After nearly a daylong session at Blair House, both sides in the health care debate walked away without much agreement on major outstanding issues. And perhaps that was the expectation all along.

About six hours into the session, Senator Mitch McConnell, Republican of Kentucky, still counseled that the existing bills should all be scrapped and everyone should start over. Afterward, Mr. McConnell wouldn’t go so far as to write off the extraordinary roundtable as a waste of time. But he said pointedly: “Frankly, I was discouraged by the outcome.”

Of course, Republicans had approached the session with considerable skepticism, especially after the White House posted a new set of proposals on Monday, three days in advance of this meeting. For days, Representative John Boehner, the House minority leader, and other Republicans had expressed dismay over the president’s apparent intention to push forward with a big, broad bill. The Ohioan’s facial expressions today suggested that he was clearly unhappy with Mr. Obama’s directions and directives.

For the Democrats’ part, one after another tried to stress to Republicans that they were “so close” on some issues and tried to tackle some of the more yawning divides between the two — such as covering more of the uninsured, dealing with insurance pools and coverage across state lines.

When it came time for Representative Eric Cantor, the Republican minority whip from Virginia, to speak, he declared that the American public just couldn’t afford the president’s plans. Like other Republicans at the table, Mr. Cantor tapped on a sizable pile of paper, the Senate bill at about 2,400 pages, along with Mr. Obama’s latest proposal.

And after Representative Peter Roskam, Republican of Illinois, complained that the latest efforts at compromise by Democrats were simply to put some Republican breadcrumbs on top of the old proposals, Mr. Obama came back around to say that these attempts were not mere sprinkles or crumbs.

While the president clearly dominated the session, often taking apart a Republican’s assertions before moving on to the next speaker, his efforts at persuasion, however realistic he had been in his approach, failed to sway the opposing side. But, as has been pointed out repeatedly, perhaps that was the strategy all along. Bring the Republicans to the table, tease out some themes, but in the end delineate the irreconcilable differences as though you were standing in divorce court. And then walk away, separately.

And that’s what Mr. Obama seemed to be suggesting toward the end. Democrats have wanted this for five decades, he said, and the American people can no longer wait. He set a deadline of a month to six weeks or so for Republicans to join them on this issue, but warned that the Democratic leaders of Congress would then go it alone to try to get it done. — Kate Phillips

The president has ended his concluding remarks and the session is over. It doesn’t sound as though he’ll convene another large roundtable like this one.

As he has been talking about the differences between Democrats and Republicans, he argues it’s too late for baby steps. At one point, he waves his hand toward another part of the table pointing to Representative John Dingell, the Michigan Democrat whose father used to introduce universal health care bills every year. “The concern of a lot of colleagues — after a year and half or more appropriately after five decades — of dealing with this issue, starting over they suspect means not doing much,” he says, adding that limiting coverage to only three million people would not be enough.

He suggests that if they cannot find agreement within a month or so, there’ll be big fights about process in the House and Senate — (hint, hint that he’ll move on without Republicans to get this done, using that reconciliation move that only requires a simple majority vote).

As for calls from Republicans, even at this session, to scrap all the proposals and head back to a drawing board, Mr. Obama told those in the room that parents of sick children and other Americans ” don’t want us to wait. They can’t afford another 5 decades.”

He did say he understands that it may be risky for Republicans to vote with Democrats on some form of this legislation. “I don’t need a poll to know that most Republican voters are opposed” to his ideas, he said.

Ultimately, judgments will be rendered on his health care plans and people will choose to disagree with him or with Republicans. “That’s what elections are for,” he said toward the end.

It did not sound as though Mr. Obama would be willing to hold another round of these talks with Republican and Democratic leaders. Afterward, although he called it a “terrific discussion, he added, “let’s see if it changes anyone’s attitudes.” — Kate Phillips

The president begins to make closing remarks, and it’s pretty clear he’s studied the details way down into the weeds. Claiming that his ideas would not result in a government takeover of health care, Mr. Obama runs through some areas that Democrats and Republicans seem to have some common ground on — on pre-existing conditions, exchanges.

But he adds, “With respect to the most contentious issue I’m not sure we can bridge the gap. How do we provide coverage not only for people who don’t have insurance right now, but people who have pre-existing conditions and are being priced out of coverage?” — Kate Phillips

Speaker Nancy Pelosi argues that even though she wishes there were still a public option, Democrats and others have shifted to talking about exchanges — something she considers incorporation of a Republican idea.

