It's hard to imagine a place seeming farther from the White House than State Street in Montpelier, Vermont. A bucolic hamlet nestled alongside the Winooski River, Montpelier, a town of 8,000, must be the only state capital without a McDonald's. On a brisk May morning, the sun glints blindingly off the gold-domed capitol building. Shops along State Street sell the latest issues of Yoga and Feng Shui, while boutiques with names like Moon Mountain and Cool Jewels offer beads and crystals. Independent bookstores abut the headquarters of Vermont's Progressive Party, the funky Capitol Grounds coffeehouse, and, of course, a Ben & Jerry's.

From this unlikely perch, Vermont Governor Howard Dean is launching a long-shot 2004 presidential bid. Even his best friends have greeted his intentions with astonishment and disbelief. "It's amazing to me that someone sets out to climb that mountain, particularly as far out on the plains as he is," says William Sorrell, Vermont's attorney general and an intimate of Dean's. "He's got a long walk even before he reaches the foothills."

Never mind that Vermont is famously mountainous ski country; the fact remains that Dean, who opted not to seek re-election this November after serving five terms as governor, is busily tilling the plains of Iowa, New Hampshire, South Carolina, and other early primary states. He has also trekked out to the money states -- New York, California, and Texas -- although he admits that he's "somewhere between an asterisk and 1 percent" in pre-election polls.

So just how does a largely unknown governor from the tiny People's Republic of Vermont plan to get himself elected president? First of all, despite Vermont's reputation as perhaps America's most liberal state, Dean is at pains to make it clear that he's not one of the flakes that cascade from the skies during Vermont winters. In fact, he's a hard-nosed, penny-pinching fiscal conservative who seems to delight in sticking his thumb in the eye of the Democrats on the party's ever-shrinking left wing. That said, he was also the first 2004 contender to kick at the cornerstone of President George W. Bush's domestic agenda, saying, "The first thing we need to do is roll back those tax cuts."

Unlike the infield's worth of Washington Senators who are suiting up to challenge Vice President Al Gore's re-election bid, Dean is a governor. And unlike the attorneys of the firm Kerry, Edwards, Lieberman, & Daschle, Dean is a doctor. Score two for Dean. But that's not counting his ace-in-the-hole: health care. Vermont's health-care safety net is the nation's most comprehensive. More than 90 percent of Vermonters have health insurance, including nearly all of the state's children, and Dean is waging a virtual one-man jihad against the pharmaceutical industry. If health-care costs continue the dizzying upward spiral of the late 1990s, if the number of Americans without health insurance continues to soar, and if Congress -- as seems virtually certain -- fulminates but ends up doing nothing about either access to health care or a prescription-drug benefit for Medicare recipients, Dean could find himself riding that tiger all the way to Washington.

"He's got a complete leg up on what is going to be the number-one issue of 2004, which is health care," says James Carville, the Democratic consultant who engineered the ascent of another small-state governor a decade ago. "If he could raise money, he'd be dangerous."

Raising money, Dean knows, is his embryonic campaign's most daunting task. "I'm going to be dead last in fundraising," he says, though he's counting on being able to pull in $8 million to $10 million going into 2004's first three primaries. "We're going to rely heavily on people who can write checks for $25, $50, $100," says Kate O'Connor, the governor's chief political aide. "We're going to campaign from the bottom up. We're being realistic, knowing that for the $1,000 donors, Howard Dean isn't going to be their first pick."

Dean established a political action committee (PAC), the Fund for a Healthy America, last fall, but so far it has collected about $140,000, and its first formal fundraising event is scheduled for late June in Fire Island, New York. That the PAC chose to host its event at a summer retreat for New York City's wealthy gay and lesbian community is no accident, as Dean is counting on support from Democratic gay activists. In 2000 the Gore-Lieberman campaign raised at least $10 million from gay donors. And Dean has a special advantage with this community: By signing Vermont's 2000 landmark legislation allowing gay and lesbian civil unions -- the first law of its kind -- Dean became something of a folk hero among gays.

