The most interesting thing about Hillary Clinton’s rollout of her health care plan yesterday was not the substance of the plan—which is not much different from what John Edwards and Barack Obama have offered—but the cautious and defensive tone she and her campaign have taken toward it. Clinton constantly repeated, during the rollout, that this idea was different from the “HillaryCare” proposal of 1993. “This is not government-run,” she told a cheering audience, “there will be no new bureaucracy.”

The chief reason for Hillary’s circumspection, of course, is her leading role in the Democrats’ last health care debacle. In one respect it actually seems like she is probably over-reading the importance of that line on her resume—how many voters really remember the ‘93 debacle or think of it as a great shadow over Hillary Clinton? This seems like a Washington cliché that has taken on a life of its own.

In another respect, her caution is absurd and misleading. The notion that an entirely new scheme of nationalized health insurance regulation will involve “no new bureaucracy” is risible. The idea that the new public insurance options to be part of the menu on Hillary’s plan won’t expand government-run coverage is ludicrous.

And more importantly, Clinton’s approach (and that of the Democrats generally) will create increasingly government-run care in more profound ways over time. Their response to the growth of health insurance premiums is to introduce new regulations and a new payer into the system. But introducing a new payer into the system does not reduce costs (on the contrary, as Medicare shows us, it tends to increase them), and Clinton has not offered any other serious way to reduce costs. She has offered, in the end, only a way to shift some costs to the government—and yet she still claims that would not shift control to the government.

He who pays the piper calls the tune. The emerging Republican approach to health care would have patients (rather than employers) pay—and would offer some aid to those who can’t. Hillary’s approach would have the government pay, and whether she wants to acknowledge it or not, would therefore have bureaucrats call the tune.

She is right to worry that government-managed health insurance will scare voters. But she is wrong to insist that her plan doesn’t qualify for the title.