The U.S. House of Representatives approved a White House-backed bill to overhaul Medicare early on Saturday after an extraordinary all-night session and intense acrimony over the fairness of the vote.

After a heated debate in the dead of night, the House began voting at 3 a.m. EST (0800 GMT). When a strange-bedfellow coalition of Democrats and conservative Republicans hit the 218 tally needed to defeat the bill, House Republican leaders simply kept the vote open until nearly 6 a.m., when they finally got people to change votes, giving them a 220-215 victory.

They kept the vote open for almost three hours -- instead of the customary 15 minutes. Democrats were outraged and said it was twice as long as the longest vote previously on record, 73 minutes during the 1994 crime bill.

"We have prevailed on this vote. Arms have been twisted and votes changed," Maryland Rep. Steny Hoyer, the Democratic whip, angrily declared as Democrats futilely challenged the vote.

"Win we did. For several hours, seniors and disabled people had a victory," House Democratic Leader Nancy Pelosi of California told reporters.

Pelosi accused the Republicans of an "abuse of power" and likened it to the contested 2000 presidential elections in Florida. "I guess it's in their DNA. They just can't play by the rules."

The Medicare bill, which would give President Bush a domestic victory as he prepares to run for re-election, would add an outpatient prescription drug benefit to Medicare and introduce new free market-style reforms and cost containment that could significantly reshape the 38-year-old federal health program for the elderly.

The $395 billion, 10-year legislation now goes to the Senate, where Republican leaders hope to pass it early next week. It had been picking up bipartisan Senate support but that dynamic could be affected by the bitterness in the House.

"I think it will come to their attention," Hoyer said wryly.

PRESSURE FROM THE PRESIDENT

Rep. Deborah Pryce of Ohio, a member of the Republican leadership, said lawmakers switched votes at the last minute because they decided it was the best policy. They feared that if the bill was defeated, they would end up with a more liberal version the Senate backed in June.

Rep. Butch Otter, Republican of Idaho who initially voted no, said Bush had called him about half an hour into the vote to ask him to switch.

"I had already told the president I didn't think I could help him," Otter said. But toward dawn he switched, citing concern about the "bigger, more expensive" Senate bill.

Bush had called lawmakers from Air Force One en route home from London, and California Republican Rep. David Dreier said the president called at least four lawmakers during the overnight House session after he landed in Washington.

The idea of including drugs in Medicare is a popular one, given that Medicare will pay for a heart transplant but not a cholesterol drug. Democrats argued that the specific benefits in this bill that go into effect in 2006 are too skimpy.

But the other market-oriented changes to Medicare are highly controversial and Democrats say they represent a Republican effort to privatize the program that serves 41 million Americans.

Even before the vote, the debate was sharp. Democrats accused the Republicans of trying to dismantle Medicare and pour billions of dollars into the pockets of insurance companies and drug makers.

Republicans said their changes were necessary to preserve the financially strapped Medicare program for future generations.

"Medicare is going bankrupt. Wake up!" said Iowa Republican Jim Nussle.

The legislation includes an expanded role for private sector health plans, more market competition, cost containment measures, and new tax-preferred health savings accounts long favored by Republicans.

http://www.reuters.com/newsArticle.jhtml?type=politicsNews&storyID=3875432