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WASHINGTON (AP) — President Barack Obama argued Thursday that a sweeping overhaul of the nation's broken health care system is imperative for the nation's future economic vitality, clashing in an extraordinary live-on-TV summit with Republicans who want far more modest changes. "We believe we have a better idea," declared GOP Sen. Lamar Alexander.
With the marathon policy debate available from start to finish to a divided public, Obama cast the health care crisis as "one of the biggest drags on our economy," painting his overhaul effort as critical to the economic revival that's even more pressing to many Americans.
"We all know that this is urgent," he said.
Obama lamented the partisan bickering that has resulted in a stalemate over legislation to extend coverage to more than 30 million people who are now uninsured. "Politics I think ended up trumping practical common sense," he said.
And yet, even as he pleaded for cooperation — and "actually a discussion, and not just us trading talking points" — he insisted on a number of Democratic points and acknowledged agreement may not be possible. "I don't know that those gaps can be bridged," Obama said. "If not, at least we will have better clarified for the American people what the debate is all about."
His skepticism about reaching consensus was vindicated as soon as the first Republican spoke — in opposition to the mammoth bills that have passed the House and Senate. Alexander said Congress and the administration should start over and take small steps, including medical malpractice reform, funding for high-risk insurance pools, allowing Americans to shop out of state for lower-cost plans and expanding health savings accounts.
"Our views represent the views of a great many American people," he said.
Disagreements were not always expressed diplomatically.
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."
As with much in the complicated health care debate, both sides had a point. The Congressional Budget Office says average premiums for people buying insurance individually would be 10 to 13 percent higher in 2016 under the Senate legislation, as Alexander said. But the policies would cover more medical services, and around half of people could get government subsidies to defray the extra costs.
With such opposing positions well staked out before the meeting and no signs of them changing, the president and his Democratic allies prepared to move on alone. Politically, it would be an all-or-nothing gamble in a midterm election year for Democrats bent on achieving a goal that has eluded lawmakers for a half-century.
One option for Democrats is passing a comprehensive plan without GOP support, by using controversial Senate budget reconciliation rules that would disallow GOP filibusters. Alexander asked Democrats to swear off a jam-it-through approach, while Senate Majority Leader Harry Reid, D-Nev., defended it. Obama weighed in with gentle chiding, asking both sides to focus on substance and worry about process later.
Polls show Americans want solutions to the problems of high medical costs, eroding access to coverage and uneven quality. But they are split over the Democrats' sweeping legislation, with its $1 trillion, 10-year price tag and many complex provisions, including some that wouldn't take effect for eight years.
The Democratic bills would require most Americans to get health insurance, while providing subsidies for many in the form of a new tax credit. The Democrats would set up a competitive insurance market for small businesses and people buying coverage on their own. Democrats also would make a host of other changes, which include addressing a coverage gap in the Medicare prescription benefit and setting up a new long-term-care insurance program. Their plan would be paid for through a mix of Medicare cuts and tax increases.
Another alternative if bipartisan agreement eludes Obama on Thursday is going smaller, with a modest bill that would merely smooth some of the rough edges from the current system. The Republican approaches, for instance, would help people now struggling with costs and coverage but probably not put the nation on a path toward coverage for all.
A month after the Massachusetts election that cost Democrats their Senate supermajority and threw the health legislation in doubt, the White House has developed its own slimmed-down health care proposal so the president will know what the impact would be if he chooses that route, according to a Democratic official familiar with the discussions. That official could not provide details, but Democrats have looked at approaches including expanding Medicaid and allowing children to stay on their parents' health plans until around age 26.
The slimmer backup plan was first reported by The Wall Street Journal.
Obama himself hinted at a Democrats-only strategy. When asked by reporters as he walked to Blair House if he had a Plan B, he responded: "I've always got plans."
"Not only are lawmakers polarized, the parties' constituencies are far apart," said Robert Blendon, a Harvard University professor who follows public opinion trends on health care. "The president is going to use it as a launching pad for what will be the last effort to get a big bill passed. He will say that he tried to get a bipartisan compromise and it wasn't possible."
The summit was held at Blair House, the elegant presidential guest quarters across the street from the White House. Leaders of both parties spoke, with Obama steering the debate as moderator.
It wasn't a grand, or even particularly comfortable, setting. About 40 senators, representatives and administration officials were crowded around a large hollow square table in a cramped room, perched for the six-hour marathon on wooden chairs with thin cushions. Coffee breaks had been ruled out, so the only pause in the action would come during lunch.
C-SPAN carried complete coverage, while news operations from cable networks to public broadcasting were making it the focus of their day.
Associated Press writers Erica Werner, Ben Feller and Natasha Metzler contributed to this story.