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WASHINGTON (AP) -- In Congress these days, the health care debate is as much about patience as patients.

In a closed-door meeting of feisty House Democrats this past week, Speaker Nancy Pelosi, D-Calif., served notice that in these final days before the Senate and House present comprehensive bills to overhaul the nation's system, hers is running short.

Rep. Earl Pomeroy, D-N.D., had interrupted Pelosi's presentation about one version of the bill with questions about its cost. According to Pomeroy and others, she cut him off - twice - with a question of her own:

Is there any version you could support?

Yes, Pomeroy said, but not the one most likely to succeed.

Pelosi moved on.

To the White House and Democratic leaders, Pelosi's question is the only one that matters at this late date. The answers help divide lawmakers into two columns: "yes" and "yes, if" under certain conditions. In another private meeting Friday, Pelosi forced her rank and file on the record by asking for a show of hands to register support for the public option plan she prefers.

In the Senate, Majority Leader Harry Reid, D-Nev., select committee chairmen and senior White House officials are meeting nightly in search of a bill that could win the 60 votes needed to overcome a Republican filibuster.

At the White House, President Barack Obama is willing to play lobbyist in chief, but first he needs a bill.

So close to that pivot point and getting close to year's end, it's no longer a debate about whether there will be a health care bill. The questions are when, how - and who can compromise.

Democratic leaders expect their members, looking ahead to next year's elections, to vote for a health care bill despite any misgivings. But the vote-counters have no real way of knowing until each chamber produces a bill.

That's why negotiators have slogged through months of hearings, hundreds of amendments and meetings with members that require interminable listening, waiting, reassuring, cajoling and answering questions from the recalcitrant.

For Reid and Pelosi, that process continues. Making a member feel heard - and promising something he or she can boast about at home - can pay off.

Sen. Mary Landrieu, D-La., sent out a blaring news release Friday after her meeting with Reid, saying she raised "the unique challenges Louisiana is facing in terms of Medicaid and the special concerns I have about teaching hospitals." She said he understood these challenges and considered ways to address the problems.

Patience is limited, however.

Reid and Sen. Charles Schumer, D-N.Y., had a testy exchange after Schumer made comments on cable news that some saw as pressuring the Nevada Democrat to make up his mind about putting a government-run insurance option in the Senate bill.

Senate Finance Committee Chairman Max Baucus, D-Mont., said Friday that patience among negotiators runs out "a little more often now" than earlier in the process.

"I say, 'Hey, we are in this together. Sixty votes. Let's keep our eye on the ball,'" he said.

The pressure on Democratic lawmakers is enormous.

The success of a health care bill is largely the success of the Democrats who control Congress and the president they helped elect. In a time of lingering recession, there is no more compelling pocketbook issue than health care overhaul. It's an effort that's intensely personal because it could affect eve! ry Ameri can.

Much depends on each lawmaker's needs - political, substantive, even temperamental - leading up to an election in which all 435 House members and one-third of the 100-member Senate face election. The calculus is different for each member on the fence.

The vote of one might hinge on fear of voters' cries about government-run health care. A lawmaker with an eye on growing deficits might want to know about containing costs. What someone might really want is the ego-stroke and the political cover of a personal appeal from the president.

An awkward meeting with Obama in the Oval Office Thursday evening illustrated just how far senators are from putting those pieces together. The only takeaway not likely to be disputed: Reid grabbed an apple on the way out.

Neither of the government-run options had received pledges of support from 60 senators but both could hit that threshold, Reid told Obama, according to congressional officials who spoke on condition of anonymity because of the sensitive talks.

One version would use the public option as a threat that would kick in if private insurers do not lower premium costs by certain deadlines. Some liberal senators would have trouble voting for that one, Reid said. The other would allow states to opt out of the public option, chief proponent Schumer told Obama.

The meeting ended with the president pledging to help rally support for whichever version crosses the 60-vote threshold first.

For Reid, it was back to his office and the phones. On Friday, Reid was meeting one on one - with no staff - with Landrieu, Sen. Carl Levin of Michigan and Baucus, whose committee had passed one of the two Senate health care bills.

"We're having a debate, and members have to reflect and represent their districts," Pelosi said. "And we're hearing from them."

WASHINGTON (AP) -- In the special interest war over health care, the White House and congressional Democrats have the nation's drug makers and hospitals generally on their side; the insurance industry, not so much.