Since last fall he's spoken to at least a dozen gatherings of gay leaders in New York, Michigan, Pennsylvania, Washington, California, and elsewhere. When veteran lesbian activist Torie Osborn attended a gathering of Hollywood actors and preening pols last year, she says, Dean stood out: "It was a roomful of stars, and he was the brightest." David Mixner, a longtime activist who raised millions for Gore and, earlier, for President Bill Clinton, had lunch with Dean not long ago. "I found him delightful," says Mixner. "I think he will be pleased. Even people who are supporting other candidates might write him checks for $250, $500, or $1,000. He risked his career over the civil-unions issue, and it's a community that doesn't forget its friends."

Still, gay activists are sophisticated political investors, and at least some of the early money is on John Edwards and Dick Gephardt, activists say. "In terms of the big-money Democratic Party insiders, [Dean] will be a force, but there will be competition," says Osborn.

Compared with the burgeoning and well-oiled machines being assembled by some of his would-be Democratic rivals, Dean's PAC is charmingly modest. So far it consists entirely of Kate O'Connor, who handles her PAC duties on a part-time basis from a small office in Montpelier while juggling her state duties. "Well, we do have somebody who's a college student right now, who's volunteering part time, and we're bringing in another person in June," says O'Connor, who's worked closely with Dean since 1989 when he was lieutenant governor. Since then, O'Connor has been collecting, organizing, and filing thousands of contacts from across the country, including a silo of new ones harvested from Dean's recent political travels. Right now, all of those business cards and contact sheets are piled up in her office.

"I have boxes of stuff," O'Connor says. Organized by state? "Oh, yeah!" she says, laughing. "I have boxes for every state." How does she remember who they all are? "It's not easy." Eventually, she hopes, those boxes -- computerized -- will be part of a Carville-style war room. "Now we're lean and mean," she says.

Many of the contacts Dean has developed date back to the 1990s, when he served as chairman of the National Governors Association (NGA) health committee, then as co-chair of the NGA's Task Force on Health Care, and finally as chairman of the Democratic Governors Association (DGA). Since 1995, he's been the DGA's main recruiter for gubernatorial candidates, a post that has given him the chance to crisscross the country for five years, meeting and greeting.

"I think some of the governors will help Dean behind the scenes, and some will help out in the open," says Joe Trippi, the veteran political consultant who's helped run presidential campaigns for Walter Mondale, Gary Hart, Richard Gephardt, and Jerry Brown. Trippi worked on all of Dean's gubernatorial wins, and has signed on to provide strategy for Dean 2004. Though he's not being paid (yet), Trippi is helping his candidate map out field operations in New Hampshire -- where Dean hopes to claim near-favorite-son status -- as well as in Iowa and South Carolina. Trippi admits that Dean faces an uphill battle. But presidential campaigns always narrow down to just two people, he observes. "Gore probably has one of the gates cinched, and the question is, who gets the other gate?" he says. "My guess is that whoever gets the other gate wins."

Dean's doing his best to lock it in for the early primaries. He has made countless visits to New Hampshire and half a dozen trips to Iowa since last fall. According to The Des Moines Register, he has visited Iowa more often than any other hopeful, and he's planning an extended swing through the state in June. His PAC kicked in $5,000 to the Iowa state party and has donated money to some local candidates, too. Part of Dean's appeal in Iowa, and in gun-friendly New Hampshire, will be his opposition to gun control. "I have an A rating from the National Rifle Association," Dean reminds Iowans. And he is especially close to Iowa Governor Tom Vilsack.

According to the Register's lead political reporter, David Yepsen, Dean's political style matches up well with Iowa. "He knows how to do small-town, one-on-one campaigning, which big-state politicians often have trouble doing," says Yepsen. "He's folksy, and he takes time to chat." Another plus, Yepsen says, is that unlike some of his rivals, Dean will be unemployed in 2003, giving him lots of time to spend building support for the Iowa caucuses.

Medium height, wiry, and fit, Dean has a swift grin and a tendency to redden beneath his politician's tan when he laughs. He speaks rapid-fire, often in bursts, and his eyes flash when he says something provocative, which is often. He is proud of his bluntness -- so much so that he not only speaks bluntly but pauses now and then to tell his listeners that he is, indeed, blunt. With alacrity, he accepts the suggestion that a Dean campaign might resemble Arizona Senator John McCain's "Straight Talk Express," even down to that senator's famous effort to wear down reporters with incessant contact.

