For months, opponents of health care reform have argued that President Obama’s proposed cure is worse than the disease. The President’s speech to Congress last night was a compelling reminder of the myriad reasons why the U.S. public has consistently ranked health care as their top concern.

So even if Mr. Obama won few converts among Republicans, he at least put the onus on them to explain why the status quo is preferable to change.

This much is certain: if health care reform ultimately fails, it won’t be because the President failed to communicate his vision. It’s reassuring to have someone in the White House again who knows how to use the bully pulpit to construct a lucid, logical and densely-textured argument case for progressive reform.

But Obama wasn’t all Vulcan – he also issued a passionate challenge to the moral complacency of those who have ridiculed and distorted his vision for cutting medical costs and extending coverage:

Everyone is this room knows what will happen if we do nothing. Our deficit will grow. More families will go bankrupt. More businesses will close. More Americans will lose their coverage when they are sick and need it most. And more will die as a result. We know these things to be true.

Obama stressed the wide consensus that already exists for actions intended to universalize coverage: a ban on insurance company practices of cherry picking healthy customers and dropping coverage of those who get sick; health “exchanges” to offer the uninsured a menu of options; public subsidies for families that can’t afford coverage; and, a legal requirement that everyone have health insurance. Passing this package alone would be an historic leap forward.

The President’s speech was disappointing in two respects. First, he reprised his awkward straddle on the public option, arguing its merits while saying it’s not central to reform. Not only does this stance confuse the public, but in trying to appease his party’s single-payer diehards, Obama gives ammunition to GOP propagandists who claim Democrats are engineering a “government takeover” of the health care system. By jettisoning the public option, the President would show he’s willing to face down ideologues in his own camp. This would enable him to ratchet up the pressure on wavering moderates in both parties to get behind reform.

Second, and more serious, is the delicate matter of how we pay for it all. Obama was unequivocal in saying he wouldn’t sign a health bill that adds to the nation’s present or future deficits. But his chief financing proposals – targeting the ever-elusive “waste” in Medicare and taxing lavish employer-paid plans – aren’t likely to cover health reform’s $900 billion price tag. His proposal for a budgetary “trigger” that would make deeper cuts if expected savings fail to materialize is creative, but the President must offer more concrete and credible ideas for redeeming his deficit-neutral pledge.

In general, however, the President has mapped out a plausible route to the goal of affordable care for all. Now it’s up to Congress to do its job – negotiate, compromise and send the President a reform bill that covers everyone, restrains health care cost growth and pays for itself.

Will Marshall is the President of the Progressive Policy Institute.