Less than three weeks after Iowa begins primary voting for the presidency, six democratic would-be shared the stage in the first debate of the new year and the last before voters begin to give their opinion.

The debate on the Drake University campus featured the six candidates leading the large presidential herd: former Vice President Joe Biden; former South Bend Indian Mayor Pete Buttigieg; and Senators Bernie Sanders of Vermont and Elizabeth Warren of Massachusetts.

The other two on stage, Minnesota Sen. Amy Klobuchar and billionaire political activist Tom Steyer, met the requirements of the polls and fundraisers that excluded half a dozen other contenders.

The debate, which aired on television nationwide, took place from 6 to 8 p.m. Pacific time and was broadcast live on the Des Moines Register and CNN websites and applications.

The dispute over “Medicare for All”

When the debate focused on health care, the candidates faced a familiar clash. Elizabeth Warren and Bernie Sanders unapologetically sold their government-run “Medicare for All” case, as Joe Biden, Amy Klobuchar and Pete Buttigieg warned that they were not being frank with voters about the huge price of such a program.

“We need to start telling people what we’re going to do and what it’s going to cost,” Biden said, arguing that Sanders’ proposal to cover the cost of free health care for everyone, largely with a 4% income tax, is unrealistic. Such a tax, he said, “doesn’t even come close to paying between $30 and $40 trillion in 10 years,” referring to the estimated cost of Sanders’ plan.

Warren tried to argue that every plan proposed by the candidates on stage is an improvement on the Trump administration’s policy of dismantling Obamacare. But he aggressively attacked moderates on stage when they pointed against his proposal.

“The numbers the mayor is offering don’t add up,” Warren said of Buttigieg’s argument that transformational change can happen in health care without spending the tens of billions that Sanders and Warren imagine. He noted that Buttigieg’s plan simply would not provide the necessary relief to a low-income family struggling with medical bills that average $12,000 per year. “You can’t cover that with the amount of money the mayor is talking about,” Warren said.

Buttigieg Objects

“It is not true that the plan I propose is small,” he said. He complained of the “Washington mentality” that, he argued, judges the greatness of a plan for how many billions it costs and the audacity is dictated by “how many Americans can be alienated.”