For Howard Dean, health care and politics are often intertwined.

As a Vermont state representative and, later, lieutenant governor, the part-time nature of those jobs allowed him to maintain his physician's practice. After being elevated to the governor's office in 1991, he expanded a health care program for children and pregnant women, which laid the ground work for a statewide push toward universal care.

He speaks the language of health care fluently, and yesterday, the one-time presidential candidate and former chair of the Democratic National Committee was speaking it on friendly turf, at a health forum organized by Netroots Nation, an annual conference of liberal bloggers and activists being held in Pittsburgh this year.

The primary topic of conversation was the health care reform proposals being debated in Washington and at town-hall meetings across the country. A public, government-operated health insurance option should be the top priority for Congress, he said, in order to expand access and control costs.

"The current system cannot control costs, ever," he said. "Medicare does a much better job of controlling costs," keeping administrative costs low relative to private insurers.

Mr. Dean warned that if Democrats, with substantial majorities in the House and Senate, failed to include a "public option" in the final reform package, they would be punished at the ballot box in 2010.

But Mr. Dean also predicted a public option bill would eventually make it to the president's desk, despite the constant cannonade of opposition criticism, and some knocking knees within the Democratic party.

"It will be ugly," he said. But "we're winning this debate."

When asked about compromising on the public-option provision in order to win a reform package, he said "we have already compromised" by leaving single-payer health care off the table from the start.

As a result, "The only piece of reform left worth doing is the public option," he said.

Mr. Dean said workers and employers should be able to find common ground on this issue.

For workers, "health care costs go up higher than their salaries do, and they never get an increase. And it's making our business communities suffer. What we're doing now is madness for our business community because they're paying for a commodity that goes up 21/2 times the rate of inflation."

Mr. Dean has been increasingly visible of late, pushing the public option -- and his upcoming book on health care -- at question-and-answer forums like this one, in speeches, and on TV, even guest-hosting MSNBC's "Countdown with Keith Olbermann."

He was thought to be a candidate for a spot in the Obama administration, either as secretary of Health and Human Services or surgeon general, but because President Barack Obama looked elsewhere to fill those posts, Mr. Dean has been free to speak his mind and collect signatures at standwithdrdean.com, a Web site dedicated to health reform.

Mr. Dean spoke for more than an hour yesterday, fielding questions from audience members and on-stage moderators. This "town hall" style event was notable for the absence of catcalls and jeering, which has become a common feature at other health care town hall meetings that have been held in recent weeks (though one jokester did ask if Mr. Dean would seek appointment to the president's "death panel").

Mr. Dean sympathized with the health care reform protesters, suggesting that many of them aren't necessarily against health care reform, but have been whipped into a froth by Republican politicians who campaign on "anger points."

"This is a group of people who feel incredibly threatened" by change, he said. "The truth is, the meetings are not about health care. ... This is not about the bill. This is about a major generational change."

Mr. Dean also told the bloggers that they were the best hope to correct misinformation.

"We're seeing extraordinary things being said that are flat-out not true," he said. "They're maliciously untrue. And the only way to counter those is the Net. So we really need your help."