U.S. President Barack Obama hosted a rare televised bipartisan meeting at the Blair House in Washington DC on Thursday in a last-ditch attempt to bring Republicans on board in the deadlocked healthcare debate.

Opening the summit with an exhortation to stay focused on areas of agreement, Mr. Obama said: “I was very pleased to see a glimpse of bipartisanship in the Senate recently in passing a jobs bill, and I hope that continues.”

Yet the debate that ensued was far from smooth sailing for the President and attending Democrats. Republican Senators and Congressmen vigorously challenged the latest reform proposal Mr. Obama unveiled earlier in the week, including cost control, insurance reform, deficit control and expanding coverage.

If Mr. Obama had any hopes that a genuine bipartisan agreement could be hammered out during the seven-hour session, it must have evaporated within the first hour.

Beginning with Senator Lamar Alexander, who argued that comprehensive bills would not work and that Republicans would not be presenting their own comprehensive bill, the debate returned periodically to points of partisan disagreement.

Republicans took issue with the Democratic plan for instituting insurance exchanges driven by mandates (such as penalties for not buying into a policy). While agreeing that competition and diversity were desirable, Congressman Paul Ryan suggested that federalising the regulation of insurance through mandates would not encourage competition and lower costs but only more decentralisation would.

Mr. Obama, while acknowledging that this was a point of “philosophical” importance, rebutted that mandates were necessary to avoid a situation where pools of older, sicker insurance buyers were slapped with higher premiums while younger, more healthy pools paid significantly less.

Mr. Obama stressed the deficit-neutral nature of the reform — and he was pushed to do so given the suggestions by Mr. Alexander that under the proposed bill premiums would actually rise. Interrupting the Senator in a testy exchange, the President cited the figures of the non-partisan scorekeeper, the Congressional Budget Office. According to the CBO, of those individually insured, 57 per cent will see their premiums go down and 43 per cent will see their premiums go up. Of those insured by companies, all of them would see their premiums either stay the same or reduce.

The Republican insistence on a step-by-step approach and starting from scratch would not work, said Mr. Obama. “Baby steps don't get you to the place where people need you to go. We can't solve the pre-existing condition problem if we don't do something about coverage.”

Giving the Republicans a month or six weeks to find common ground with the Democrats, Mr. Obama implied that reform would have to be enacted and financed with or without Republican support.

The real, if slender, hope for a bipartisan bill rests on the few areas of agreement that were fleshed out during the discussion.

These include the need for regulation of insurance markets, the need for insurance exchanges and inter-state insurance, medical malpractice liability reform and curbing of fraud and wastage within the extant system.

If Republican support is not forthcoming, Democrats would likely use reconciliation, a legislative procedure infrequently invoked but simplifying the passage of bills into law on the basis of a simple majority of 51 votes.

While the move may be unpopular and Republicans would likely seize upon it as the “tyranny of the majority”, it would nevertheless permit the Democrats to claim a victory for their top priority of 2009 and move on to tackling the looming crisis of unemployment.

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