“If there were an emperor of progressive Democrats, Howard Dean would be the man — except of course his fellow Vermonter, Sanders, is now that man,” Ben Sarle wrote for the Atlantic last year. Certainly it’s hard to imagine the unexpected success of Bernie Sanders’s and Barack Obama’s campaigns without Dean’s insurgent 2003-’04 presidential run. Dean inspired thousands of new youth organizers, pioneered the use of digital technologies for political campaigns, and amassed sizable funds through many modest donations.

In March 2003, Dean righteously slammed the Democrats’ establishment leadership, opening a California speech: "What I want to know is what in the world so many Democrats are doing supporting the president's unilateral intervention in Iraq?" The doctor turned popular Vermont governor’s catchphrase was that he was from "the Democratic wing of the Democratic Party," and he was blunt about the failings of both his own side and the Bush administration.

The Democrats’ frontrunner collapsed in the Iowa vote, after coordinated attacks from the party hierarchy, and he quit the race after finishing second to John Kerry in New Hampshire. Dean morphed his campaign into Democracy for America. The million-member organization’s goal? To “empower the progressive grassroots to take our democracy back from corporations and the wealthy few and aggressively combat growing income inequality.” While Dean was chair of the Democratic National Committee, between 2005 and 2009, the party took back the House, the Senate, and the White House.

I spoke with Dean, now 68, over the phone from his Burlington home. We discussed health care and Iraq, politics as war, Dean’s beef with business, and Donald Trump’s “mental problems.”

This conversation has been condensed and edited.

Alexander Bisley

What messages were you advancing back in 2004 that you most wish people listened to you on?

Howard Dean

I think I’ve been proven right about a number of things: the war in Iraq, Bush’s tax cuts, which ran up huge debts, and his lack of regulation, which allowed the entire infrastructure of the Western financial world to collapse. I don’t think Republicans know anything about fiscal policy; I don’t think they care. I think they’re so ideologically driven that they don’t care about balanced budgets. You wait and see Trump’s tax cuts; I guarantee the budget will be less balanced afterward. Republicans are ideologues; they don’t care what the facts are.

Alexander Bisley

You were prescient about the opioid epidemic. In a 2001 interview with the LA Times, you warned about OxyContin’s catastrophic impact; as governor, you restricted its prescription in Vermont.

Howard Dean

Right — because I was a physician, I could see that one coming. There was no real need for OxyContin. It was highly addictive, and there were lots of reasons it became so addictive. That was what really created the heroin addiction, which is the scourge of our country, everywhere. Once the government forced OxyContin to reformulate so you couldn’t abuse it as easily, people switched to heroin because it was more available and cheaper.

Alexander Bisley

Do you think the opioid epidemic played a role in getting Donald Trump elected president?

Howard Dean

I think it did have an effect. There’s a sort of constellation of hopelessness in a lot of rural America for many reasons, and I think the opioid endemic is pretty high on their list of worries. It’s on my list as the three things we have to do to try to reconstruct rural America.

First is real tax reform — not the kind that Trump is about to pass that helps billionaires, but the kind that actually encourages investment in places that need it. Second is a better education system, not the kind that [Education Secretary] Betsy DeVos wants, which is to privatize all the schools with lower quality.

The third is dealing with the opioid epidemic, which is one of the reasons Obamacare is so important. It may not be perfect, but it certainly does help people who have really serious drug problems. We’re going to have to use a medical model to deal with this problem because throwing everybody in jail clearly doesn’t work. We need to be smart about what happens to people who are in trouble. If they’re violent and dangerous, obviously they have to be in prison. But if they have a drug problem, they probably need to be in treatment [instead].

Alexander Bisley

Obamacare has given 20 million more Americans health care. However, even Obama acknowledged it needs improvements. What would you suggest?

Howard Dean

A bunch of things. First of all, I’d allow people under 65 to buy into Medicare on a voluntary basis. There would never be the problem of not having an adequate number of insurance companies in the market. If insurance companies chose to leave a market, for whatever reason, you’d have Medicare as a backup.