But she also takes issue with statements made by Republicans earlier in this session, and singles out Mr. Boehner, the minority leader in the House, saying his assertions were “not factual.” She says, “The law of the land is no public funding of abortion and there is no public funding of abortion in these bills” to much murmuring farther down the table where Mr. Boehner is sitting. She also said she had to correct another lawmaker’s discussion of Medicare benefits, saying the cuts outlined in the existing bills would not cut benefits to the elderly. “They do not. They do not,” she says.

There’s no question that trying to pass health-care legislation is hard, she adds. “The misrepresentation campaign that’s gone on about these bills — it’s a wonder anybody would support them, as Mr. Waxman said,” Ms. Pelosi says. But she cites Social Security and Medicare legislation as examples of how this can be achieved.

Senator Mitch McConnell may as well be pitching a line for extreme makeovers. He reiterated his opposition to the existing proposals, citing polls saying the American people want these plans put on the shelf. He urges starting all over again, calling health care an extremely personal issue.

On the issue of polls, President Obama retorts that in many polls, when you get down to individual questions, people favor a lot of the varying provisions. (It is true that many answers vary on certain plans when a pollster varies the phrasing and the language of a specific piece.) As for the notion that lawmakers understand what their constituents want and have their pulse on their districts and states, Mr. Obama says, “I hear from constituents in every one of your districts and every one of your states.” — Kate Phillips

Stephen Crowley/The New York Times

Senator Ron Wyden, whose bipartisan health care bill with Senator Bob Bennett of Utah never really gained traction, promises to gather ’round those who are in favor of interstate shopping for insurance to hammer out differences.

Mr. Wyden returns to the issue of federal coverage for lawmakers and government officials, saying: “Folks, all of us can fire our insurance companies. …. We’ve got to stay in this battle until everybody has this right.”

(That reminds us of Senator Durbin’s smack earlier at Republicans opposed to health care changes: “If you think it’s a socialist plot, then please drop out of the federal employees health program,” Mr. Durbin says.)

Mr. Wyden offered up some areas of compromise in an earlier post. — Kate Phillips

Senator Chris Dodd, the Democrat from Connecticut who has played an instrumental role on the late Senator Ted Kennedy’s committee, the Health, Employment, Labor and Pension panel, uses his time to cite statistics and studies that he argues show how coverage needs of the uninsured affect the costs of others as well as their own lives. As they sit there, he says and raises his voice, “14,000 of our fellow citizens will have lost their health care today. Roughly 6 to 8 people will have lost their lives today because they’re uninsured,” and cites a study.

In the next 10 years, he continues, every state will have a 10 percent increase in the number of uninsured. He finishes with the argument that coverage is critical and that coverage defies an incremental approach because so many pieces are interlocking. — Kate Phillips

Mr. Obama wants to know whether Republicans have any new proposals for extending areas of coverage to those who don’t have it. The conversation then moves to Representative Peter Roskam, Republican of Illinois, who first diverts to talk about how Mr. Obama was a proven negotiator when he was back in the state Legislature, but that this is far different.

He too keeps patting the 2,400 page Senate bill, taking issue with the Democrats’ claim that it’s a G.O.P. prop. Mr. Roskam says he feels that the current state of things — even at this stage — is throw a little salt and a little pepper on the existing proposals, throw on a few Republican bread crumbs and then the White House and Democrats ask, “Do you like it now?”

He contends that people in his district have grown “increasingly disappointed” with the process.

In case you missed it, Mr. Obama has had another exchange with Senator McCain about using reconciliation, a maneuver that would allow Democrats to pass through certain provisions with a simple majority vote. Mr. McCain warns that it would be harmful for the country, and notes how he and the “Gang of 14″ circumvented a threat for a simple majority when the Republicans were in control and tried to move judicial nominations forward.

While Mr. Obama says “I think most Americans think a majority vote makes sense,” he also adds that they seem able in this session to bridge some differences. — Kate Phillips

Mr. Obama, noting that lawmakers have yet to address the fourth segment to be covered here — coverage — decides to extend the session, which was to end at 4 p.m., to continue until 4:30 p.m.

