First lady and U.S. Senate candidate Hillary Rodham Clinton, fresh from her difficulties with the fate of Puerto Rican terrorists, indicated this week that she is ready for round two of her universal health care battle. Here’s hoping she has learned something in the last six years about presenting her ideas to the public.

“One of the issues that I will, if I run, emphasize is health care,” she said to a group of elderly Long Islanders. “We are going to have to face that problem in the next few years because the problem will only get more difficult and more expensive.” The “if I run” part is merely cute, but she is right about the state of health care. A recent estimate by a national research group suggests that Medicare costs will more than double in 25 years, as the baby boomers become elderly. While nationalizing health care under the supervision of the federal government seems an anathema to some, horror stories of managed care denials are piling up at state agencies that regulate insurance companies.

The American Medical Association notes that 49 percent of all medical care is now paid for through HMOs, and the conduct of the managed care companies has become so controversial that a “bill of rights” designed to give patients the right to sue health insurers is now proceeding through Congress. Worse, the number of people without health insurance continues to climb by approximately 1 million per year and is now approaching 45 million. Clearly, the U.S. health care system is not adjusting smoothly to its plunge into the choppy waters of the open market.

As Mrs. Clinton knows, no single swipe at the shortcomings of the system is going to pass Congress. Rather, an industrious senatorial candidate might propose a series of steps that nation could take over several years to repair the broken system. The first of these is to recognize, as has often been stated, that health care ought to be viewed as a right of citizenship and not an obligation of business. Just as primary and secondary education are provided to all students, health care should be regarded as an essential part of an enlightened society.

In the meantime, there are many smaller issues that Congress should address, like reducing pharmaceutical costs for the elderly, improving mental-health access and fixing the reimbursement system for long-term care. One step some consumers might consider is to find out whether their doctors are part of a trend that includes physician groups and networks across the country. They are reducing their fees by 35 percent to 50 percent to patients who are willing to pay at the time of the visit. These doctors charge less to avoid the increasingly acrimonious and time-consuming interactions with health insurers.

Patients who pay up front can plan to pay for hospitalization by using high-deductible major medical insurance to cover catastrophic illness. The plan would make sense if a patient regularly spent less on health care in a year than the amount paid in health insurance premiums. A call to the local Blue Cross-Blue Shield office was revealing: Health insurance for a family of five costs $898 a month for the HMO plan, and $218 a month for the $5,000 deductible, catastrophic illness coverage, a difference of $8,160 a year.

Such a solution, however, is temporary and should not be seen as a substitute for widespread access to health care. Instead, it is an example of what Americans might consider in the absence of an effective system.

Whether or not she becomes the junior senator from New York, Mrs. Clinton has an important issue in health care. Despite her troubles with it back in 1993, she can help the nation understand that it need not accept the current failures that beleaguer this essential service.