Number two, I actually would get rid of the individual mandate. If you’re a purist about the insurance market, you need it. But we managed to insure every child under 18 in Vermont minus 1 percent, and we didn’t have a mandate. For the 1 percent that are going to do the wrong thing, it’s not worth antagonizing the 99 percent that don’t want to be told what to do by the government. There’s plenty of people across the entire political spectrum that feel that way; that’s not just a conservative position. So I would probably get rid of the individual mandate. I’d allow people to buy into Medicare, the so-called public option, and I’d use Medicaid the way President Obama did. I think that was the most successful part of the bill.

Alexander Bisley

Trump is the Republicans’ “chickens coming home to roost,” Bill Maher told me recently. “The problem is that they’ve been riding this tiger for a long time. Republicans have been feeding their base all kinds of crazy for years,” Obama put it at the end of the 2016 campaign.

Howard Dean

I think that’s very accurate. When you feed your base anger and lies, eventually it’ll catch up with the feeder. And that’s what happened.

Alexander Bisley

People like Paul Ryan, Mitch McConnell, Mike Pence: These guys are similarly responsible?

Howard Dean

Sure, they all did it, or almost all of them did. There’s almost a total absence of moderate Republicans now. The stuff that Paul Ryan was saying about the health care bill was just mumbo-jumbo and nonsense. He and McConnell were making things up; that was the party line.

I was shocked by what Ryan said about insurance. He didn’t appear to understand how it works.

Alexander Bisley

How does your party get through to swing voters who voted for Trump?

Howard Dean

First of all, I really do believe it’s time for my generation to step back and assume a coaching role. I think we need to get the young people of what I call the “first global generation” into politics. Trump may do it for them. This is a generation who doesn’t like establishment politics, they don’t like institutions because they find them clunky and slow, which they are, and they’ve remade the world in many ways without the help of institutions on an ad hoc basis.

I think the shock of the Trump win for them was, “Oh, gosh, you really do need institutions as clunky and slow as they are.” Trump was an affront to the values of the younger generation, who value diversity, inclusion, respect for others, facts, and metrics. They’re not particularly left, and they don’t necessarily consider themselves Democrats, but they always vote for the Democrats because the Republicans are busy throwing red meat to their base, which includes excluding all the ... first global generation’s friends.

I see this as a generation with less ideological bandwidth from left to right than ours, somebody who’s put the culture wars behind them, which our generation is still fighting. Young people who want to get stuff done and not just screaming, yelling, carrying on on television. That’s not going to benefit the country, and it’s because the Republicans have pushed so hard against the values of their own children. I think we’re going to see a huge change in politics as soon as that generation begins to take over the levers of power.

Alexander Bisley

What are some of your coaching tips?

Howard Dean

I think young people don’t quite understand that politics is a substitute for war and it’s a rough game. You don’t find nice people because the stakes are enormous, and people will do a lot of bad things to each other. Four hundred years ago, if we had a question on the succession of power, lots of people would’ve lost their lives. Instead, we essentially had a revolution in this country, and people didn’t lose their lives because we use elections instead. Politics is a substitute for war, and therefore you have to be tough, unyielding, and uncompromising in battle. That’s why the Republicans generally, with the exception of the two Obama campaigns, have run campaigns better.

They’ve survived a long time as a minority party. It’s a funny thing to say they’re a minority party, given their huge gains in the last eight years, but the truth is their views do not represent the views of most Americans on most issues, such as Social Security, Medicare, the right to have women make up their own reproductive decisions, and same-sex rights, including marriage. Those are all positions that the Republicans have been left behind on. But they’re very clever, they’re incredibly disciplined, they understand that politics is like war, they’ve been methodical about getting what they want.

The younger generation isn’t like that at all. They aspire to a higher vision of what human beings are, and we’ll get there, but we’re not going to get there without breaking some glass.

Alexander Bisley

Trump “believes truly insane, deranged and delusional things”, Chris Hayes told me. “It’s very much an Infowars presidency in many ways. The president is a conspiracy theorist.” What do you think?

Howard Dean

Well, I think the American people are smarter than most writers and intellectuals give them credit for. Richard Nixon had a 24 percent favorability rating the day he left office a disgrace. So there’s going to be 24 percent of the people who are going to believe whatever they believe, and they don’t care what the facts are.