Now the bill's supporters are making a play to lock in the American Medical Association, the organization that says it represents 250,000 doctors and medical students in every state and congressional district. The principal enticement, a $247 billion measure making its way to the Senate floor, aims to wipe out a scheduled 21 percent rate cut for doctors treating Medicare patients and replace it with a permanent, predictable system for future fee increases.

The AMA, firmly in favor of higher pay for doctors, began airing ads last week saying the increase would "protect seniors' access to quality care." In case lawmakers need any inducement to act, a late 2008 study by the Medicare Payment Advisory Commission, which advises Congress, found that nearly 30 percent of Medicare patients looking for a new primary care doctor had trouble finding one.

Yet the AMA won't yet pledge support for the major health care bill that is the chief objective of the White House and congressional Democrats, despite a request that several officials say was made at a meeting last week with Senate Majority Leader Harry Reid, D-Nev.

Nor does it seem eager to soft-pedal another of its own top priorities, legislation to restrict medical malpractice payments.

"We continue to press for significant medical liability reform because we know that is a very important contributor to unnecessary health care costs," Dr. J. James Rohack, president of the AMA, said in an interview in which he decli! ned repe atedly to say whether the organization had been asked to back off.

Higher payments to doctors and curbs on medical malpractice awards "in my mind are separate issues. I can't speak for how other people are putting this whole thing together," he added.

Evidently not in the minds of Democrats. Several officials say that request, too, was conveyed to the AMA and other doctor groups in last week's session with Reid. Not coincidentally, any limitations in medical malpractice awards are anathema to trial lawyers, whom Democrats count as among their most reliable and generous campaign supporters.

The dance is one of many in the long-running health care debate, the issue that has consumed Congress, the administration and a vast constellation of outside groups for months.

Take the Senate Finance Committee, which last week approved a middle-of-the-road measure that may eventually prove a template for a compromise on an issue that has defied solution for decades. Sen. Olympia Snowe of Maine drew headlines when she became the first Republican to support White House-backed health care legislation.

But according to some of the bill's supporters, a vote that occurred with little fanfare several evenings earlier was crucial to the legislation's survival.

It pitted the drug makers and the White House on one side and most of the committee's Democrats on the other.

At issue was a plan by Sen. Bill Nelson, D-Fla., to sweeten drug benefits for certain Medicare beneficiaries - normally something all lawmakers can favor. In this case, Nelson proposed raising fees on drug companies by $106 billion over a decade to cover the costs. "Did PhRMA come to the table in the agreement with the White House with enough? A number of us feel that is not the case," he said of the industry.

But his approach happened to run afoul of a deal! the ind ustry made months ago with the White House and Sen. Max Baucus, D-Mont., the committee's chairman. Drug makers would cover $80 billion of the cost of the legislation over a decade, and the White House and Baucus would help shield them from attempts by other lawmakers to impose additional fees or taxes.

Left undisclosed for weeks was a critical codicil - that the industry would bankroll an expensive advertising campaign to promote the bill's passage, at a cost of $100 million or more.

Passage of Nelson's proposal "may well undermine our ability to pass comprehensive health care reform in this Congress and I think that would be a great tragedy," Sen. Tom Carper, D-Del., said shortly before the vote.

Baucus, too, spoke against Nelson's recommendation, although he added, "we have to find some other time and some other way to fill the doughnut hole," a reference to a gap in coverage under the Medicare prescription drug program.

Of Nelson, Baucus said, "I frankly wish the senator had decided not to push" for a vote.

Not only Baucus, but also the White House had urged Nelson to drop his amendment, according to Senate sources who spoke on condition of anonymity. On the vote, the chairman, Carper and Sen. Bob Menendez, D-N.J., joined all committee Republicans in opposing the plan, and it failed on a vote of 13-10.

The drug deal was secure, and so, too, the bill.

Special interest politics was also at play for the nation's hospitals. They, too, have a side deal with the White House and Baucus, and they also received a measure of protection in the bill that cleared the committee.

At the last minute, the chairman decided to shield them from any future cuts to be recommended by an independent commission charged with recommending savings in Medicare.

The insurance industry?

Reid made an unusual appearance at a Senate committee hearing recently to support repeal of 60-year-old antitrust laws that benefit insurance companies.

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EDITOR'S NOTE - David Espo is chief congressional correspondent for The Associated Press.

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WASHINGTON (AP) -- Health care legislation taking shape in the House carries a price tag of at least $1 trillion over a decade, significantly higher than the target President Barack Obama has set, congressional officials said Friday as they struggled to finish work on the measure for a vote early next month.

