Though former Vermont Gov. Howard Dean, M.D., still seems to think and act like a policy wonk, the immediate past chair of the Democratic National Committee came to Des Moines yesterday as an outsider to the policy-making process.  But that didn’t prevent last night’s forum on health care reform from feeling like a campaign stop.

The meeting, sponsored by Democracy for America, the activist organization spawned by his unsuccessful 2004 presidential campaign, included brief introductory remarks from Dean followed by a question and answer period.  In his remarks, Dean dropped anecdotes from his time campaigning around Iowa, and he touted his own efforts to get health insurance for more citizens as governor of Vermont.

Just like his campaign stops in 2003 and 2004, there was a large contingent from the Service Employees International Union, and there was more than one “Dean for America” bumper sticker in the parking lot. (Also parked outside were at least 11 Toyota Priuses — a sign that some things do change.)

At any moment, Joe Trippi could have walked in and started lurking in a back corner, and he wouldn’t have been out of place.

Though Dean’s time as chair of the DNC may have forced him to dial back on the direct, confident speaking style Iowans came to know six years ago, he has returned to full form.  He distinguished frequently between an ideal health care reform plan and the plan he thinks could garner enough votes to pass.  “One thing about single-payer is it is more efficient than any other system,” he said before essentially dismissing the proposal, which would abolish the nation’s employer-provided health insurance system, as politically infeasible.

“I think President Obama has put together the best plan, politically, that I’ve ever seen,” he noted.

A few protesters later interrupted Dean’s speech, angry that single-payer had been taken off the table, but Dean seemed more open to the idea than most officials in Washington, D.C., and he pointed that out himself.

Dean also tackled the question of how to fund universal health care.  He admitted bluntly that it would probably be most strategic to avoid answering that question with any specificity until after a health care reform plan passes.  The more specific a plan becomes, the more enemies it attracts, he said.

Then Dean answered the funding question anyway, explaining that the best way to pay for a public health insurance plan would be through a carbon tax.  Dean isn’t the only serious person to support the idea of a carbon tax, but most admit that it is too heavy a lift to accomplish alongside health care reform.

Dean’s main purpose for the visit was to highlight the necessity of a public option in whatever health care reform proposal ends up passing Congress.  “If [Americans] want to be in a public option, let them be in a public option,” he said.  Without a public option, he argued that private insurance companies would find a way to manipulate whatever new system is created, and nothing would really change.

Aside from the protesters, who seemed committed to getting either single-payer or nothing, it seemed that everyone in the room already agreed with him.  So they asked the sorts of questions that you might hear at a presidential campaign stop, challenging Dean on specifics without regard for the fact that he would not be in the room with the senators who  ultimately hash things out.

I left the meeting with the same sense of Dean that I had when I first saw him on the presidential campaign trail: the guy knows so much about what he talks about that he can seem abrupt and even arrogant in the face of questions.  As we learned in the waning days of the 2004 Iowa Caucuses, that can be both a blessing and a curse.