The top Democratic presidential candidates are clashing over a “Medicare for All” plan to provide universal, government-run health insurance — again.

Wednesday’s tussle began with squabbles over a program that some Democrats worry could alienate swing voters who are wary of fully government-run health care and fear it would be extraordinarily difficult to get through Congress. And yet, partly because it’s one of the few areas where the field has clear ideological divides, Democratic primary contenders can’t stop talking about it — and subjecting prime-time audiences to often collectively tying themselves in knots over the issue.

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 former Vice President Joe Biden’s durability, while others fear that Sens. Elizabeth Warren and Bernie 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.

Democratic presidential candidates from left, Sen. Cory Booker, D-N.J., Rep. Tulsi Gabbard, D-Hawaii, Sen. Amy Klobuchar, D-Minn., South Bend, Ind., Mayor Pete Buttigieg, Sen. Elizabeth Warren, D-Mass., former Vice President Joe Biden, Sen. Bernie Sanders, I-Vt., Sen. Kamala Harris, D-Calif., former technology executive Andrew Yang and investor Tom Steyer wave to the audience before a Democratic presidential primary debate, Wednesday, Nov. 20, 2019, in Atlanta. (AP Photo/John Amis)
Democratic presidential candidates from left, Sen. Cory Booker, D-N.J., Rep. Tulsi Gabbard, D-Hawaii, Sen. Amy Klobuchar, D-Minn., South Bend, Ind., Mayor Pete Buttigieg, Sen. Elizabeth Warren, D-Mass., former Vice President Joe Biden, Sen. Bernie Sanders, I-Vt., Sen. Kamala Harris, D-Calif., former technology executive Andrew Yang and investor Tom Steyer wave to the audience before a Democratic presidential primary debate, Wednesday, Nov. 20, 2019, in Atlanta. (AP Photo/John Amis)

Warren and Sanders, representing the most progressive wing of the Democratic Party, defended Medicare for All on Wednesday, with Sanders saying, “Some of the people up here think we should not take on the insurance agency,” but adding, “I think now is the time.”

Biden argued that many people are happy with the private insurance that comes through their employers.

Pete Buttigieg complained about others taking “the divisive step” of ordering people onto universal health care, “whether they like it or not.”

The 37-year-old mayor of South Bend, Indiana, was a prime target as the four candidates now bunched at the top of the polls seek to distinguish themselves. He 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,” he said. “But frankly, where we live, the infighting on Capitol Hill is what looks small.”

Another early clash came between two candidates looking for big moments: Sen. Kamala Harris of California and Hawaii Rep. Tulsi Gabbard, who has criticized prominent Democrats, including 2016 nominee Hillary Clinton.

Democratic presidential candidate Sen. Cory Booker, D-N.J., speaks as Rep. Tulsi Gabbard, D-Hawaii, listens during a Democratic presidential primary debate, Wednesday, Nov. 20, 2019, in Atlanta. (AP Photo/John Bazemore)
Democratic presidential candidate Sen. Cory Booker, D-N.J., speaks as Rep. Tulsi Gabbard, D-Hawaii, listens during a Democratic presidential primary debate, Wednesday, Nov. 20, 2019, in Atlanta. (AP Photo/John Bazemore)

“I think that it’s unfortunate that we have someone on the stage who is attempting to be the Democratic nominee for the president of the United States, who, during the Obama administration, spent four years full time on Fox News criticizing President Obama,” Harris said.

“I’m not going to put party interests first,” Gabbard retorted.

Medicare for All has dominated the primary — especially for Warren. She released plans to raise $20-plus trillion in new government revenue on universal health care. But she also said implementation of the program may take three years — drawing criticism both from moderates like Biden and Buttigieg, who think she’s trying to distance herself from an unpopular idea, and Sanders supporters, who see the Massachusetts senator’s commitment to Medicare for All wavering.

Democratic presidential candidate Sen. Bernie Sanders, I-Vt., speaks during a Democratic presidential primary debate, Wednesday, Nov. 20, 2019, in Atlanta. (AP Photo/John Bazemore)
Democratic presidential candidate Sen. Bernie Sanders, I-Vt., speaks during a Democratic presidential primary debate, Wednesday, Nov. 20, 2019, in Atlanta. (AP Photo/John Bazemore)

The Georgia backdrop for the debate, featuring the cycle’s first all-female moderator team, may be fitting for such doubts since Democrat Stacey Abrams was narrowly defeated in the gubernatorial race last year — raising her party’s hopes of winning a state in 2020 the GOP has consistently carried in recent presidential cycles.