But I think there are a lot of people who thought Trump really might be somebody who would turn the country around, so they were willing to forgive his craziness. Now I think they’re not, because it looks like he probably can’t do the job as a result of his mental problems.

Alexander Bisley

To be human is to have regrets. Do you have any particular political regrets?

Howard Dean

Well, yes, I didn’t win in 2004. It would’ve been great to be president; we might’ve saved ourselves a lot of trouble. We would’ve been out of Iraq earlier, we would’ve had a more equitable economic system, we would’ve had universal health care a long time ago. That’s assuming I could’ve had a Congress that I wanted. But remember, these campaigns are like war, and they’re very tough. I actually think if you can’t get through the campaign then you probably shouldn’t be president. And I didn’t get through the campaign.

Alexander Bisley

What about the most recent presidential campaign? You told MSNBC the Democratic National Committee “should never have taken sides” — do you have any regrets from that one?

Howard Dean

Well, I regret Hillary didn’t win. I always like to teach my classes that there’s one instrument that’s incredibly popular among both physicians and politicians because they use it twice as much as anybody else: the retrospectoscope. The retrospectoscope is always correct. I try not to do too much looking in the rearview mirror. You want to do enough of it to learn, but you don’t want to do enough of it to fundamentally undermine what your values are.

Alexander Bisley

Okay, but is there a particular learning from the last campaign you’d emphasize?

Howard Dean

I think the thing we learned about the most was that America was not quite ready to elect a woman president; we’ve got a ways to go there. But we did make a crack in the ceiling, and I think it’s very important.

Alexander Bisley

What has changed the most in American politics since 2004?

Howard Dean

I think what’s changed the most is the ability to run technical campaigns with metrics. What we did was very crude compared to where people are today. While it was invented by the left, mostly by the kids on my 2004 campaign, the right has now taken up technology and actually surpassed us in their ability to use it.

Alexander Bisley

What did you think would change but hasn’t?

Howard Dean

I’m not sure. I think someday we’ll get away from the reliance on the right-wing crazy stuff, otherwise known as fake news, and the Breitbarts, and all that. But I don’t think that’s at hand now; the Russians are using that as an international weapon. I’m a little surprised it hasn’t gone away sooner. I think until this next generation gets into politics, I don’t see major cleaning up of the place. I think the partisanship is going to continue for a while, and fake news and all this other destructive stuff is going to stay as long as my generation is in politics. There’s technology that my generation knows how to use but doesn’t know what it really means.

Alexander Bisley

“Washington is the last place in America that has any idea about what the hell is going on,” you told Katie Couric recently.

Howard Dean

That’s true. I always call it middle school on steroids. They’re all wrapped up in their own little bubble, and they don’t really understand what’s going on elsewhere. The Republicans know what the anger is, and then they exploit it. The Democrats, I don’t think they understand what people really want. The Republicans understand what people want; they just don’t want to give it to them because it requires some rearranging and tough choices. People want to live in a fair society where if they work hard, they have a shot. Since about 2000, that hasn’t been the case.

I think the moral leadership in the business community has fallen apart for the most part. When I was young, businesses integrated their boardrooms before they had to, and they actually were fairly pro-environmental. Now I think there’s an appalling lack of concern sometimes in the boardroom of multinational corporations. After all, their allegiance is to multinational shareholders, not necessarily [to] the United States. There are some exceptions — for example, Starbucks and all those companies that made Mike Pence back off his anti-gay bill.

They really came through in North Carolina. Who ever thought the NCAA would come through on anything like that? Arizona refused to recognize Martin Luther King Day, so the National Football League forced them to do that. We need large corporations to use their influence. There are more that don’t do the right thing than there used to be. I think the business community needs to think seriously about where we’re going and not simply about what the next tax break is.

Alexander Bisley

Matthew Yglesias wrote in Vox about how Deaniacs became Democrats and believes Sandersistas can do the same. Do you agree?