More Michael Dukakis than Bill Clinton -- we are, after all, in stony New England -- Dean is not warm and cuddly, and he is not easily given to introspection. He keeps his notoriously media-shy wife, Judith Steinberg, also a physician, out of sight, and she declines all interview requests. Word is that Dean is quick to anger. "The governor has a temper," says John O'Kane, manager of government affairs for IBM Microelectronics Burlington. "He's thin-skinned. We choose our words very carefully around him."

Dean's plainspoken directness might seem like a Vermont Yankee trait, but in his case it's the New York Yankees. Born in 1948 into a wealthy New York family -- his father and grandfather were stockbrokers, his mother an art appraiser -- Dean grew up in the Hamptons and on Manhattan's Upper East Side, attending elite private schools before going to Yale University. The New York Deans were Rockefeller Republicans, and Dean recalls accompanying his father to the GOP's 1964 convention in San Francisco, where at age 15 he watched Nelson Rockefeller get pummeled by the Barry Goldwater right.

Some analysts, including the University of Vermont's Garrison Nelson, a veteran observer of state affairs, still consider Dean a Rockefeller Republican, but one who, like his friend Jim Jeffords, discovered that the GOP no longer provides a home for that wing of the party. "I think he learned in retrospect that the kind of Republicanism that Rockefeller represented, i.e., fiscally conservative but socially liberal, was probably dead within the Republican Party," says Nelson. Increasingly uncomfortable with the Republican right but equally repulsed by the Democratic left, Dean slowly began gravitating to the exact political center.

After college, Dean followed his father to Wall Street, spending two years as a broker. Dissatisfied with that life, he chose to travel and then to spend a year in Aspen, Colorado. Back in New York, he enrolled in classes at Columbia University's School of General Studies, volunteered in the emergency room at St. Vincent's hospital -- "I wanted to see if I could stand the blood and the gore," he says -- and eventually decided to enroll at the Albert Einstein College of Medicine, graduating in 1978. Months later, Dean did his residency at the University of Vermont Medical Center and then, with his wife, established a medical practice in Shelburne, just down the road from Burlington on the shores of Lake Champlain.

Cynics say Dean settled in Vermont because it offered him a perfect entrée into politics. "He needed a state as a springboard," says Nelson. "He was barely in the state, and right away he got involved in politics." Dean admits that he had political ambitions even before medical school, but insists that Vermont intrigued him for other reasons. "I had a lot of connections here," he says.

Soon after moving to the state, Dean found himself in the living room of Esther Sorrell, a former senator and godmother of Vermont Democratic politics whose home doubled as a political salon in the late 1970s. Bill Sorrell, the attorney general and Esther's son, says, "I was in sixth or seventh grade before I realized the dining room table was for eating, not for holding piles of voter lists." He recalls Dean as a frequent visitor on Friday nights, when Vermont's politicos would gather to talk politics and watch Vermont This Week on TV. Not long after that, Dean ended up as chairman of the Chittenden County Democratic Committee, which served as the launching pad for his entry into electoral politics.

Elected to the state legislature in 1982 and in 1984, Dean became assistant minority leader -- thanks in part to his sheer persistence. The University of Vermont's Nelson quotes Ralph Wright, the longtime speaker of the House, comparing Dean to a "tagalong kid, the kind whose mother says you have to let him play." The stars aligned for Dean in 1986, when he found an opening to run for lieutenant governor. He was re-elected in 1988 and again in 1990, under both Madeleine Kunin, a Democrat, and Richard Snelling, a Republican. The lieutenant governorship is a part-time job, and Dean continued to practice medicine. But on August 14, 1991, while examining a patient, Dean received the phone call that changed his life. Governor Snelling had suffered a fatal heart attack.

From the start, Dean navigated a triangular course between the two parties, clashing often with the Democrats over taxes and spending -- and helping to drive many liberal-left Democrats into the arms of the Progressive Party and of Representative Bernie Sanders, Congress's lone socialist. Inheriting a fiscal crisis from Snelling, Dean slashed the budget and dramatically reduced taxes. During the 1990s, Dean repeatedly unsheathed his veto pen, and he often allied with a growing contingent of conservative Blue Dog Democrats and Republicans to outmaneuver the Democratic leadership on issues such as taxes.