Senator Dick Durbin, the No. 2 in his chamber, pleads with his colleagues not to make medical malpractice the foremost issue in these discussions. He acknowledges that yes, some reforms would indeed reap savings, but also cites the overall statistics in studies that show medical malpractice awards have been decreasing, not increasing over the last several years.

Senator McCain is back, pointing out how Texas caps awards on various medical malpractice lawsuits, and reminding the president that he too had asked Secretary Kathleen Sebelius to review ways to make savings on reforms in this area. (Mr. Obama does agree that some measures need to be taken, but wryly notes that Republicans don’t mind the federal government stepping in when it’s about an idea they like.)

(The two exchange more light banter: Mr. McCain says “I pay close attention to all of your speeches.” And Mr. Obama responds: “Thank you. That’s more than Michelle does.”) — Kate Phillips

Representative Boehner reminds the president that the House had a very serious discussion about abortion-related provisions (remember the Stupak amendment), and says that any provision about abortion still needs to be addressed.

Mr. Obama asserts that many of Mr. Boehner’s points aren’t on point, per se, with this segment on deficit reduction, and disputes some of the Ohio Republican’s assertions. “Every time we get somewhere, we go back to the standard talking points,” Mr. Obama says. And the president moves on to the next speaker. — Kate Phillips

Representative John Boehner, the minority leader in the House, is another Republican using the mounds of paper representing the existing bills as his prop. He fingers the stacks next to him, arguing that “The American people want us to scrap this bill. They said it loud and they said it clear.” — Kate Phillips

Senator Chuck Grassley, the ranking Republican on the Senate Finance committee, just remembered the thousands of hours and meeting upon meeting held by the former “Gang of Six” on the Finance Committee who tried to reach a consensus bill last year. Mr. Grassley, along with other Republicans, ultimately did not support the overall bill. “I learned a heckuva lot about our health care system that I wouldn’t otherwise know,” Mr. Grassley said of all those meetings, smacking his hand against the table.

Mr. Grassley and Mr. Obama go back-and-forth over Medicare Advantage and whether it actually improves the health of seniors. — Kate Phillips

Mr. Obama and Republicans exchange discussions about Medicare Advantage, to talk about whether the program benefits the elderly or insurers more. Mr. McCain complains again that elderly Floridians are getting a carve-out so that their Advantage programs aren’t cut, while say, elderly residents in his home state of Arizona don’t get the same deal. Mr. McCain said it should be even across the board, and Mr. Obama nods, acknowledges that his former rival has made a “good point.” — Kate Phillips

Representative Paul Ryan, saying he’s respectfully disagreeing, challenges a remark made by Vice President Biden that no one could really presume to know what Americans are thinking. Mr. Ryan argues that lawmakers are qualified to understand the public’s opinions, they’ve held town meetings, they talk to their constituents. “If you think they want a government takeover of health care, I would simply submit you’re not listening to them,” Mr. Ryan said.

Senator Jay Rockefeller, Democrat of West Virginia, paints the insurers as scary sharks, complaining about those who won’t cover pre-existing conditions. “The health insurance industry is the shark that swims just below the water and you don’t feel that shark until you feel the teeth of that shark,” he says.

Very little has been said today about the presumably doomed public option, which did not have enough votes in the Senate. Mr. Rockefeller notes how much he had favored the public option, but acknowledged “that’s probably not going to happen.” — Kate Phillips

The afternoon session begins with Senator Mike Enzi, Republican of Wyoming, talking about some of the proposals he favors. Mr. Enzi lamented that this type of meeting hadn’t occurred 9 months to a year ago.

While heading back to the White House during the break, President Obama stopped to talk to the White House pool reporters outside: “I don’t know if it’s interesting watching it on TV,” he said. “But it’s interesting being a part of it.”

“I think we’re establishing that there are actually some areas of real agreement. And we’re starting to focus on what the real disagreements are. If you look at the issue of how much government should be involved, the argument that the Republicans are making really isn’t that this is a government takeover of health care — but rather that we’re ensuring the — we’re regulating the insurance market too much. And that’s a legitimate philosophical disagreement. We’ll hopefully be able to explore it a little more in the afternoon.”

The session has broken for lunch and a House vote. We’ll be back with more this afternoon.

If there was any doubt about the extraordinary nature of today’s health care session, consider the scene that just played out.

