A cap on premiums has been part of Mrs. Clinton’s universal coverage proposal since she announced it in September. Her published plan did not disclose her thinking on where to place the cap. She also said in the interview that she preferred to set the limit at a single level for all Americans rather than varying it by income.
Mrs. Clinton, a New York Democrat, set out a comprehensive approach to her signature issue of health care in three speeches last year, but she has been criticized for not providing details on several crucial components. She largely continued that approach in the interview, saying she would leave particulars like the eligibility criteria for her proposed health insurance tax credits to negotiations with Congress.
But she did discuss her thinking on other questions, including the premium cap, and expressed openness to measures she had not previously embraced.
She said, for instance, that it “might be appropriate” to require insurers to spend a heavy proportion of every premium dollar on health care as opposed to overhead and profit. Several governors, including Arnold Schwarzenegger of California and Edward G. Rendell of Pennsylvania, have proposed requiring that insurers spend 85 percent of premiums on health care.
Without specifying a number, Senator Barack Obama, Mrs. Clinton’s rival for the nomination, has backed that general concept.
Mrs. Clinton also she said if she could not generate the money needed to pay for universal coverage through other means, she would not object to raising the excise tax on tobacco products, which Congress last increased in 1997 to 39 cents a pack.
“I’m a big believer in raising tobacco taxes,” Mrs. Clinton said when asked whether an increase should be on the table. “You know, when we were working on the Children’s Health Insurance Program, that’s the funding stream that the Congress came up with, which was bipartisan, which worked out very well. At some point, there’s going to be diminishing returns. But, sure, why not? I don’t have any objection to that.”
As in her debates with Mr. Obama and other contenders, Mrs. Clinton displayed an easy command of health policy in the 45-minute interview, conducted in a basement meeting room in the Midtown Manhattan tower that houses her Senate office. Her voice hoarse, she conceded some weariness from the lengthy campaign, saying her decision to take off the Easter weekend had only allowed exhaustion to set in. But despite calls by some Democrats for her to abandon the race, she gave no hint that she was viewing her campaign in the past tense.
Mrs. Clinton presented a confident defense of her call for universal coverage, saying it reflected not only a moral imperative, but also the best chance to reduce costs and improve quality.
“I know that there are a lot of experts who may disagree about how to get to universal health care,” she said. “But they agree with me that in the absence of universal health care it’s very difficult to control costs, and it’s extremely hard to incentivize quality improvements at the level you need to really see results.”
Though that view is not shared by Senator John McCain or any of the rivals he vanquished to secure the Republican nomination, Mrs. Clinton said she thought that “the time is right” to build a bipartisan consensus to reorganize the health system.
She pointed to a growing demand for change by businesses, which bear the brunt of rising premiums, and to the support by some Republicans for a Senate bill that, like her proposal, would require individuals to buy policies and toughen regulation of the insurance industry.