Elizabeth Warren

Bill Barrow and Will Weissert, Associated Press

The top Democratic presidential candidates spent large chunks of prime-time television clashing over “Medicare for All” — again.

Like a string of previous debates, Wednesday’s prominently featured squabbles over a program that could alienate general-election swing voters who may be wary of fully government-run, universal health care and that will be extraordinarily difficult to get through Congress — even if Democrats take the White House and make significant 2020 congressional gains.

The latest faceoff, in Atlanta, came against the backdrop of impeachment consuming Washington, President Donald Trump making major foreign policy moves and well-known Democrats having left — or recently joined — the race. But the White House hopefuls just couldn’t stop debating Medicare for All, in part because it represents an important ideological divide between progressive candidates and moderates but also because the party sees health care as a winning issue — especially after it helped Democrats win the House last year.

Sens. Elizabeth Warren of Massachusetts and Bernie Sanders of Vermont, the race’s strongest progressive voices, staunchly defended Medicare for All.

“The American people understand that the current health care system is not only cruel, it is dysfunctional,” Sanders said.

Former Vice President Joe Biden said many people are happy with private insurance through their jobs, while Mayor Pete Buttigieg of South Bend, Indiana, complained about others taking “the divisive step” of ordering people onto universal health care, “whether they like it or not.”

The debate came at a critical juncture for the Democratic Party — less than three months before the first voting contests and with big questions hanging over the front-runners. Some Democrats have grown worried about Biden’s durability, while others fear that Warren and Sanders are too liberal to win a general election. Those concerns have prompted former Massachusetts Gov. Deval Patrick to launch a late bid for the nomination, with former New York City Mayor Michael Bloomberg expected to jump in as well in the coming days.

In the moderators’ chairs were four women, including Rachel Maddow, MSNBC’s liberal darling, and Ashley Parker, a White House reporter for The Washington Post. It’s only the third time a primary debate has been hosted by an all-female panel to date.

Buttigieg was asked early about how being mayor of a city of 100,000 residents qualified him for the White House, and he said he was more than up to the challenge.

“I know that from the perspective of Washington, what goes on in my city might look small,” Buttigieg said. “But frankly, where we live, the infighting on Capitol Hill is what looks small.”

Going into Wednesday’s debate, it seemed that Buttigieg, who has been rising in recent polls, would be a key target for attacks as his rivals tried to blunt his momentum. But other than the early question about his credentials, few candidates took many shots at him.

That could reflect the fact that candidates who previously have hit the front-runners hard have seen it backfire. Harris was very critical of Biden for once working with segregationist senators and saw a small bump in the polls quickly vanish. Former Obama administration housing chief Julián Castro had been tough on Biden but failed to qualify for Wednesday night’s debate.

A memorable exchange occurred when Biden — who was absent for large periods of the debate and didn’t face any real attacks from his rivals — was asked about curbing violence against women and responded awkwardly, “We have to just change the culture. Period. And keep punching at it. And punching at it. And punching at it.”