WASHINGTON – Giving no ground, President Barack Obama and Republican leaders fought forcefully for their competing visions of historic health care reform Thursday in an exhausting, often-testy live-on-TV debate. Far from any accord, Obama signaled the Democrats were prepared to push ahead for an all-or-nothing congressional vote.
The marathon, 7 1/2-hour session did reveal narrow areas of agreement on the topic that has vexed Congress for months and defied U.S. leaders for decades. But larger ideological differences overwhelmed any common ideas, all but cementing the widely held view that a meaningful bipartisan health care bill is not possible as time grows short in this election year.
Obama rejected Republican preferences for starting over, discussing the issue much longer or dealing with it in a limited, step-by-step fashion.
"We cannot have another yearlong debate about this," Obama declared. "I'm not sure we can bridge the gap."
Party officials said March is probably the last chance to act.
It has been more than a year since he proposed his overhaul, which would be important to virtually all Americans in remaking the way they receive and pay for health care. The version he embraces, basically tracking legislation passed by the Senate, would expand health coverage to some 30 million people who lack it and stop insurance companies from dropping people for questionable reasons or denying coverage to people who have certain illnesses.
Obama and the Democrats portray the current situation as a major crisis, with tens of millions of people left with no health insurance at all and health care costs threatening to bankrupt the nation. The Republicans see problems as well, but seek more modest steps to deal with them and say Obama's plan would run up the federal deficit — despite his claims to the contrary.
Obama strongly suggested that Democrats will try to pass a sweeping overhaul without GOP support, by using controversial Senate budget rules that would disallow filibusters. And then, he said, this fall's elections would write the verdict on who was right.
Democratic leaders tried to portray Republicans as hypocrites for denouncing parliamentary tactics they, too, have used. Democratic leaders hope to embolden colleagues who worry about re-election races in the face of polls showing substantial dislike for the party's approach.
The Democrats-only strategy could face particularly strong resistance in the House, where 39 party members voted against an Obama-backed health care bill last year.
Democratic officials confirmed Thursday that the White House has developed a slimmed-down health care plan as a possible "Plan B" fallback.
But that contingency also faces problems, including possible defections from House liberals who insist the overhaul must be expansive. Democratic officials conceded it's possible that no health care legislation will pass this year, which would leave their candidates with little to show while Republicans claimed a big win.
At Thursday's summit, Rep. Eric Cantor, the No. 2 House Republican, agreed with Obama that "we have a very difficult gap to bridge here." But he differed strenuously about resolving it. "We just can't afford this," he said of the $1 trillion, 10-year proposal. "That's the ultimate problem."
Cable news networks carried long portions of the summit, which featured 38 lawmakers sitting around a square table heaped with documents and notepads. They spoke of arcane issues such as insurance "rescissions" between sharp partisan exchanges. Moderator Obama, looking annoyed at times, interrupted Republicans fairly often, and a few of them interrupted him back.
At one point, Senate Republican leader Mitch McConnell of Kentucky accused him of shortchanging the GOP on opportunities to speak.
With the conversation veering between mind-numbing detail and flaring tempers, the two sides held onto long-entrenched positions.
Sen. Lamar Alexander, R-Tenn., derided Obama's plan. "This is a car that can't be recalled and fixed," he said, "and we ought to start over."
Alexander challenged Obama's claim that insurance premiums would fall under the Democratic legislation. "You're wrong," he said. Responded Obama: "I'm pretty certain I'm not wrong."
Democratic officials said House and Senate leaders will confer with colleagues in coming days or weeks to see if they have enough votes to push a far-reaching bill through both chambers with no GOP help.
Republicans repeatedly pressed Obama to renounce the possibility of using "budget reconciliation" rules to push the Democratic plans through the Senate without allowing GOP filibusters. Obama brushed them off, saying they seemed more interested in process than substance.
Americans want a decision on health care, the president said, and most of them think "a majority vote makes sense." Democrats control 59 of the Senate's 100 seats, one vote short of the number needed to halt bill-killing filibusters.
Top Democrats described the summit as the beginning of the end of their long push to overhaul health care, a bid rocked by raucous, conservative-dominated forums last summer that threw Democrats on the defensive. Eyeing the November elections, rank-and-file Democratic lawmakers are desperate to resolve the debate and focus on jobs and economic revival.
"If nothing comes of this, we're going to press forward," Democratic Senate Whip Richard Durbin told reporters during a break in the summit. "We just can't quit."
One of the sharpest exchanges occurred between Obama and Sen. John McCain, the Arizona Republican he defeated for the presidency. As McCain criticized numerous provisions in the Democrats' plan, Obama said, "we're not campaigning anymore. The election is over."
McCain laughed and said, "I'm reminded of that everyday."
At another point, McCain refused to yield to Obama, saying, "Can I just finish please?"
Obama ribbed Cantor, the House GOP whip, for bringing to the table the 2,400-page Senate bill, which the Virginia congressman described as too costly, bureaucratic and intrusive. Obama called it a political prop, and said health care is a complex issue that can't be reduced to snippets.
Republicans repeatedly noted that polls suggest Democrats are on the wrong track. A USA Today/Gallup survey released Thursday found Americans, by 49 percent to 42, lean against Democrats forging ahead without any GOP support. Slightly more than half oppose the idea of Senate Democrats using budget rules to bar filibusters to stop the bill.
Congressional aides said top Democrats will take a few days to gauge the summit's impact on the public and, perhaps more importantly, on moderate House members who are likely to determine whether any health care bill will pass.
If the effort fails, Democrats may try a scaled-back plan to insure about 15 million more Americans, rather than 30 million. Among other things, the plan would require insurance companies to let people up to age 26 stay on their parents' health plans.
The summit participants noted a handful of areas where the two parties seem largely to agree. They include barring insurers from dropping customers who become sick, ending annual and lifetime monetary limits on health insurance benefits and letting young adults stay on their parents' health policies to their mid-20s or so.
But Republicans stuck to their main talking points. "The American people want us to scrap this bill," said House GOP Leader John Boehner of Ohio, reaching over and touching the massive Senate legislation.
As darkness neared, McConnell also urged Obama to "start over with a blank piece of paper."
Associated Press writers Ricardo Alonso-Zaldivar, Erica Werner, Ben Feller, Jennifer Loven and Natasha Metzler contributed to this story.