Vice President Joseph R. Biden Jr. jumped into the fray to debate a point on the government’s role in regulating insurance with Representative Eric Cantor, Republican of Virginia.

And for a brief moment, as Mr. Biden spoke, the cameras showed him and President Obama, sitting side by side, engaged in an animated policy debate with the opposition party — a remarkable exchange between the executive and legislative branches of government.

Mr. Biden noted that if Republicans agree that there is a need to end annual and lifetime caps on insurance benefits, and they agree there is a need to bar insurers from denying coverage based on pre-existing medical conditions, and they agree on a number of other regulatory steps, then they cannot also argue that the government has no role to play and Washington should butt out.

“Either you are in or you’re out,” Mr. Biden declared.

Stephen Crowley/The New York Times

Representative Eric Cantor, Republican of Virginia, began to speak at the health care summit, but before he could get more than a word in, President Obama interrupted to make a comment about the mountainous pile of paper sitting in front of Mr. Cantor on the table.

Mr. Obama said: “Let me just guess, that’s the 2,400-page health care bill. Is that right?”

Mr. Cantor was not about to let the president undercount: “Actually, Mr. President, this is the Senate bill along with the 11-page proposal that you put up on line that really I think is the basis for the discussion here.”

For newspaper reporters, the resumption of the health care debate in full force this week seemed to wind back the clock to December, when the Senate battled over the health care legislation for 25 straight days of floor debate.

But now Senator John McCain of Arizona is finally weighing in at the summit meeting, and he seems to be winding the clock back to the 2008 presidential campaign, accusing President Obama of failing to live up to his campaign promise of changing the ways of Washington.

Citing a variety of “special deals” and “special interests” that he said were catered to in the Democrats’ health care legislation, Mr. McCain said, “What we got is a process that you and I both said we would change in Washington.”

Mr. Obama was not going to take it idly. “Let me just make this point, John,” he begain, “because we are not campaigning any more. The election is over.”

With a nervous laugh, Mr. McCain shot back, “I am reminded of that every day.”

Mr. Obama is laying out how much time Congressional Democrats spent on health care legislation over the last year in forums and hearings and floor debate.

Mr. McCain, however, would not relent about the special interests. “The American people care about what we did and how we did it,” he said.

But Mr. Obama closed the door on the exchange. “Yes they do,” he said. “We can have a debate about process or we can have a debate about how we are going to help the American people at this point.”

Representative George Miller, Democrat of California, is explaining how private insurance companies deny coverage, particularly by citing pre-existing medical conditions. And Mr. Miller offered himself up as Exhibit A, noting that he has two artificial hips, arthritis and a kidney stone.

If he had to shop for insurance on the individual market, Mr. Miller said, “I’m dead.”

Mr. Miller is also pointing out the limitations of high-risk insurance pools, one of the core components of the Republicans’ step-by-step alternative approach, noting that anyone who enters a high-risk pools, which tend to provide expensive coverage, has little or no chance of obtaining any other type of coverage.

Stephen Crowley/The New York Times

Mr. Miller’s points were all solid, and no Republican expressed any objection to anything he said.

But Mr. Miller can also rest easy about his own coverage. He’s not up for re-election until November, meaning his coverage through the Federal Employees Health Benefits Program is good at least through the end of his year. And in May, he will turn 65 and become eligible for Medicare.

President Obama has chastised the Senate Republican whip, Jon Kyl of Arizona, for trying to frame the debate in terms of Democrats trusting Washington to make decisions while Republicans trust American individuals and families.

Mr. Obama called that a “good talking point” given the anger directed at Washington these days, but said Mr. Kyl was not getting at the core question of how to make sure that families are protected by decent health insurance.

Mr. Obama then began recounting what he believes to be areas of agreement between Republicans and Democrats on a variety of issues including allowing parents to continue dependent coverage of their adult children through age 25 or 26, barring insurance companies from suddenly revoking coverage through a process known as “recission” and barring insurers from denying coverage based on pre-existing conditions and ending annual and lifetime caps on benefits.

To the extent that Mr. Obama and the Democrats succeed in pointing out where Republicans agree with the Democrats’ goals, they may be able to undercut the core Republican argument that Democrats need to throw out all the legislation they have done so far and start over.

