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President Obama has injected a dose of clarity and urgency into the national health care reform debate.

More importantly, in his address last week to a joint session of Congress he reached out to Republicans and conservative Democrats in an effort to find common ground and move this important discussion forward.

He repeated his insistence on a plan that prohibits insurance companies from denying coverage because of pre-existing conditions.

He also stood by earlier pronouncements that all Americans should be required to enroll in some form of health insurance coverage.

Overtures across the aisle

But the president also opened the door to compromise and embraced some Republican proposals.

He proposed pilot programs that would test measures designed to contain the costs of medical malpractice awards, a cause embraced by many Republicans.

He endorsed Republican Sen. John McCain's idea to create high-risk insurance pools for Americans with pre-existing conditions.

Even after an impassioned defense of a public health insurance option, he couched it as just that -- an option, not a deal-breaker. "The public option is only a means to an end and we should remain open to other ideas that accomplish our goals," the president said.

Ideas anyone?

Obama said he would consider other approaches that would accomplish the same goal, including the public option as a "trigger" that would come into play only if health insurers fail to meet certain benchmarks.

Most significantly, he announced he will see this legislation through, with or without Republican votes.

That's not being obstinate. It's being realistic. The most the president can do is reach across the aisle and bring ideas from both parties into a more constructive discussion.

Beyond that, his greatest obligation is to ensure the quality of the legislation itself, not whether it bears a bipartisan stamp.

"I am not the first president to take up this cause," Obama said, "but I am determined to be the last."

The president added, "Our collective failure to meet this challenge -- year after year, decade after decade -- has led us to a breaking point."

Indeed. A recent report on health care in North Carolina said in plain and alarming tones that more and more of us lack health insurance as the spiraling cost of health care far outpaces Tar Heels' salaries.

By contrast, another report one day after the president's speech cited the success of government-subsidized coverage for children in the state under Medicaid and SCHIP.

Of course, having the strength of Republican and Democratic voices behind a substantive health reform package would be the best of all possible outcomes.

But at some point you have to move on, and the president appears to realize that.

If the Republicans are serious about wanting to pass meaningful health reform, they should step up and play.

Finally, the president responded to concerns among Republicans and Democrats that the price tag for his proposed reforms was simply too high by pledging to write into whatever legislation emerges a cap on spending. The president said any costs beyond a $900 billion, 10-year threshold would by law have to be offset by spending cuts.

That sounds good, but Americans need more specifics. The president has been least convincing in his discussions of how to pay for health reform.

'Scare tactics'

Of course, not all of the president's rhetoric was conciliatory. He dismissed as myth critics' claims that the reform he supports would include death panels. "Instead of honest debate," he said, "we have seen scare tactics."

He specifically rebutted repeated claims that his plan calls for "death panels," a charge he described as "a lie -- plain and simple." He also said that his health reform plans would not provide insurance for illegal immigrants, which also has been a frequent allegation.

At that point, Republican Rep. Joe Wilson of South Carolina yelled from the audience, "Lie!"

That surprising and wholly inappropriate outburst illustrates how harsh and disrespectful this discussion has become.

Wilson has since apologized for his behavior. But at least he reminded us of where, until now, the debate has been mired.

This should not be a question of who wins and loses political points. What matters most is practical, meaningful reforms that make health care more accessible and affordable for all Americans.