In his fiscal conservatism, Dean has been guided for more than a decade by a behind-the-scenes kingmaker named Harlan Sylvester, a senior executive at Salomon Smith Barney in Burlington who chairs Dean's council of economic advisers. Sylvester praises Dean for forcing through a dramatic tax cut during his first year in office, over the objections of "the left of the party [who] wanted to soak the wealthy," Sylvester explains, leaning back in his chair in an expansive office just off Lake Champlain. "One-quarter of 1 percent of Vermonters pay 16 percent of state income taxes," he says. "That's 829 people, and a lot of them are clients of mine. Four of them moved out of state rather than pay Vermont taxes."

Dean's support for tax cuts may be unorthodox, but he has little appetite for soul-searching about his party. "The ideological debate in the Democratic party is a waste of time," he snorts. "I have no patience for ideologues." Nonetheless, it's clear what ideology guides him. "My politics has been aimed at the middle," he says. "I don't believe in giving away the store. I'm not an old-fashioned, 1960s liberal." And as Vermont's elected Democratic officials watched Dean consistently win re-election with three- and four-to-one majorities against Republican opponents, says Peter Freyne, a political writer for the Vermont weekly Seven Days, "they've taken notes and adjusted appropriately."

Not surprisingly, business groups have tended to back Dean since 1991. "He's been a strong supporter of many of our baseline issues," says Chris Barbieri of the Vermont Chamber of Commerce. IBM's O'Kane says, "For the most part, business has viewed him favorably." IBM is far and away the state's largest employer, and Dean has assiduously courted the company, meeting quarterly with its executives for 11 years. When the plant in Essex Junction pulled for a highway construction project that environmentalists opposed, Dean took the company's side. In mid-May, rumors circulated that IBM might scale back or close the plant. Dean told a press conference, "There have been very few things that they've asked for that they haven't gotten."

For all that, the crown jewel in Dean's Vermont legacy remains the state's health-care system. A web of state programs -- an expansive Medicaid plan, Dr. Dynasaur, the Vermont Health Access Plan (VHAP), VHAP-Pharmacy -- provide an extraordinary level of care to Vermonters over a broad income range. Dr. Dynasaur guarantees coverage to children in families with an income up to three times the poverty level, meaning that a family with four children and an income of $72,936 gets free care for its kids. VHAP provides coverage and low-cost prescription drugs for adults not eligible for Medicaid. And Dean's vaunted Success by Six program provides for early child care and parental guidance, including home visits by case workers, for virtually all children born in Vermont.

When Dean first waded into the health-care wars in the early 1990s, he proposed a sweeping plan for universal coverage -- but, like President Clinton's, Dean's plan drew fire and collapsed in the legislature. Since then, he has pursued an incremental approach that has shown real results. Doing so has meant walking a fine line, however; while his initial support for universal health care has led some business groups and conservative Republicans to grumble, his subsequent caution has alienated supporters of more fundamental reform. Deborah Richter, a physician and leader of Vermont Health Care for All, accuses Dean of sabotaging the creation of a Canadian-style single-payer system, which has consistently had significant backing in the state legislature, the endorsement of the Vermont AFL-CIO, and even support from many small businesses and doctors. Dean simply dismisses single-payer as an unrealistic goal. "I don't want another Harry and Louise campaign," he says.

But there is one industry Dean hasn't shied away from fighting full-on, and that's Big Pharma. "They consider me an enemy, I'm sure," he says -- and he's right. He's pressed the NGA to demand action to force drug prices down. He's helped set up a national coalition that lobbies Congress to close loopholes allowing drug makers to extend patent protections unfairly. And he's even urged Vermonters cross the Canadian border in order to buy drugs, which are vastly cheaper there.

Doctors, of course, never sell snake oil. If the Dean camp is right in thinking that health care will be at the very center of Americans' concern about economic security in 2004, Dean might very well end up doing his next residency in Washington.