President Barack Obama, Democratic and Republican members of Congress, finishing a long day of discussions on health care reform, remain far apart on the need to extend coverage to millions of U.S. residents, primarily because of the costs involved.

I'm not sure we can close that gap, said Obama today at the end of a health care summit in Washington he convened today to try to find common ground on bills already passed by the House and Senate.

Obama, who has been pushing for reform in Congress for the past year, told House representatives and Senators today that they have six weeks to work in a bipartisan way to agree on a final health bill.

Procedurally it could get done fairly quickly, Obama said, a reference to the reconciliation process, which would be used to merge passed bills.

We cannot have another year-long debate about this, Obama said.

At the beginning of the six-hour televised summit, Republican Sen. Lamar Alexander warned that Democrats should not try to push through a bill in that manner.

Republicans have said the process was meant to be used for provisions affecting taxes and spending, not wide-ranging reforms such as the current health reform proposals.

The top Republican in the Senate, Mitch McConnell called the process legislative sleight of hand.

McCain, Obama spar

Sen. John McCain criticized President Barack Obama during the summit for allowing the current health care proposals to be created behind closed doors in an unsavory way.

We promised them change in Washington, but what we got was a process that we had both promised to change, he told Obama.

He noted that negotiations were finally being aired live on television long after the president had promised.

We're not campaigning anymore. The election is over, Obama told McCain.

I am reminded of that every day, McCain replied.

We were supposed to be talking about insurance. Obama said later, after emphasizing that many hearings had been held on reform.

American people care about what we did and how we did it, McCain said.

Strong feelings surge

In a moment that highlighted divisions over costs and the need for expanding coverage, Sen. Jay Rockefeller of West Virginia unleashed an attack on the health insurance industry and the need for more regulation.

The health insurance industry is terrible. They're in it for the money, he said.

They so dominate the market that there is no real competition, Rockefeller said. This is a rapacious industry that does what it wants.

A proposal for reform being considered, which Rockefeller supports, is the so-called individual mandate, which would require U.S. adults to purchase health insurance.

Benefits of such a requirement would be to distribute the costs of insuring people with pre-existing conditions, which are often excluded by health plans today.

Rockefeller stated that 44 of 50 states allow health insurance companies from excluding such individuals from joining their plans.

He said there was not enough support for even more stringent limits on the industry.

You have to go at them to clip their wings in every way that you can, he said.

Bipartisan support for Small Business

Amid contentious issues, the President and senators from opposing parties agreed on the idea that small businesses should be allowed to pool together to lower health insurance costs.

Economies of scale would lower expenses for small businesses, exactly in the same way that large businesses do, said Republican Rep. John Kline of Minnesota.

We really are close on that issue, said Democratic Senator Max Baucus of Montana.

He said he had proposed something similar in the Shop Act, which would set up a small business exchange and takes advantage of pooling to shop and get the best insurance deal.

Unaddressed issues

Despite the comprehensiveness of the proposals already passed by the House and Senate, certain people won't be covered by the legislation, Rep. James Clyburn on Louisiana pointed out, proposing a significant expansion of community health centers.

No matter the plan we develop, there will be many people left uncovered and we need a safety net for those people, he said.

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