WILMINGTON, Del. – It was a classic Howard Dean moment. His face was red, his voice was a bellow and his hand was slamming the lectern.
Back in 2004, as a Democratic presidential hopeful, the former Vermont governor was outraged about the Iraq war. Now it's the U.S. health care system – in particular, at a union hall here Friday, the tale of a breast cancer survivor who said she was denied chemotherapy for months because she didn't have insurance.
Without offering any details, she said she finally did manage to qualify for care – by divorcing her husband. "I had to get rid of him so that I could live," the woman told Dean. "I'm proud to say we're still together." She added tearfully that she can't get life insurance, "so if I die my family will pretty much be trying to figure out how to bury me."
"First of all, let me say just one thing," Dean said. And then, in the space of a tiny pause, he rocketed into high dudgeon.
"There is not one other industrialized democracy on the face of this earth that somebody with that story would happen! Not one other country! Not one! How can America be like this? This is America for God's sakes," he shouted, to cheers and applause. "It just makes me furious. Not one other country! ... Not one!" Smash of hand into lectern. "This is a disgrace and that is why we need real health insurance reform."
This is Dean's latest crusade, prodding Congress – and prodding Americans to prod Congress – to pass the type of health care reform President Obama proposed last year on the campaign trail. That is, health care that gives people a choice between private insurance and a competing government-run plan.
Those over 65 already have that option, Dean says, and it's called Medicare. "We are asking that people have a choice" no matter what their age, he says.
Dean, who chaired the Democratic National Committee from 2005 until early this year, is an unlikely cheerleader for the White House. Obama is, after all, the president who failed to give him a job.
"My attitude is totally results driven. Whatever my feelings about how I was or wasn't treated have nothing to do with the public policy good of the country," Dean told me Friday after his presentation to a standing-room-only group of more than 100 people. "It's pretty clear that what Barack Obama wants to do on health care is the right thing to do. To let personal discussions or disputes get in the way of that is foolish and petty."
Dean had well-publicized disputes in 2006 with Rahm Emanuel, the head of the Democrats' efforts to win House seats that year, over whether to fortify state parties across the country or funnel money to districts where Emanuel saw opportunities to win.
Emanuel is now White House chief of staff, and Dean, spurned for now and maybe for the duration, is back in his familiar role as an outside agitator. Backed by unions, health care groups and his own Democracy For America network, he's talking up health reform and his primary passion – giving all Americans the chance to buy a public insurance plan – at town hall meetings across the country.
Last week Dean was in Denver, Des Moines, and Wilmington. Today he's in Washington to promote his lobbying campaign at a liberal conclave called America's Future Now
Tomorrow, June 2, he's publishing an e-book
called HOWARD DEAN'S PRESCRIPTION FOR REAL HEALTHCARE REFORM: How We Can Achieve Affordable Medical Care for Every American and Make Our Jobs Safer
. It comes out in paperback July 1. All this and he's the newly named board chairman of the Progressive Book Club which, as you may imagine, promotes books by liberals.
Dean has more credibility than most on health care. He is a medical doctor who signed into law near-universal health coverage for Vermont children.
Yet back during his 2004 campaign, Dean's career as a doctor was curiously absent from what we professional observers would call his narrative. We didn't hear about his patients or from his patients – two elements that could have softened the edges of a candidate who was always blunt and often cutting.
Dean is still blunt and he still has that very short Marine-style haircut. And as he demonstrated here in Delaware, he still is partial to the occasional campaign-style rant. But as people told their tales of woe, he also displayed glimmers of Dr. Dean – a knowledgeable, no-nonsense family physician who listens carefully and explains things in plain English.
And for an hour it was one tale after another. A nurse practitioner who said she spends hours arguing with insurance company clerks who say things like "That's impossible, an adult can't have ADHD." An insurance agent who lamented that she often can't find policies for people, even those who are not seriously ill. A woman who struggled to find coverage for her husband (a stroke victim) and herself (a breast cancer patient) after losing her job and insurance.
While Dean is unyielding on the need for a public plan that stays with you wherever you live or work, whether you have a job or not, no matter how old you are, he told this group the inevitable one-size-fits-all nature of such a plan won't work for everyone.
And that means private insurance will never disappear. "They're going to make more money if we have a public option and they fill in the cracks that we leave," he told me. "Because the public option's not going to be perfect."
In his more diplomatic moments, and yes, there are some, Dean casts the private insurance industry as a thoughtful player in the reform process. Still, he is skeptical about recent industry offers to abide by federal rules that would require coverage of virtually everyone, and at reasonable rates. "I don't really believe the insurance industry wants to be a regulated utility. And that is the only way that you can have health reform without a public option," he said.
Obama and many Democrats say they want health reform to include a public insurance plan, but it's unclear how much they'll compromise in pursuit of broad support for a reform package. Dean, applying pressure from the outside, is crystal clear: Getting Republican votes is far less important than getting a good bill. And any bill without a public option is a bad bill.
So, is Dean talking to the White House about his crusade? "Yeah, sort of," he says. Is he getting any encouragement? "Not necessarily," he says. And if and when health reform passes, what will he do next?
Dean laughs. "Who knows," he says. "The Progressive Book Club is always there."