Senator Charles E. Schumer, Democrat of New York, laid some of the groundwork for that effort, pointing out that Democrats agree with many of the points made earlier by Senator Tom Coburn, Republican of Oklahoma, and would be glad to include his ideas along with other steps the Democrats have proposed to combat fraud.

Mr. Schumer also pointed to a proposal by Senator Maria Cantwell, Democrat of Washington, included in the Democrats’ bill that would begin to reward health care providers who consistently provide higher-quality care with higher Medicare payments.

Once again, the president seems to be expressing a little impatience with Republican speakers, most recently Senator Jon Kyl of Arizona, whose remarks included criticisms of the existing bills. Before allowing the next person to speak, Mr. Obama takes issue with some of the positions outlined by Mr. Kyl on premium costs and interstate purchase of insurance.

Mr. Obama makes up a name for his hypothetical car insurance company — ACME?

Stephen Crowley/The New York Times

The Republican Health “Fact Check” team is using the Senate majority leader’s own words against him on the question of whether Democrats will use a parliamentary move known as budget reconciliation to finalize the health care legislation.

Here’s their “Fact Check” bulletin, citing a blog post from The Hill, a publication that covers Congress.

“Reid Said … Democrats Would Use The Reconciliation Process. ‘We’re Going To Have That Done In The Next 60 Days.’” “Democrats will finish their health reform efforts within the next two months by using a majority-vote maneuver in the Senate, Majority Leader Harry Reid (D-Nev.) said. Reid said that congressional Democrats would likely opt for a procedural tactic in the Senate allowing the upper chamber to make final changes to its health care bill with only a simple ‘I’ve had many conversations this week with the president, his chief of staff, and Speaker Pelosi,’ Reid said during an appearance Friday evening on ‘Face to Face with Jon Ralston’ in Nevada. ‘And we’re really trying to move forward on this.’ The majority leader said that while Democrats have a number of options, they would likely use the budget reconciliation process to pass a series of fixes to the first healthcare bill passed by the Senate in November. These changes are needed to secure votes for passage of that original Senate bill in the House. ‘We’ll do a relatively small bill to take care of what we’ve already done,’ Reid said, affirming that Democrats would use the reconciliation process. ‘We’re going to have that done in the next 60 days.’” (“Reid: Dems Will use 50-Vote Tactic To Finish Healthcare In 60 Days,” The Hill’s Briefing Blog, 2/20/10)

Stephen Crowley/The New York Times

Here’s the transcript of what Mr. Reid said today, responding to Senator Lamar Alexander, Republican of Tennessee, and it is not entirely clear what point he was trying to make. Clearly, he wanted to note that Republicans have used the reconciliation process in the past, and he seemed to want to say that Democrats do not see reconciliation as the only path forward.

: “Again, Lamar, you’re entitled to your opinion but not your own facts. No one has said — I read what the president has online — no one has talked about reconciliation, but that’s what you folks have talked about, ever since that came out, as if it’s something that has never been done before. Now, we as leaders here, the speaker and I, have not talked about doing reconciliation as the only way out of all of this. Of course, it’s not the only way out. But remember, since 1981, reconciliation has been used 21 times. Most of it has been used by Republicans, for major things like much of the Contract for America, Medicare reform, that tax cuts for rich people in America. So reconciliation isn’t some thing that’s never been done before. It’s as if there’s a different mindset, a different set of facts than the reality.”

President Obama and Democrats are finding out that it’s easier to play offense than defense in the health care arena.

As Senator Tom Coburn, Republican of Oklahoma, urged a greater focus on combating “waste, fraud and abuse” he suggested that the Democrats’ legislation did not address these issues. And Democrats, including President Obama, could find little to argue with, and could only respond that they generally agreed and had included provisions aimed at those goals in their legislation.

But there is virtually no way in the televised forums for the Democrats to begin reciting the specific provisions that would likely numb the audience if not the participants themselves.

A quick search of the Senate-passed bill finds 85 different mentions of the word “fraud.”

Pasted below are excerpts from the Table of Contents of the Senate bill showing some provisions aimed at fraud, and/or improving the integrity of government health care programs.

The list provides just a small example of how there is general agreement on some issues, but also highlights the limits of the summit meeting at Blair House – lawmakers and the president are not in a position to make any particular improvements to any particular provisions in the bill. They may not even be able to reach agreement on adding or deleting entire chapters.