Howard Dean

I do think it’s true, but it’s interesting what’s going on with the Sanders people because it went on with me in 2004 too. We divided into three groups. I told them when I was dropping out, I said, “You go to join your local Democratic Party. If they welcome you with open arms, then you’re part of the fabric of the party. If they try to keep you out, then you try to beat them in an election, which has happened.” The Sandersistas have done that too; they have several state chairmanships.

I think what Sanders did was fantastic; it was great for the country and great for the body politic. However, there is a faction of Sanders people that I call “the sourpuss party” who don’t really want to win; they just want to be self-righteous. That always exists in humankind. They’d rather be on the sidelines and be right than get dirty and have to make some compromises. Bernie himself is not like that; he was quite a good mayor. He had to make compromises, he told his supporters so, and they had to like it. Whether it’s the right or the left, in every group there’s always people who believe that purity of ideology is more important than results. That’s not where I am on the political spectrum.

Alexander Bisley

What’s your relationship with Bernie like?

Howard Dean

I think we like and respect each other. We’re not close, but I think what he did was good and he knows that I think he did was good. I went out of my way not to say anything that I thought was really destructive about him during the campaign even though I was supporting Hillary. I think he’s been a big addition to the country.

Alexander Bisley

What do you think of the recent wave of nostalgia and goodwill for George W. Bush?

Howard Dean

Look, I’ve always thought George W. Bush was an honorable person, although that doesn’t fit exactly with what happened in Iraq. My theory is that [Dick] Cheney manipulated him and controlled the amount of intelligence he was getting. But I know George Bush, I like him, he’s a great parent. I had some major problems with the war and some of his domestic policies, but as a human being I think it’s hard to dislike George W. Bush.

Alexander Bisley

In my opinion — and your opinion in 2003 and 2004 — he certainly misled America into Iraq, which was and is horrendous, and had a lot of bad domestic policies too.

Howard Dean

I agree with that. I didn’t support him for president; I don’t think he should’ve been president. I actually don’t think he was elected president. I think [Al] Gore should’ve gone and taken the next constitutional step, which was to ask Congress to make the decision, although the outcome might not have been different. I do not think [Bush] was a good president, but I do think he’s a good person.

Alexander Bisley

Today some liberals even feel wistful toward the W years: Have the Republicans gotten more extreme since he was president?

Howard Dean

The Republicans have gotten much more extreme. In the times of legislation, they’re just vindictive. It’s almost know-nothingism; their position on climate change, the purism on abortion, the hostility to people of color — which they may deny but then play to and dog-whistle it. Trump didn’t even bother to dog-whistle it; he just laid it out there. My parents were both Republicans; that’s not the Republican Party I grew up with in my house.

Alexander Bisley

What can a tiny state like Vermont do to challenge Trumpism?

Howard Dean

We can do a lot. We were the first state in the nation to legalize same-sex unions. We’ve had universal health care for people under 18 since 1992. There’s a lot of things we can do. I think one of the impressive things that Bernie did as mayor of Burlington was start the Burlington Community Land Trust, which was a way of allowing modest-income people to stay in their own homes and to buy homes, and that’s been copied all over the country. A lot of our environmental stuff has been copied all over the country. Even small states can lead the way if they’re internally consistent and they have principles they believe in.

Here in Vermont, you get rewarded for telling the truth. I think what people loved about Bernie is that he wasn’t afraid to say things that everybody else is afraid to say that were pretty obvious. Bernie will win elections as long as he wants to here because his coalition is essentially the Trump voters and the lefties and the progressives.

I had my car jump-started in my driveway this past summer. I got yakking about politics with the tow truck driver. As we’re putting the jumper cables on, he says, “You know what I’d like to see in politics? I’d like to see a Trump-Sanders ticket. That’d give the big middle finger to all those people in Washington.” Well, Bernie gets all those people up here. I think people here are pretty practical about the politics in Washington; they want somebody to go down there and shake the place up.

Alexander Bisley

Bernie seems to me like the John McCain of the left in that he’ll never retire.

Howard Dean

He’s a little more consistent than John McCain, but you’re right. Bernie’s independent; he’s not afraid of calling out his own side, which is important.

