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Source: Bloomberg Source: Bloomberg

Elizabeth Warren swatted back at Joe Biden’s criticism of her $21 trillion Medicare-for-All plan Friday, accusing him of “running in the wrong presidential primary.”

“Democrats are not going to win by repeating Republican talking points,” the Massachusetts senator said in Des Moines, Iowa. “So, if Biden doesn’t like that, I’m just not sure where he’s going.”

Warren’s unusually direct attack on her campaign rival came after she released a long-awaited explanation of how she to planned to pay for her $20.5 trillion proposal to create a government-run health care system. The Biden campaign called that plan “mathematical gymnastics” intended to hide the fact that it would result in tax increases on middle-class workers.

The health care rift has been a defining feature of the crowded Democratic contest and has become a proxy for an broader ideological battle over how far left the party should go. One one side: Warren and Bernie Sanders, who want bold, progressive ideas. On the other: Biden and Pete Buttigieg, who say the party should be more concerned about winning back moderate voters in swing states who could be turned off by big-spending government programs.

The flap comes at a crucial moment in the Iowa campaign. Fourteen presidential candidates, including Biden and Warren, are scheduled to speak Friday at the Liberty and Justice Celebration dinner, the state party’s keynote event of the year. Most of them will meet again Saturday at a Cedar Rapids fish fry.

Iowa Poll

A New York Times/Siena College poll of Iowa Democrats released Friday showed the top four candidates — Warren, Sanders, Buttigieg and Biden — all bunched up in a five-point spread at the top of the field, within the poll’s margin of error.

In last month’s debate, Warren had rebuffed challenges by Biden and Buttigieg to explain how she would pay for her plan. Warren and Sanders want to abolish private health insurance in favor of government-paid health care supported in part by steep taxes on wealthy Americans.

Biden and Buttigieg support more modest changes to the existing Affordable Care Act, including a public option to allow more people under age 65 to be eligible for Medicare-style coverage. They call that plan “Medicare for All Who Want It.”

The Biden campaign renewed its criticism of Medicare for All after Warren unveiled the price tag and her plan for meeting the cost. “We cannot defeat Donald Trump with double talk on health care -- especially not about the impact and cost of a proposal to completely dismantle our health care system and eliminate employer-sponsored and all other private health insurance,” said Biden’s deputy campaign manager, Kate Bedingfield.

She said Warren’s plan relied on rosy projections about health care costs and tax revenues intended to hide the real cost of Medicare for All.

While not weighing in on the presidential contest, House Speaker Nancy Pelosi appeared to come down closer to the Biden-Buttigieg approach. Speaking at a roundtable of Bloomberg reporters and editors Friday, she said she’s “not a big fan of Medicare for all.”

“I welcome the debate,” she said. “But it is expensive. Who pays is very important. What are the benefits that come in there?”

When she was first speaker in 2010, Pelosi worked with Biden to help draft the health insurance legislation known as Obamacare and get it pushed through a Democratic Congress. She said Friday she would give Medicare for All proponents a fair hearing in House committees but was skeptical it could work.

Pelosi said Democrats needed to unite around the fundamental principle of universal health care, even if they differ about how to go about it.

“Hopefully as we emerge into the election year, the mantra will be more health care for all Americans,” she said. “Myself I think, ‘Remember November.’ This is a time when we have to win the Electoral College. Otherwise, we’ll be faced with a president again who doesn’t really care about increasing health benefits.”

— With assistance by Laura Litvan, and Sahil Kapur