Subtitle F—Additional Medicaid Program Integrity Provisions

Sec. 6501. Termination of provider participation under Medicaid if terminated under Medicare or other State plan.

Sec. 6502. Medicaid exclusion from participation relating to certain ownership, control, and management affiliations.

Sec. 6503. Billing agents, clearinghouses, or other alternate payees required to register under Medicaid.

Sec. 6504. Requirement to report expanded set of data elements under MMIS to detect fraud and abuse.

Sec. 6505. Prohibition on payments to institutions or entities located outside of the United States.

Sec. 6506. Overpayments.

Sec. 6507. Mandatory State use of national correct coding initiative.

Sec. 6508. General effective date.

Subtitle G—Additional Program Integrity Provisions

Sec. 6601. Prohibition on false statements and representations.

Sec. 6602. Clarifying definition.

Sec. 6603. Development of model uniform report form.

Sec. 6604. Applicability of State law to combat fraud and abuse.

Sec. 6605. Enabling the Department of Labor to issue administrative summary cease and desist orders and summary seizures orders against plans that are in financially hazardous condition.

Sec. 6606. MEWA plan registration with Department of Labor.

Sec. 6607. Permitting evidentiary privilege and confidential communications.

Sec. 10606. Health care fraud enforcement.

Sec. 10607. State demonstration programs to evaluate alternatives to current medical tort litigation.

Senator Tom Coburn, Republican of Oklahoma, is the first of several doctor-legislators in the room – all on the Republican side – to speak. And he’s making the case that Congress should focus first on attacking waste, fraud and abuse in the health care system and offering rewards for effective management of chronic diseases.

“What I would hope we would do is go back and concentrate on the areas that have the biggest pot of gold for us,” Mr. Coburn said. “We don’t incentivize prevention. We don’t pay rewards for great management of chronic disease. We have a system throughout the country where we are encouraging lawsuits that are not productive for the country.”

“With one out of three dollars not helping everybody, we ought to go where it is,” Mr. Coburn said.

Stephen Crowley/The New York Times

Mr. Alexander is challenging Mr. Obama saying the Congressional Budget Office has predicted that premiums in the individual market would rise as a result of the Democrats’ legislation.

“No no no,” Mr. Obama cut him off.

“The cost for families for the same type of coverage that they are currently receiving would go down 14 to 20 percent,” the president said.

Mr. Alexander is trying to jump back in and Mr. Obama is using the advantage of being president to hold the floor. There is no easy way to interrupt the president of the United States.

“We have tried to take every cost-containment idea that is out there,” Mr. Obama said. “Every health care proposal that economists say will reduce health care costs we have tried to adopt in the various proposals. There are some additional ideas that Republicans have presented and we think are interesting and we have also tried to include.”

Mr. Obama is challenging Republicans to discuss those ideas, and talk about how they might be included in the legislation.

The Senate majority leader, Harry Reid, sought to take on Senator Alexander in his opening remarks, repeatedly telling Mr. Alexander, “You are entitled to your own opinions, but not your own facts.”

But Mr. Reid seemed to push the bounds of credibility himself when he suggested that Democrats have not been talking about budget reconciliation – the parliamentary maneuver that Democrats are indeed contemplating as a way to move the final health care legislation through the Senate without getting blocked by a Republican filibuster.

Mr. Reid seemed to try to qualify his point, saying that Democrats have not discussed reconciliation as the “only way” — but the cameras quickly caught Mr. Alexander with a deeply skeptical look on his face.

President Obama is now addressing Mr. Alexander’s criticism, saying obviously they disagree but noting that he heard a number of areas of common ground in terms of broad goals. And he is now introducing the first of four substantive chapters in the forum, focusing on cost control.

Senator Alexander is urging Mr. Obama and Democratic Congressional leaders to renounce the parliamentary maneuver called “budget reconciliation” that Democrats are eying as a way to move the final changes to the health care legislation through the Senate without being stopped by a Republican filibuster.

Calling it “a suggestion and a request about how to make this a bipartisan and truly productive session,” Mr. Alexander challenged Mr. Obama and the Democrats “to renounce jamming it through in a partisan way.”

Otherwise, Mr. Alexander said, borrowing a favorite line of Mr. McConnell, “The only thing bipartisan will be the opposition to the bill.”



