Biden argued Tuesday that Buttigieg, the mayor of South Bend, Indiana, is riding his coattails in pushing for a "public option" government-insurance plan to be sold alongside private insurance. He argued that Warren, meanwhile, is out of step with the Democratic Party and the general electorate with her call for a single-payer "Medicare for All" system that would supplant the private insurance market altogether.
Biden entered the race earlier this year as a front-runner, but his increasingly aggressive stance toward Buttigieg and Warren marks a recognition that the race is far from locked up in the crucial states that kick off the primary season. And by zeroing in on health care, Biden is highlighting an issue that he sees as core to his candidacy.
Biden points to his work helping pass the Affordable Care Act in 2010 as an example of the type of leadership experience most of his rivals lack. And he argues that while the other candidates have shifted their positions, he's been consistent during the 2020 campaign in embracing the public option, which he thinks will be less objectionable to moderate voters than a single-payer system.
"I was the first guy to come out with the plan to build on Obamacare, and I'm glad Pete has a version of that same plan," Biden told reporters Tuesday in Mason City, Iowa. A day earlier, Biden was even more direct, saying the mayor essentially "stole" his idea after having once endorsed Medicare for All before he became a presidential candidate.
On Warren, Biden said there is "great enthusiasm" among Medicare for All supporters who back the Massachusetts senator, though he clarified that those enthusiastic supporters don't represent a majority of the party. It came a day after he told reporters that he didn't see enthusiasm for Warren.
"I don't think ... that's where the center of the party is or the left or the right of the party," Biden said Tuesday. Most Democrats "know it will take a long time, they know it costs a lot of money, and it's causing some consternation for people," he continued. "And I think ... people are gonna find some version of what I've been talking about for a long time, and it's to build on Obamacare with a public option."
Buttigieg pushed back at Biden's criticisms after attending a health care roundtable in Montgomery, Alabama, in Tuesday. He noted that he has been talking about "Medicare for all who want it" since at least February, before Biden entered the 2020 race.
"I'm glad when there's overlap among Democrats who have shared values," Buttigieg said. "Our policies are not the same, but there are certainly some areas that are consistent because we believe in the same things across this field. I will continue to advocate for what is right and seek to earn support based on that."
Both men have pushed back at Warren and fellow progressive Bernie Sanders on the debate stage this year, casting single-payer as too expensive and impossible to get through Congress.
Buttigieg had taken a different view before his campaign.
In February 2018, Buttigieg was drawn into a Twitter back-and-forth as progressives were urging Democratic politicians to back single-payer. "When/where have you ever heard me oppose Medicare for All?" he asked in a Feb. 17, 2018, response to an activist's query. A day later, he tweeted out a column he wrote as a Harvard University senior, saying he'd "been on record on this one since 2004." On the same day, he declared in a separate tweet: "Gosh! Okay ... I, Pete Buttigieg, politician, do henceforth and forthwith declare, most affirmatively and indubitably, unto the ages, that I do favor Medicare for All, as I do favor any measure that would help get all Americans covered. Now, if you'll excuse me, potholes await."
For his part, Biden can't claim to have cornered the market on a "public option." Two other candidates - Sens. Amy Klobuchar of Minnesota and Michael Bennet of Colorado - have long backed "public option" legislation on Capitol Hill.
The intraparty debate has proved fraught for other candidates.
California Sen. Kamala Harris, who ended her 2020 bid Tuesday, took a considerable hit over the summer as she backed off her Senate sponsorship of Sanders' Medicare for All bill but then delayed making her own proposal. At least twice as a candidate, she seemingly endorsed a single-payer system that would eliminate private insurance, only to retreat soon afterward. She ultimately produced a plan intended as a sort of hybrid between single-payer and a public option.
Warren, meanwhile, fueled her rise to the top tier of Democratic contenders in part by branding herself as the candidate with detailed policy plans for a range of national challenges. But she noticeably delayed offering a health care proposal, sometimes saying only, "I'm with Bernie." She eventually unveiled a single-payer plan but put a $20 trillion price tag on the first decade - lower than independent estimates that put the cost at $30 trillion or more. And, unlike Sanders, she maintains that she could cover the cost without tax increases on middle-class households. Biden openly mocks the contention.
Undecided Democrats like Wendy Ewalt and Diane Schlei will end up settling the issue - at least before the general election.
Ewalt is a 68-year-old retiree who came to hear Biden on Monday in Storm Lake. "We need single-payer because nothing else is working," she said, arguing that Warren and Sanders are pushing a debate the nation must have.
Schlei, 69, is also a retiree. She's not necessarily happy with the existing health care system. But she's not convinced the United States will accept an all-government insurance system - or a presidential candidate who wants one.
"We don't need someone too far out there," she said, saying she'll likely choose between Biden and Buttigieg. "I just don't think they can make it work."
Associated Press writer Kim Chandler in Montgomery, Ala., contributed to this report.
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