HOUSTON — The leading Democratic presidential candidates split sharply over the issue of health care in a debate Thursday night, exposing the gulf between former Vice President Joe Biden’s careful moderate politics and the transformational liberal ambitions of Sens. Elizabeth Warren of Massachusetts and Bernie Sanders of Vermont.

Biden, facing all of his closest competitors for the first time in a debate, quickly took the initiative to challenge Warren and Sanders for supporting a “Medicare for All”-style health care system that would displace the existing forms of private insurance. Cloaking himself in the accomplishments of the Obama administration, Biden branded Warren as seeking to upend the progress of the Affordable Care Act.

“I know the senator says she’s with Bernie — well, I’m for Barack,” Biden jabbed, attacking the cost of a single-payer program: “How are we going to pay for it?”

Warren and Sanders, flanking Biden onstage, pushed back in tandem, dismissing Biden’s criticism and promising that a government-managed health insurance system would ultimately be less expensive for consumers than the private insurance they currently buy. Warren credited former President Barack Obama with having “fundamentally transformed health care in America” but said the country needed to go further.

“The richest individuals and the biggest corporations are going to pay more, and middle-class families are going to pay less,” she said.

But asked twice by a moderator whether she would acknowledge that the taxes of middle-income Americans would go up under her proposal, she declined to respond directly.

The back and forth among the three leading contenders over health care was a continuation of the discussion that dominated the first two debates and illustrated the fierce divisions in the party over what approach best honors Obama’s legacy — building upon the Affordable Care Act or replacing it entirely with a single-payer system.

In a tart exchange that channeled their profound philosophical differences, Sanders held up Canada as a country that provided universal coverage for a lower total cost, prompting Biden to jump in: “This is America.”

Sanders fired back: “Americans don’t want to pay twice as much as other countries.”

The remaining field of candidates arrayed themselves around the same philosophical dividing line, most of them aligning more closely with Biden. And for the first time in this primary race, a handful of the trailing contenders sharpened their attacks.

Sen. Amy Klobuchar of Minnesota derided Sanders’ single-payer bill as a “bad idea,” while Mayor Pete Buttigieg of South Bend, Indiana, accused Sanders and Warren of seeking to take away choice from consumers.

“I trust the American people to make the right choice for them,” Buttigieg said. “Why don’t you?”

But it was a harshly contentious clash between Biden and Julián Castro, the former federal housing secretary, that had the potential to stand out the most from the early exchanges of the evening, at least in terms of political theatrics. Seizing on a moment in which Biden appeared to reverse his own description of his health care proposals, Castro questioned Biden’s memory — a charged subject for the 76-year-old Democratic front-runner.

“Are you forgetting already what you said two minutes ago?” Castro said, prodding insistently before boasting, “I’m fulfilling the legacy of Barack Obama and you’re not.”

Biden shot back: “That would be a surprise to him.”

Castro later revived an argument Sen. Cory Booker of New Jersey deployed in the last debate, mocking Biden for embracing Obama when it was politically convenient but sidestepping more fraught questions about the former president’s legacy. “He wants to take credit for Obama’s work, but not have to answer to any questions,” said Castro, who noted that he himself had also served in the Obama administration.

Biden pointedly declined to address the question at hand — whether he had any regrets over Obama’s deportations of undocumented immigrants — but continued his embrace of the former president. “I stand with Barack Obama, all eight years, good, bad and indifferent,” he said.

As the bickering grew more intense, Buttigieg interjected that voters would not like the attacks and attempts to “score points,” which he said prompted only more derision.

“That’s called a Democratic primary election,” Castro interjected. “This is what we’re here for.”

Trying to stay above the fray was the candidate who unleashed one of the race’s toughest attacks at the first debate, Sen. Kamala Harris of California. Harris used her opening statement to speak directly to, and criticize, President Donald Trump and during the health care contretemps lamented that “not once have we talked about Donald Trump.”

