’t create a “loser-pays” system for legal bills. Doing any of that would actually confront the problem, but it would also risk alienating a key Democratic constituency, trial lawyers. Instead she proposes to allow doctors who admit their errors to settle with patients — not a bad idea, but somewhat beside the point.

She proposes to create new restrictions on commercial free speech — and attack the already ailing newspaper and magazine industries — by saying she would “limit direct-to-consumer advertising” by drug companies. It’ll be interesting to see how Mrs. Clinton’s base in the abortion-rights community reacts to the idea of restricting, say, Duramed’s advertising of Plan B, the emergency contraceptive.

And it is all framed in a rather grim, budget-crunching way — not speaking optimistically about medical innovation or warmly about the doctor-patient relationship, but pessimistically about how health care in America is costing more than we can afford. “Health care costs are spiraling out of control. Premiums have almost doubled since 2000 — increasing four times faster than average wages,” Mrs. Clinton said yesterday. “Every day, parents choose between paying the premium for themselves or their children. Small businesses wonder how they will stay afloat when their health care costs eat up their profits year after year. CEOs of major American companies worry about how they will succeed in the global economy when they’re competing with foreign companies that spend significantly less on health care.”

From Massachusetts to New York to California, states are already tackling the challenges of insuring more patients. It’s unclear why Mrs. Clinton feels a Washington-based solution is necessary. Senator Frist, a physician, would have been a good person to challenge Mrs. Clinton on these issues, but he isn’t in the presidential race. That leaves Tommy Thompson, the former governor of Wisconsin who was President Bush’s secretary of health and human services, and two other politicians who have yet to enter the race formally, but who know a lot about health care — Newt Gingrich and Mr. Bloomberg. Both understand the importance of innovation and entrepreneurship, and the need to look at health care — and the rest of the American economy, for that matter — not strictly as an area from which to wring cost savings, but as an area in which American creativity and excellence can contribute to economic growth while healing the sick in America and around the world.