Sen. Bernie Sanders Bernie SandersTrump, Biden will not shake hands at first debate due to COVID-19 Sanders tells Maher 'there will be a number of plans' to remove Trump if he loses Sirota reacts to report of harassment, doxing by Harris supporters MORE (I-Vt.) and former Vice President Joe Biden Joe BidenBiden says voters should choose who nominates Supreme Court justice Trump, Biden will not shake hands at first debate due to COVID-19 Joe Biden should enact critical government reforms if he wins MORE sparred over the Vermont senator’s signature "Medicare for All" proposal on Thursday night, highlighting a major rift in the presidential race.

“I don’t think it is realistic,” Biden said of Sanders’s Medicare for All proposal during the Democratic debate. He pointed to its roughly $30 trillion cost over 10 years, also saying others have said it is closer to $20 trillion, a jab at Sen. Elizabeth Warren Elizabeth WarrenOvernight Defense: Appeals court revives House lawsuit against military funding for border wall | Dems push for limits on transferring military gear to police | Lawmakers ask for IG probe into Pentagon's use of COVID-19 funds On The Money: Half of states deplete funds for Trump's 0 unemployment expansion | EU appealing ruling in Apple tax case | House Democrats include more aid for airlines in coronavirus package Warren, Khanna request IG investigation into Pentagon's use of coronavirus funds MORE (D-Mass.), who also backs the idea, but with a somewhat lower price tag.

When Sanders raised his hand to signal his desire to interject, Biden responded, “Put your hand down for a second, Bernie, OK?”

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Sanders joked in response, “I’m just waving to you, Joe, saying hello.”

Sanders shot back that Biden’s plan would maintain the “status quo,” to which Biden responded “that’s not true.”

Biden’s plan does in fact call for changes, though they are somewhat smaller than what Sanders proposes. Biden wants to give people the option of a government-run health plan, rather than mandatory government coverage for all as Sanders proposes.

The Medicare for All debate has been a central divide of the primary, though it has faded somewhat from the earlier debates. The question on health care did not come until about two hours into the debate.

The sparring also largely avoided Warren. She has drawn scrutiny for putting forward a detailed financing plan for Medicare for All and a transition plan that calls for first passing an optional government health insurance before later pushing to pass full-scale Medicare for All.

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None of the candidates sought to attack her on those fronts on Thursday.

Warren noted actions she could take on her own as president, without Congress, such as steps to lower drug prices. Sanders, in contrast, dodged a question on what he would do if Republicans controlled the Senate and he could not pass his plan, instead insisting that he could build pressure for Medicare for All by appealing to the public.

Sen. Amy Klobuchar Amy Klobuchar3 reasons why Biden is misreading the politics of court packing Social media platforms put muscle into National Voter Registration Day Battle lines drawn on precedent in Supreme Court fight MORE (D-Minn.), who is more of a moderate, told Biden and Sanders “this fight that you guys are having isn’t real,” noting there are moderate Democrats like freshmen House lawmakers from formerly red districts who do not support Medicare for All and would not vote for it.

She focused on more targeted actions like lowering drug prices.

The debate also did not focus much on a court ruling on Wednesday that threw the future of the existing Affordable Care Act into doubt.

President Trump Donald John TrumpBiden says voters should choose who nominates Supreme Court justice Trump, Biden will not shake hands at first debate due to COVID-19 Pelosi: Trump Supreme Court pick 'threatens' Affordable Care Act MORE has backed the lawsuit from conservative state attorneys general seeking to overturn the health law.