Just as he did as governor of Vermont for 11 years, the Democratic presidential candidate refers to himself in every official statement or news release as "Gov. Howard Dean, M.D." His campaign placards proclaim "The Doctor Is In." Pill bottles filled with coins advertise his "prescription for change." He has even waved a stethoscope at an audience to make the point that he can be trusted on health care issues because he is a doctor.
"It's given him the political cover of a highly esteemed profession," says Garrison Nelson, a political science professor at the University of Vermont and longtime Dean observer. "And he has capitalized on that."
Should Dean win the presidency, he would be the first physician to do so.
The health industry and medical community have been significant sources of support for Dean, who had a family practice in Vermont with his wife, Judith Steinberg Dean, also a physician, before becoming governor in 1991.
There are fund-raising groups of "Doctors for Dean," "Nurses for Dean," even "Med Students for Dean." And the health industry has given more money to Dean than to any other Democratic candidate, according to the Center for Responsive Politics. Health professionals rank fourth among the industry groups that have contributed to his campaign (behind retirees, lawyers and educators). By comparison, health professionals rank ninth among the groups that have contributed to rival Democrat Richard A. Gephardt, a Missouri congressman who has made health care reform the centerpiece of his candidacy.
Last week, Dean's medical credentials helped him collect the coveted endorsement of the two largest unions within the AFL-CIO - the Service Employees International Union and American Federation of State, County and Municipal Employees, groups intensely interested in health care issues.
In throwing his union's weight behind Dean last week, SEIU President Andy L. Stern told members: "After Nov. 4, there will be a doctor in the house - the White House, that is - and that doctor will be Dr. Howard Dean."
And although Dean's fierce opposition to the war in Iraq ignited his presidential run, he started his campaign intending to make health care his signature issue, believing the "M.D." after his name would lend him credibility just as the title of "General" gives presidential candidate Wesley K. Clark a leg up on defense issues.
Dean has promoted his accomplishments in Vermont, where he expanded state programs to offer health insurance to nearly every child younger than 18, as well as his experience as a family physician who, as he said in a speech in June, "saw clearly the human costs of America's flawed health care system."
The health care plan he has presented, much like those of several other Democratic candidates, would increase access to health care, mostly by expanding public programs such as Medicaid and the Child Health Insurance Program that provide coverage for the uninsured.
Rather than overhauling the health care system as Gephardt has proposed, Dean has outlined more of an incremental approach toward universal coverage modeled on what he did in Vermont, where, he says, 96 percent of children and 91 percent of adults now have insurance.
And rivals such as Gephardt and Sen. John Kerry of Massachusetts have criticized Dean for comments he made in 1995 praising a Republican effort to cut the rate of growth for Medicare by $270 billion to balance the budget. Dean has said he was supporting cost containment measures that President Clinton adopted, although Clinton accepted a much smaller cut.
"Clearly, if you're a doctor, you start with a little bit of credibility on health care," says Sarah Bianchi, policy director for the Kerry campaign. "But doctors aren't always perfect allies with consumers and nurses. Luckily, the early state voters look beyond the surface."