Sen. Hillary Rodham Clinton (D-N.Y.) has learned a few things over the last 15 years.

And if Republicans aren’t careful, she is going to put that knowledge to use to jam a new version of Hillary healthcare down their throats.

First, Hillary’s new proposal is much different — at least, superficially — from her proposal a decade and a half ago. Gone is the big mousetrap, full of government bureaucracy and noxious mandates. Gone is the socialistic decree that nobody’s healthcare can be better than anybody else’s. Gone are the back-room secret meetings and the big imagination of Ira Magaziner

Now, those things might come back in the legislative details of a real proposal. And of course, she includes higher taxes (on the rich) and a mandate that everybody must buy insurance. But she has some carrots in their as well, things like subsidies for the poor and small-business owners to buy insurance.

Things are different now.

True, most Americans are very satisfied with their own health coverage (close to 80 percent in a Democracy Corps Poll). That says to me that most Americans don’t want radical change that could put their own healthcare insurance in jeopardy. But polls also show that most Americans are anxious about their healthcare future.

The ground is shifting on healthcare in this country.

It is shifting in corporate America. Big business wants the government to take over the burden of employee healthcare. With the rest of world’s governments paying for the healthcare of their citizens, corporate bigwigs see that they are losing their competitive advantage because of big healthcare costs. So Republicans need to beware on this issue.

And the ground is shifting in the rest of America, too. The numbers of people who work in small businesses or work for themselves have increased substantially. People no longer start with a company and expect to stay with it for 30 years. They take buy-outs, they start consulting businesses, they open coffee shops. And many of these folks are terrified by the high cost of healthcare.

There are two fundamental approaches to dealing with the healthcare future of this nation. One is to shift more of the burden to the government, with government mandates, government rules and government bureaucracy. This is the choice of most Democrats, and it appeals to many people, because it seems so easy.

The other approach is to introduce more market reforms to inspire competition, to take away the inflated costs of third-party liability, to cut down on frivolous lawsuits, and to take the burden away from the government and give consumers the power to make choices. That is the preferred model of most free-market Republicans. But for some reason, the concepts of the free market and the benefits of capitalism have lost luster in many quarters in this nation.

Republicans need to engage this battle and they need to do it soon. They shouldn’t rely on big business to be on their side, because I think business is looking to the government for a bailout. They need to engage in this battle and they need to get the messaging right, because Hillary healthcare is not as far away as it seems. And they won’t be able to use the same tactics they used 15 years ago. Hillary has changed her game plan. Republicans need to change theirs, too.