A televised debate chaired by Barack Obama has failed to resolve the political deadlock over his health care reform plans and ended with calls to scrap the proposals.
The US president hoped the summit would revive momentum in Congress for his attempt to make health care more affordable and extend coverage to the 30 million Americans currently without insurance.
But Mr Obama's plans for negotiations were trashed when the Republicans said the fundamental difference was that their party and their supporters did not want the health system to change.
They claimed the plans would give too much power to the health system while removing it from doctors and patients.
"There are some fundamental differences between us that we cannot paper over," Republican Senator Jon Kyl told Mr Obama.
"We do not agree about the fundamental question of who should be in charge."
Banners show both sides of the healthcare debate
The president admitted it might not be possible to bridge the differences with Republicans but said: "I thought it was worthwhile for us to make this effort."
Afterwards, Republican Senate leader Mitch McConnell said he was "discouraged" by the summit's outcome.
He said he thought it was clear Democrats planned to ram through a version of the Senate-passed health care plan.
Senate Democratic leader Harry Reid did little to contradict that view when he said: "It is time to do something and we are going to do it."
Mr Obama had urged politicians to dispel political theatre and partisan opinions.
But over seven-and-a-half hours the polite tone was interrupted several times by tense exchanges with Republicans, including Mr Obama's 2008 presidential foe.
Senator John McCain said people were angry because Mr Obama had not brought the change to Washington he had promised.
Obama listens as the Republicans make their case
Mr Obama bluntly told Senator McCain: "We're not campaigning any more. The election is over."
His Republican nemesis replied: "I'm reminded of that every day."
The White House is making what is seen as one last push on the issue of health care.
Two separate health bills were approved by Congress last year but, as the Democrats were working out the final details of the legislation, the Republicans unexpectedly won a Senate seat in an election in Massachusetts.
That cost the Democrats their 60-vote super-majority needed to push the bill through regardless of Republican opposition.