Today, President Obama held a healthcare reform summit and struck a tough but inclusive tone:

"Each of us must accept that none of us will get everything that we want, and that no proposal for reform will be perfect," the president said as he welcomed more than 150 forum participants.

"Everybody has a right to take part in this discussion. Nobody has the right to take it over," Obama said. "The status quo is the only option that is not on the table. And those who seek to block any reform at any cost will not prevail this time around."

Obama here seems to be drawing a line in the sand that he did not draw during the stimulus debate. He's insisting on an open and inclusive process but is also putting his opponents on notice that obstruction for obstruction's sake will not be tolerated and, presumably, that he will not sacrifice substance for process.

Obama also expressed the urgency of action and addressed the view that we can't invest in healthcare reform during an economic downturn, again, as he did during his address to congress, turning that view on its head and framing reform as a "fiscal imperative":

And today, there are those who say we should defer health care reform once again - that at a time of economic crisis, we simply cannot afford to fix our health care system as well.

Well, let's be clear: the same soaring costs that are straining our families' budgets are sinking our businesses and eating up our government's budget too.  Too many small businesses can't insure their employees.  Major American corporations are struggling to compete with their foreign counterparts.  And companies of all sizes are shipping their jobs overseas or shutting their doors for good.

Medicare costs are consuming our federal budget.  Medicaid is overwhelming our state budgets.

And at the Fiscal Summit we held here last week, the one thing on which everyone agreed was that the greatest threat to America's fiscal health is not Social Security, though that is a significant challenge; and it is not the investments we've made to rescue our economy; it is the skyrocketing cost of health care.

That is why we cannot delay this discussion any longer.  And that is why today's forum is so important.  Because health care reform is no longer just a moral imperative, it is a fiscal imperative.  If we want to create jobs and rebuild our economy, then we must address the crushing cost of health care this year, in this Administration.  Making investments in reform now, investments that will dramatically lower costs, won't add to our budget deficits in the long-term - rather, it is one of the best ways to reduce them.

During the Q&A afterward, Obama defended the inclusion of a public plan, which the GOP has already signaled outright opposition to. Ezra Klein has the interesting exchange with Sen Chuck Grassley:

Grassley then moved onto a more relevant sore spot: The public insurance option. "The only thing," he pleaded, "that I would throw out for your consideration -- and please don't respond to this now, because I'm asking you just to think about it -- there's a lot of us that feel that the public option that the government is an unfair competitor and that we're going to get an awful lot of crowd out, and we have to keep what we have now strong, and make it stronger."

The question was no surprise: In recent Finance hearings, Grassley has clearly signaled his anxiety on this issue. What was a surprise was that Obama rejected Grassley's plea to think it over and instead replied on the spot with a strong articulation of the case for a public plan. "The thinking on the public option has been that it gives consumers more choices, and it helps give -- keep the private sector honest, because there's some competition out there. That's been the thinking."

"I recognize, though, the fear that if a public option is run through Washington, and there are incentives to try to tamp down costs and -- or at least what shows up on the books, and you've got the ability in Washington, apparently, to print money -- that private insurance plans might end up feeling overwhelmed. So I recognize that there's that concern. I think it's a serious one and a real one. And we'll make sure that it gets addressed."

Obama is clearly in listening and groundwork laying mode but his toughness on the policy questions that have come up, even as he signals the desire for input from all sides, is heartening. Seems he learned the lessons from the confused and undisciplined stimulus bill process. So, while we don't have much to judge Obama on quite yet, I'd give him an A for dictating the terms of the debate and for doubling down on the urgency and imperative of reform this year.

What grade would you give him?

And by the way, the administration launched HealthReform.gov today and you can signal your support of the president's health reform principles HERE.