Alexander Bisley

“Since his career in politics ended, Dean has found a home in the K Street establishment he once held in such disdain,” the New Republic’s Jonathan Cohn, a Deaniac, wrote in 2013. What’s your response?

Howard Dean

Jonathan Cohn wrote that?

Alexander Bisley

Yes.

Howard Dean

He must have read the Intercept. That was a mistake [laughs]. I’m not a lobbyist. I do work at Denton’s, which is the largest law firm in the country, and I have a great time doing it. But I don’t lobby, I don’t work for clients I don’t particularly like, I don’t do billable hours; I do it my way. I have no intention of going to K Street. I must’ve missed that article, but I still think Jonathan Cohn is the best health care writer in the United States, bar none.

Alexander Bisley

What do you hope your legacy is?

Howard Dean

There’s the Vermont legacy: what I did in Vermont in terms of balancing the budget, same-sex marriage, health care, and that we blocked up hundreds of thousands of acres that’ll never be developed here because I wanted to preserve the character of Vermont long after nobody remembered who I was.

But the national legacy, the most important part of my legacy, is I think I was the first candidate to get the first global generation involved in politics.

Alexander Bisley

Despite Trumpism, you’re hopeful about their capacity to improve America and improve the world?

Howard Dean

I have very little patience for people who whine and moan about millennials or the first globals, as I call them. I think this generation is absolutely extraordinary. Of course they have faults, but I think a lot of the criticism [from] older people about this generation [is] older people who are insecure about some of the things these guys are pointing out. This is a generation of human beings who have more power as individuals than any generation in human history. It’s unbelievable what they’ve done.

I know kids who are 28 years old who started foundations when they were 18. They’re changing more lives than USAID does, and there’s thousands of them. I think inner-city education has been transformed by Teach for America and by the charter school movement. Nobody did anything about inner-city education for 40 years — not white, not black, not Republicans, not Democrats, nobody.

Now we’ve got to get [more of] them into politics. They hate it, they don’t have any use for it — it’s too slow, it’s cumbersome, it’s full of self-interested people that are unattractive — but it’s going to have to happen. And they’re going to change it. The problem is they’ve never wanted to get [into politics]. Now I think they understand why they have to do it, and that’s my great hope for the salvation of the world.

Alexander Bisley

You came up during the ’60s and ’70s, so you would’ve known young leftists who were more annoying than the odd fool on campus today.

Howard Dean

You know that’s true. Here’s the great thing about this generation from my point of view: They have our values, but they’re much more sober-minded, much more willing to work with each other, much more pragmatic, much less ideological, which is one of the more unattractive features of my generation in the ’60s.

Bernie’s left, but there’s not really much of a left in this country. I remember when there was a left — they were blowing up buildings, they were self-righteous as hell — and now there isn’t one. Now the right’s really unpleasant and doing crazy things. This generation has our values without having our rough edges and intolerance of others. I think that’s very important.

Now, there’s still a hell of a lot of work to be done. The race issue in this country still exists. I think before Ferguson, [Missouri,] my generation thought we were post-racial, and that’s not true: There’s a hell of a lot of work to be done. There’s not many nice things about getting old, but one of them is that I can look backward as well as forward. When Freddie Gray was killed, what you media were writing about was riots in the streets of Baltimore. When Martin Luther King was killed, 99 cities were burned down in the United States. What happened in Baltimore was barely a riot by our standards. Second of all, there were white kids out there protesting along with the black community; that never would’ve happened in the ’60s and the ’70s.

In 1968, King was killed, Bobby Kennedy was killed, the Chicago Convention blew up, and 99 cities were burned down. If you told us 40 years later we’re going to have a black president, we’d have told you you’re out of your mind, you’re smoking too much pot. Forty years later, Barack Obama was elected president of the United States. The amount of change in this country is unbelievable, but it’s not going to really accelerate until the first global generation takes their rightful place, which has been usurped by my generation. We’ve just stayed on a little too long, I think.

Alexander Bisley also writes for Maclean’s, the Guardian, BBC, and more.

First Person is Vox's home for compelling, provocative narrative essays. Do you have a story to share? Read our submission guidelines, and pitch us at firstperson@vox.com.