There was more consensus on the stage when it came to praising the leadership of former Rep. Beto O’Rourke of Texas in the aftermath of the mass shooting last month in El Paso, his hometown. And O’Rourke won a booming ovation from the Democratic audience when he was asked whether he would try to confiscate some weapons.

“Hell, yes, we’re going to take your AR-15, your AK-47,” he said. “We’re not going to allow it to be used against fellow Americans anymore.”

Booker, who lives in Newark, said the outrage over gun violence was long overdue. “I’m sorry that it had to take issues coming to my neighborhood or personally affecting Beto to suddenly make us demand change,” he said. “This is a crisis of empathy in our nation. We are never going to solve this crisis if we have to wait for it to personally affect us or our neighborhood or our community before we demand action.”

Thursday’s debate, the first since July, came at a moment when a race that once seemed volatile had become remarkably stable. Over the summer the field divided into two distinct classes, with Biden, Sanders and Warren representing the top tier both in national and early-state polling.

While Biden remains the front-runner in the Democratic race, he has yet to produce the kind of commanding debate performance that might excite undecided Democrats or put to rest their unease about his readiness for a contest with Trump. Biden’s support has held steady for the past few months, hovering around 30% of primary voters, but there is no indication he has won over any skeptical voters since entering the race in April.

After a disastrous first debate in June, when Harris delivered a thumping denunciation of his record on race, Biden appeared somewhat more sure-footed during a July debate in Detroit.

The most significant change to the campaign over the course of the summer has been Warren’s steady rise — and the impact her surge has had on the trailing candidates. After months of training their fire at Biden, a few of the Democratic hopefuls have started to target the Massachusetts senator, specifically her array of ambitious policy proposals.

Sanders entered the debate under political pressure, too: With Warren gaining strength and his own poll numbers stalled, he cannot afford to let her emerge as the leading champion of their party’s populist left. Should a Biden-Warren rivalry come to dominate the next phase of the race, Sanders could find himself frozen in third place.

But that is a better position than where most of the other contenders find themselves at the moment. And few were under as much pressure to show signs of progress as Booker and Buttigieg.

For Booker, demonstrating a sign of political life in Houston was a necessity, because it would be difficult for him to finance a full-fledged campaign into next year if he did not show growth in early-state polling.

Buttigieg, 38, has similarly sought to avoid lining up with either ideological bloc and has not been able to sustain any real growth in the polls with his generational case. He is in no danger of being unable to meet a payroll, but he faces the specter of being branded as a mere donor candidate, beloved by the party’s wealthy financiers but with scant support from its rank-and-file.

Harris surged when she confronted Biden. But she has struggled in the months since to articulate a coherent case for her candidacy or even to settle on a single identifiable message. Like some of the contenders just on the other edge of the top tier, Harris has sought to avoid being seen as full-throated progressive or as a pragmatic moderate.

There is little doubt about Klobuchar’s positioning — she aligns with the party’s centrist wing. But she has proved unwilling to take on her fellow Democrats and has been stagnant in the polls, even in her neighboring state of Iowa where she has spent considerable time on the ground this year.

For Castro and O’Rourke, the debate offered at least a symbolic home-field advantage. The two Texans have held up their home state as something of a rationale for their campaigns: They have both presented themselves as experts on the culture of America’s border region and called for liberalizing the country’s immigration laws, with Castro positioned on the left flank of the field.

O’Rourke’s candidacy has changed drastically since then: After a white supremacist gunman carried out a massacre in his hometown, El Paso, last month, O’Rourke reoriented his campaign to focus on cracking down on gun violence and battling racism. He has pushed the Democratic debate leftward on the issue of gun control with his call to require the owners of assault-style weapons to sell them to the government.

The least-predictable figure onstage was perhaps Andrew Yang, the former technology executive who has promised to establish a new government benefit to give every citizen $1,000 per month. Yang, who has never held public office, has built a small but sturdy constituency that has kept him in the debates longer than a throng of more conventionally qualified candidates, including sitting governors and senators. Whether his message of alarm about the automation of American jobs can resonate more widely remains to be seen.

New York Times

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