Democrats have touted an unreleased Congressional Budget Office estimate of $871 billion in recent days, a total that numerous officials acknowledge understates the bill's true cost by $150 billion or more. That figure excludes several items designed to improve benefits for Medicare and Medicaid recipients and providers, as well as public health programs and more, they added.

The officials who disclosed the details did so on condition of anonymity, saying they were not authorized to discuss them publicly.

Some moderate Democrats have expressed reluctance to support a bill as high as $1 trillion. Last month, Obama said in a nationally televised address before a joint session of Congress that he preferred a package with a price tag of around $900 billion.

Obama also said he would not sign a bill that raised deficits, and the CBO estimates the emerging House bill meets that objective. Officials said the measure would reduce deficits by at least $50 billion over 10 years and perhaps as much as $120 billion.

Democrats also said the bill would slow the rate of growth of the giant Medicare program from 6.6 percent annually to 5.3 percent.

"The bill will be paid for over 10 years. It will reduce costs but also will not add a dime to the deficit" in future years, House Speaker Nancy Pelosi, D-Calif., said at a news conference.

St ill, Obama's speech provoked enough concern among House Democrats that senior presidential aides were called to a meeting in the Capitol to explain precisely what the president had in mind when he set the $900 billion target.

The figure of $871 billion "is a coverage number. I think the White House has made that very clear. It is a number about coverage," Pelosi said recently when asked about the size of the measure.

Linda Douglass, a spokeswoman for the White House, said, "The speaker is working on a plan that meets with the president's price tag of around $900 billion for health insurance reform and will not add a dime to the deficit."

House Democrats took steps to fulfill another of Obama's goals during the day, announcing their legislation would completely close a gap in Medicare prescription drug coverage within a decade, five years faster than originally contemplated.

In addition, Pelosi said, "as of Jan. 1, 2010, our legislation will give a 50 percent discount for brand-name drugs to recipients in the donut hole and it will reduce the size of the donut hole by $500."

After months of delay, Democrats in the House and Senate are aiming for votes next month on legislation to fulfill Obama's goal of expanding coverage to millions who lack it, banning insurance industry practices such as denying coverage for pre-existing conditions and slowing the growth in health care spending nationally. The House bill will also lift the insurance industry's exemption from federal anti-trust laws, a provision under consideration in Senate negotiations as well.

With time growing short, Pelosi and Senate Majority Leader Harry Reid are struggling independently with the most controversial of all issues involved with health care, proposals for a government-run insurance option to compete with private industry.

In the House, Democrats have tent! atively concluded they cannot win passage of the provisions favored by most liberals, one calling for a nationwide government-run plan with payments to doctors and hospitals linked to rates paid by Medicare. It was unclear what fall-back plan was under consideration, but the internal disagreement cast doubt on plans to publicly unveil legislation early next week.

Across the Capitol, Reid, D-Nev., assessed support for a nationwide government-run insurance option that would allow states to opt out of the system. While the plan evidently enjoys a clear majority, it is uncertain whether it can command the 60 votes needed to overcome a threatened Republican filibuster.

Democrats hold 60 votes in the Senate, but one, Sen. Ben Nelson, D-Neb., has spoken out strongly against a so-called public option. A few other members of the rank and file have been non-committal.

One, Sen. Mary Landrieu, D-La., met with Reid during the day and later issued a statement saying she was encouraged that a compromise might be possible. She also added pointedly that she had told Reid about "the unique challenges Louisiana is facing in terms of Medicaid and the special concerns I have about teaching hospitals," a possible signal that easing home-state concerns could influence her vote on the larger, national question of a government-run insurance option.

Also opposed is Sen. Olympia Snowe of Maine, the only Republican this year who has voted for a Democratic-drafted health care bill in committee. As an alternative, she favors allowing the government to step in only if there is insufficient competition in the private insurance industry.

Nor was it clear whether Democrats would be able to enlist additional Republicans. Sen. George Voinovich, R-Ohio, frequently mentioned by Democrats as a potential convert, said in an interview, "We can't afford the health care system that we have right now. And if we can't afford th! e one we have right now, how are we going to afford another one that's going to cost more money."

For Reid, the question of a government-run option is one of a many thorny issues to be settled before he can bring health care legislation to the Senate floor. He and senior committee chairmen have been meeting with top White House aides in recent days to produce a bill, and hopes of largely wrapping up the work by the end of the week went unfulfilled.

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Eds: Associated Press writers Chuck Babington, Laurie Kellman and Erica Werner contributed to this story.