WASHINGTON - There is no forgetting that Howard Dean once wore a white lab coat.
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.
For Dean, who is in Baltimore today for a rally and fund-raiser on his 55th birthday, his career as a physician is more than just a few paragraphs in his biography. His medical background plays a central role in his political life, giving him a certain cachet with voters and fellow politicians, a degree of authority on health-related issues and, as he has conceded, an off-putting attitude of infallibility that at times has collided with the give-and-take of politics.
"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."
Helped Clinton effort
In many ways, Dean's medical license has led him down the path he is following. In 1993, his credentials made him valuable to President Bill Clinton, who recruited Vermont's doctor-governor to help craft the administration's ill-fated health care plan. Dean's entree to the White House, including sleepovers there and a seat behind first lady Hillary Rodham Clinton at the 1994 State of the Union address, was enough to give him "the national bug," Nelson said.
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.
Criticism from rivals
But some Dean critics say Vermont - with its largely white population - is hardly a typical state and doesn't present the insurance enrollment difficulties that a bigger, more ethnically diverse state such as California or New York does.
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."
Still, Dean reminds audiences of his former profession in nearly every speech:
"As a physician, I am outraged that the Senate has decided it is qualified to practice medicine."
"As a doctor, I have seen the enormous health consequences of domestic violence."
"As a doctor, I know that failure to act on the environment has devastating health consequences."
This year, however, speaking to an audience of abortion-rights advocates, Dean seemed overly eager to highlight his experience as a doctor and appeared to stretch the truth. In explaining why he opposed parental notification laws, he told a moving story of a 12-year-old pregnant girl he had treated and left the false impression that the girl's father had impregnated her. "You explain that to the American people who think that parental notification is a good idea," Dean said.
In later interviews, Dean defended his story, saying the fact that the father had not impregnated the girl was irrelevant because, at the time he treated her, he suspected that the father had.
Some who know Dean believe his stubborn, prickly, at times arrogant manner - traits on display recently when he seemed to have trouble apologizing for a remark he made about the Confederate flag that many found offensive - has its roots in his years as a physician.
"Doctors tend not to be challenged," said Nelson, of the University of Vermont. "If the doctor says so, it must be true."
Dean, who enrolled at the Albert Einstein College of Medicine in the Bronx after a short career as a stockbroker, has said nearly as much. "We do have this extraordinary sense of the power we've been given, and sometimes that makes us a little more overbearing than we should be," he said last month in an interview in Modern Physician magazine.
Dean had been in Vermont for less than two years, starting his life as a family doctor, when he turned his attention to politics. He worked for President Jimmy Carter's 1980 re-election campaign and was elected to the Vermont Legislature in 1982. Four years later, he became the state's part-time lieutenant governor, all the while keeping the private practice he shared with his wife.
He was seeing a patient in August 1991 when he got a call that Gov. Richard Snelling had died of a heart attack.
Dean finished the physical he was doing, asked his wife to see the rest of his patients that day, made some calls and headed to the statehouse. He may have put away his stethoscope, prescription pad and lab coat, but not his title and all that goes with it.