Hillary Clinton’s long walk through health insurance hell has greatly strengthened her as a candidate and as an advocate for a decent system of medical care.

The senator seems to understand that most Americans want safe and secure health insurance and, at the same time, retain the freedom to pick their physicians, remedies and drugs. “If you’re happy with your health care, nothing changes,” she said when she introduced her plan on her Web site.

That’s a common-sense thought, and she expresses it in strong, simple words. Her political education was brutal during the collapse of her health insurance plan in 1993-94. But the experience made her one of the nation’s experts. Most importantly, while Clinton is knowledgeable, she has also learned that nobody likes a know-it-all.

Only the most discerning policy fanatic could find many differences in the healthcare plans offered by Democratic front-runners Clinton, Sen. Barack Obama, Gov. Bill Richardson and John Edwards, who was first to come up with a program. Generally, they envision health insurance for all and enforced price competition for drugs and insurance. They would prevent insurance companies from refusing policies to those with illness or potential illness. Big employers would have to contribute to employees’ healthcare policies. The Bush tax cuts for those earning more than $250,000 a year would be repealed to help pay for the plan.

The biggest distinction is that Clinton, Richardson and Edwards would require everyone to buy health insurance, just as is done with auto insurance. Those who can’t afford it would get tax breaks or subsidies to help them pay for policies. Only Obama doesn’t propose this potentially explosive mandate. And it is explosive. According to healthcare reform site CalHealthReform.org, a 1998 study found that almost half the non-poor uninsured in California didn’t think health insurance was a good value. They thought they were healthy and intended to remain so. Such blind optimists are not likely to support a health insurance mandate.

The most noticeable contrast between the Democratic presidential candidates is in their presentation, particularly on television and the Internet, the main sources of information for the portion of America interested in the race.

This was evident on Sept. 20 when PBS televised an AARP forum in Davenport, Iowa.

The moderator, Judy Woodruff, gave the event a smart and civilized tone that was perfect for such a generally well-mannered state. Obama skipped the forum, prompting David Yepsen, columnist for the Des Moines Register, to characterize him as the night’s “clear loser.” Yepsen said, “Since the average age of a caucus-goer in Iowa is something over 50, it wasn’t as if Obama was stuffing some obscure party constituency group.” The Iowa caucuses are Jan. 14.

Uninvited were former Sen. Mike Gravel and Rep. Dennis Kucinich. Michael Getler, the PBS ombudsman, quoted Gravel as saying the AARP decided that candidates must have at least “one paid campaign staff representative” and “a campaign office” inside Iowa.

With three candidates missing, I thought the debate was more incisive than the usual mass candidate shout-out. Occasionally it was even funny. After listening to Richardson repeatedly brag about being governor of New Mexico, Sen. Joe Biden said, “My good friend from New Mexico, God love him — it’s a couple of million people. Great. If you can pull that together, pull together 300 million people. That’s like saying, ‘I played halfback when I was in high school; now I can play for the pros.’ “

When it came to issues, Clinton had the home field advantage. The topics were old-age security and health insurance. “Been there, done that,” she said.

Clinton was also strong earlier in the week in a half-hour presentation of her plan on her Web site, hillaryclinton.com. Answering soft questions from supporters, she gave a clear explanation of what to expect. Her most important point, as far as the consumer is concerned, is that Americans would be able to “choose your own doctor, if that’s what you want.”

Clinton, like the others, leaves the insurance companies in the health equation, but would regulate them much more than they are now. On her webcast, Clinton said the insurance industry must “make a big change because of their refusal to offer coverage to people at an affordable price, their refusal to cover people’s pre-existing conditions. … I’m very hopeful we will put doctors back in charge of your health care. … “

Only Kucinich wants to eliminate the insurance companies. He favors what is confusingly called a “single payer plan.” In other words, the federal government collects the money and dispenses it to your physician, hospital or pharmacy. Medicare works that way. While I hope I don’t frighten away any younger readers, I’ll confess to being a Medicare recipient, and it is a terrific system.

But Medicare for all is too big a change for the other candidates and probably impossible to pass. Congress and its constituents don’t like huge change.

There is another factor in the campaign debate over healthcare. The health and insurance businesses are big contributors who no doubt figure they have bought themselves a place at the table.

Reports of the Center for Responsive Politics show Clinton has received $990,611 from health professionals, ranging from doctors to hospitals, from nursing home to dentists. Obama has received $748,637, Edwards $246.926, Richardson $149,450, Biden $70,600 and Sen. Christopher J. Dodd $67,250. Dodd, from insurance capital Connecticut, received $605,950 from insurance companies. Insurance also gave Clinton and Obama substantial amounts.

Clinton, according to the Los Angeles Times/Bloomberg Poll, is holding a five-point lead over Edwards in Iowa, where he is pounding her for her contributions from the health and insurance industries. Polling leads don’t mean much in Iowa at this point. Four years ago, Howard Dean led in the Iowa polls until the caucuses neared. He finished third behind John Kerry and Edwards.

But Clinton is a better candidate than Dean ever was. She grows stronger in every debate. She has a direct way of speaking. She is positive. While she doesn’t seem especially warm, she appears friendly and understanding.

Most important, she knows what she is talking about. After six years of incompetence, that may be enough to win.

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