We have quietly reached the key question in the health care debate.
Will government be allowed to enter the general health care market?
The insurance industry has a great fear it will, and take the best risks with it. This despite the fact that, until now, government has only taken the worst risks -- the aged, the poor and those heroes already wounded.
The two sides in the debate seem closely balanced, although a betting man would admit that, as of now, insurers have the upper hand.
Enter Howard Dean M.D. The former Vermont Governor, Presidential candidate and Democratic National Committee chair has gone back to his roots, using his status as a doctor, and his original campaign organization, to push for a "public option" in health reform.
The "public option" is a shorthand for what many liberal activists have long called for, and conservatives have long feared. That is, the government offering businesses and consumers a health insurance plan, in competition with private industry, to those who can't afford private insurance and those willing to pay for it.
As a Washington outsider, Dean has some power President Obama lacks. He can stand by his campaign list without conflict of interest fears. As a former practicing physician (his wife still practices) he has some authority in this debate.
The original Dean campaign organization, Democracy for America, atrophied a bit after 2004. Dean's decision to become DNC chair forced his brother, who really is named James Dean (he goes by Jim) to man the storefront in his absence.
One can argue that the health care debate is just Dean's way of trying to rebuild his organization, and it is that. (Under Jim it was rebellion without a cause.) But before Barack Obama showed up, Dean's was the largest army of volunteers liberals had.
What makes this newsworthy is how closely matched the two sides are in the health reform debate, and the fact that until recently grassroots pressure mainly came from the right, not the left.
You may argue that the liberal grassroots have swept the field, with the President and Congress both now Democratic. But the natural tendency in that case is for grassroots to wither, its leaders entering the establishment and the rest drifting away.
Some in the media argue this is already happening in the case of the President. He is now in the position Franklin Roosevelt was in when he told his own party activists, "I agree with you, I want to do it. Now make me do it."
Doctor Dean will try. Can the Netroots be energized again? Does Dean have the authority over that movement he once had?
The next few months will answer.