With Democrats against the ropes on national health care reform, Vermont’s political prizefighter has come out swinging.

Howard Dean is traveling the country trying to fire up Democrats weary from months of setbacks at the hands of Republicans — who, despite their small numbers in Congress, have skillfully blocked much of the Democratic agenda. At an appearance in Brattleboro on February 17, the former Vermont governor and Democratic National Committee chairman told a gathering that Democrats must get “tougher” if they want to win political battles.

“We have a Republican minority who acts like a majority, and we act like a minority sometimes,” Dean told the crowd, according to the Brattleboro Reformer. “We need to stand up for what we believe in and we need to do it every single day.”

Dean never really left the political stage after stepping down as Democratic chairman. But he’s playing an especially prominent role in the national health care debate. No longer a candidate, office holder or establishment party insider, Dean has reemerged as a left-wing rabble-rouser and a champion for what he’s referred to as “the Democratic wing of the Democratic Party.”

Dean’s outspokenness has even fueled rumors about his challenging President Obama in a 2012 primary, or retaking his post as chairman of the national Democratic Party — actions Dean has said are not in his future.

For now, though, he is maintaining a jam-packed public appearance schedule. Dean appears almost weekly on MSNBC and is frequently quoted on well-read news and opinion websites such as the Huffington Post, Politico and Firedoglake. He is stumping for Democratic candidates in New Hampshire and Oregon, addressing a direct-to-consumer marketing convention in Washington, D.C. — and even debating Karl Rove in college campus auditoriums. For money, he works as a senior strategic advisor and independent consultant with the Washington, D.C., law and lobbying firm McKenna Long & Aldridge.

Dean declined to be interviewed for this article, despite numerous requests by Seven Days. But those who know Dean and understand the Washington political landscape say his influence is significant.

“The real influence that Howard Dean has is not inside the Beltway; it’s out in the grassroots around the country,” says Bob Rogan, who worked for Dean as governor and presidential candidate and is now chief of staff to U.S. Rep. Peter Welch. “When Howard Dean talks, the grassroots listen and react.”

Even as the president and Democrats hold televised health care debates in search of compromise, Dean has been calling for a bare-knuckled fight. In December, he branded the health care bill a “bailout” for insurance companies and said the legislation should be “killed” because it was too expensive and not real reform.

That earned him a rebuke from the White House. Senior advisor David Axelrod characterized Dean’s criticisms as “predicated on a bunch of erroneous conclusions” and said that for liberals to undermine the push toward health reform would be “a tragic, tragic outcome.”

Dean has usually stood his ground. For months, he has called on Democrats to stop accommodating Republican demands and pass a health care plan using reconciliation, a parliamentary procedure that requires only 51 votes in the Senate, rather than the 60 needed to break a Republican filibuster.

“Bush would have had the health care bill done a long time ago,” Dean told ABC News on January 19. “He would have gone through reconciliation.”

Now, with bipartisan talks stalled, Democrats are finally moving toward reconciliation as a way to pass health care. Is “the Beltway” finally listening to Dr. Dean?

From where she sits in Vermont, Dr. Deborah Richter believes the answer is yes. “It’s really a testament to how strongly people feel about him, that his opinion mattered in health care,” says Richter, a leading health care reform advocate in Vermont. “That caused a lot more pause about this national health care reform, and I think a lot of that was due to Howard Dean. I do think he’s got a lot of respect out there.”

Despite Dean’s grassroots appeal, Rogan says there are many in Washington who “wince” at the mention of his name.

“They’re wincing because what Howard Dean is doing is holding people accountable,” Rogan says. “He doesn’t mince words. His ability to speak clearly, consistently and forcefully is his strength.”

Observers of Dean suggest that his position as an outsider has freed him to speak his mind; he’s no longer beholden to constituents, voters or powerful Democratic establishment figures.

“He doesn’t have to pander to any particular group,” says Richter. “He can really say the honest truth.”

Sen. Bernie Sanders seemed to acknowledge as much in a February 10 interview on the MSNBC show “Countdown.” Sanders called Dean’s criticisms of the health bill “constructive” and said his fellow Vermonter “makes good points.”

“On the other hand, as a United States senator, a member of Congress, I’ve got to deal with the reality that there are a lot of people who desperately need health insurance and that has to be taken into consideration,” Sanders said. “We’ve got to all deal with the reality that if this bill goes down, what does it mean politically in this country? When is the next time the legislation is going to come up?”

Ironically, some of the measures Dean’s fighting for in the health care bill wouldn’t affect Vermont. For instance, the state has already expanded Medicaid eligibility well beyond what the federal legislation would allow, Richter says. It also has a “community rating” system that prevents insurance companies from cherry-picking the healthiest individuals. The system spreads risk out evenly, so healthy people in the pool pay the same premiums as sicker ones.

Who originated many of those remedies? Howard Dean.