Top contenders for the Democratic presidential nomination torched one another’s proposals to overhaul the health care system Wednesday, as the contest to unify behind a single candidate to defeat President Donald Trump took a bitterly divisive turn.

Minutes after Tom Perez, the chairman of the Democratic National Committee, warmed up the debate audience in Las Vegas by describing the party as a spirited but unified family, most of the candidates abruptly shifted into attack mode — and not just against Mike Bloomberg, the billionaire businessman and former New York City mayor making his first, belated appearance in the ninth debate.

Fighting to regain momentum after weak performances in the Iowa caucuses and New Hampshire primary, Sen. Elizabeth Warren of Massachusetts dispatched with her opponents’ plans in brutally rapid succession.

Pete Buttigieg, the former South Bend, Indiana, mayor, has offered “not a plan” but “a PowerPoint” that she claimed would leave millions uninsured, she said. Sen. Amy Klobuchar of Minnesota has a proposal that is “like a Post-it note: Insert plan here,” she quipped. And Sen. Bernie Sanders of Vermont, whose “Medicare for All” plan she initially adopted as her own, “has a good start,” but his campaign cannot stop attacking those who question how it would work, she said.

“Health care is a crisis in this country,” Warren concluded. “My approach to this is, we need as much help for as many people as quickly as possible.”

It wasn’t the only tense moment.

Sanders Angers The Culinary Workers Union

How Sanders’ Medicare for All proposal would affect unions in particular isn’t a new question. But despite strong support for the proposal from some national unions, it emerged as a flashpoint in the run-up to Nevada’s caucus on Saturday, turning the state’s prominent Culinary Workers Union against Sanders, the current front-runner, in the eleventh hour.

The union did not endorse a candidate but warned members that Sanders’ proposal could eliminate the health care coverage they have gained through years of collective bargaining, replacing it with a system that is untested and unknown.  The union then put out a statement last week saying its members had been “viciously attacked” by Sanders’ supporters over the organization’s opposition. Sanders responded by saying that, though there were some bad actors on social media, it was “not thinkable” that his supporters would attack union workers.

“Let me be very clear for my good friends in the Culinary Workers Union, a great union: I will never sign a bill that will reduce the health care benefits they have,” Sanders said. “We will only expand it for them, for every union in America and for the working class.”

Klobuchar defended the “hard-working” culinary workers “who have health care plans that have been negotiated over time, sweat and blood,” she said. “And that is the truth for so many Americans right now.”

Last summer, Sanders tweaked his proposal to try to alleviate concerns from unions. Under a Medicare for All system, he said, the National Labor Relations Board would supervise unions in renegotiating contracts with employers, so that they could acquire “wrap-around services and other coverage not duplicative of the benefits established under Medicare-for-all.”

The idea, Sanders’ aides said then, was so that any savings a switch to single-payer achieved could still be passed on to workers, as increased benefits or wages.

But members of the Culinary Workers Union — and some other groups — still worry about losing the coverage they have, in exchange for something unknown.

Would that happen? Technically, yes, the health plan Nevada’s culinary workers get through their union would no longer exist. Under Medicare for All, private health plans could not sell coverage that duplicates what the government program offers.

But it’s worth noting that, in this world, culinary workers would still have generous health insurance. Sanders’ envisioned health plan is robust — he says it would cover virtually all practicing physicians and medically necessary services, with virtually no cost sharing.

Of course, that would also depend on whether a President Sanders could muster support for his plan among skeptical members of Congress.

$100 Billion In Profits

Sanders brought up one favorite talking point twice Wednesday — his claim that the health care industry makes $100 billion a year in profits. We previously checked this claim and rated it True. The number comes from adding the net revenues in 2018 from 10 pharmaceutical companies and 10 health insurance companies. We recalculated the numbers, and they added up. Experts said it was even likely that the figure was an underestimate. 

Big Pharma Is Giving Money To Buttigieg And Others 

In another biting moment, Sanders charged that drug companies are donating to Buttigieg and other campaigns as the pharmaceutical industry profits off the current system.

We previously checked Sanders’ claim that Buttigieg was a “favorite of the health care industry” and rated it Half True. This is in part because it is actually Sanders who has received the most donations of any Democratic candidate from the entire health care sector, which includes pharmaceutical companies, insurers, hospitals/nursing homes and health professionals.

But, while checking this claim, we also found that Buttigieg has received donations from employees and executives of pharmaceutical and health insurance companies such as AbbVie, Aetna, Anthem, Eli Lilly and Co., Merck & Co. and Pfizer. We did not check into donations for other candidates from pharmaceutical executives. 

Do People ‘Love’ Their Insurance?

“You don’t start out by saying, I have 160 million people, I’m going to take away the insurance plan that they love,” Bloomberg said just minutes into the debate, pointing out the shortcomings of Sanders’ Medicare for All plan.

It is true that Sanders’ signature health proposal would eliminate private health insurance, replacing it with a single public plan that covers everybody. That would include the roughly 160 million Americans who get employer-sponsored insurance

But Bloomberg’s argument here — that those people “love” their plans — is complicated.

When we previously checked a similar claim — that 160 million people “like their health insurance” — we rated it Half True. Cursory polling suggests people with that coverage are mostly satisfied. 

But most isn’t all. And, experts pointed out to us then, once Americans try to use that coverage, many find it lacking. In a Kaiser Family Foundation/ L.A. Times poll, for instance, 40% of people with employer-sponsored insurance still reported having trouble paying for medical bills, premiums or out-of-pocket costs. In that same poll, about half said they skipped or delayed health care because — even with coverage — they couldn’t afford it. (Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.)

More About Warren’s Comments On Klobuchar’s Health Plan

“Amy, I looked online at your [health care] plan. It’s two paragraphs,” Warren said.

This is highly misleading.

Warren’s campaign told PolitiFact that she was referring specifically to Klobuchar’s plan for “universal health care.” It pointed to the two paragraphs at the end of a Klobuchar campaign webpage, which comes under the heading “Propose legislation to get us to universal health care.” 

But that ignores most of Klobuchar’s health care plan, which she outlines in quite a bit of detail on four different webpages — a main health care policy page, a more detailed sub-page, a sub-page on prescription drugs and a sub-page on mental health.

We did a word count on the text from those four webpages, and it exceeded 6,000 words — and a lot more than two paragraphs.

PolitiFact’s Louis Jacobson contributed to this report.