From the White House pool report, as President Obama and Vice President Joseph R. Biden walked from the White House to Blair House where the meeting is taking place, a reporter shouted out to Mr. Obama, does he have a Plan B if this session doesn’t produce results? Mr. Obama kept walking, but said, “I always have plans.”

The Senate Republican leader, Mitch McConnell of Kentucky, has just announced that he chose Senator Lamar Alexander of Tennessee, to give the Republican opening statement. It is an interesting choice. Mr. Alexander is a former governor and one of the more studious members of the Senate, though he has sharpened his political rhetoric since joining the leadership as chairman of the Senate Republican conference.

Mr. Alexander is describing the summit as a visit to the Detroit auto show, where car manufacturers roll out a new model but customers end up unimpressed. “That’s the same model we saw last year, and we didn’t like,” Mr. Alexander said.

He urged Mr. Obama and the Democrats to scratch all of their proposals and start over. “As they say in Detroit,” Mr. Alexander added, “We think we have a better idea.”

Mr. Alexander is warning that the Democrats’ plan includes too many tax increases and spending cuts on Medicare.

He also criticized a proposed expansion of Medicaid, the federal-state insurance program for low-income Americans. “It dumps 15 million to 20 million Americans into a Medicaid program” he said, noting that many doctors refuse to take new Medicaid patients because the payment rates are too low.

“It’s like giving someone a ticket to a bus line where the buses only run half the time,” he said.

Mr. Alexander is also making clear that Republicans will not offer a comprehensive alternative to Mr. Obama’s plan and do not intend to propose legislation that would cover more than 30 million people, as the Democrats’ plan is projected to do.

“If you are waiting for Mitch McConnell to roll in a wheelbarrow here with a 2,700 page comprehensive bill, it’s not going to happen,” he said.

Mr. Alexander also continued his automobile metaphor. “This is a car that can’t be recalled and fixed and we ought to start over,” he said of the Democrats’ plan.

Mr. Obama, as expected, is also stressing the many areas of common ground that exist in various health care proposals that Democrats and Republicans have brought forward over the years – which is true, though the current differences between the parties’ positions are huge.

“When I look at the ideas that are out there, there is overlap,” Mr. Obama said. “It’s not perfect overlap. It’s not 100 percent overlap. But there’s overlap.”

He also talked briefly about his own plan unveiled on Monday, saying the White House posted what it thinks is the best blend of the House and the Senate legislation that has already passed. “The basic concept is that we would set up an exchange, meaning a place where individuals and small businesses could go and get choice and competition for private health care plans, the same way that members of Congress get choice and competition for their health care plans,” he said. “For people who couldn’t afford it, we would provide some subsidies. But because the pool is larger, the costs we would be smaller, because they would be in a position to negotiate.”

And as he closed his opening remarks, Mr. Obama allowed for the possibility that at the end of the day the two sides would still be far apart. “I don’t know that those gaps can be bridged, and it may be at the end of the day, we come out of here and say, ‘Well, we have some honest differences.’ ”

Luke Sharrett/The New York Times

The health care summit is under way, and President Obama is framing his remarks in the context of economic recovery and the challenges that health care costs pose for individuals, families, small businesses and the federal government.

He has also shared some personal insights, recalling times when he sat in the emergency room to get treatment for family members, including his daughter, Sasha, who had meningitis as a baby. “I remember thinking while sitting in the emergency room, what would have happened if I didn’t have reliable health care,” the president asked.

Dealing with Congress can often make people feel like they are walking in circles and that’s how Mr. Obama began the morning, walking in a big square actually around the conference table to shake hands with all the participants.

But then he told everyone to have a seat, and there was a chuckle in the room as Vice President Joseph R. Biden Jr. seemed to stumble to his chair next to the president.

Mr. Obama said it was crucial for the country to begin confronting long-term challenges.

“This is an issue that is affecting everybody,” Mr. Obama said. “It’s affecting not only those without insurance but it is effecting those with insurance

When you talk to every single expert, and when you talk to ordinary people and to businesses, everybody understands the problem is not getting better, it’s getting worse.”

Earlier this morning, we framed the debate and outlined what to expect and to watch for during today’s health care summit. We’ll be updating events in this post as the meeting gets under way, so stayed tuned.