WASHINGTON - Giving no ground, President Obama and Republican leaders fought forcefully for their competing visions of historic health-care reform yesterday in an exhausting, at times 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, 71/2-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 that March was 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 30 million people who lack it and stop insurers from dropping people for questionable reasons or denying coverage to people who have certain illnesses.

Obama and the Democrats portray the situation as a crisis, with millions of people left with no health insurance and costs threatening to bankrupt the nation. The Republicans also see problems but seek more modest steps and say Obama's plan would run up the federal deficit - despite his assertions to the contrary.

Obama strongly suggested that Democrats would try to pass a sweeping overhaul without GOP support, by using 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 that they, too, have used. Democratic leaders hope to embolden colleagues who worry about reelection 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 bill last year.

Democratic officials confirmed yesterday that the White House had developed a slimmed-down plan as a possible "Plan B" fallback.

'A very difficult gap'

But that contingency also faces problems, including possible defections from House liberals who insist the overhaul must be expansive. Democratic officials conceded it was possible that no health-care legislation would pass this year, which would leave their candidates with little to show while Republicans claim a big victory.

At yesterday'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 plan. "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 to long-entrenched positions.

'You're wrong'

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 assertion 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 that House and Senate leaders would confer with colleagues to see whether they had 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 said 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 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 J. Durbin of Illinois said during a break in the summit. "We just can't quit."

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 was a complex issue that could not be reduced to snippets.

Republicans repeatedly noted that polls suggest Democrats were on the wrong track. A USA Today/Gallup survey released yesterday 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. The phone poll of 1,009 adults had a margin of error of plus or minus 4 percentage points.

Video from the summit and other links via http://go.philly.com/obama EndText