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DES MOINES, Iowa — Former Vice President Joe Biden took a barely veiled swipe at the candidate who has largely caught him atop the Democratic presidential field, telling thousands of cheering activists in Iowa on Friday that he would overhaul health care nationwide without "increases in taxes for the middle class. None. None. None."

Biden didn't mention Massachusetts Sen. Elizabeth Warren by name, but his pronouncement came hours after she unveiled a $20-plus trillion "Medicare for All" universal health care plan that she vowed wouldn't require a middle-class tax increase — but that Biden's campaign panned as requiring "mathematic gymnastics" to cover its huge costs.

Taking her turn on stage at the Iowa Democratic party's marquee annual fundraiser, Warren argued unwaveringly for sweeping change.

"It's easy to give up on a big idea, but when we give up on a big idea we give up on the people whose lives would be touched by those big ideas," she said. "Anyone who comes on this stage and tells you to dream small and give up early is not going to lead our party to victory." Biden and Warren were among more than a dozen 2020 presidential candidates at the Liberty and Justice Celebration, where candidates addressed more than 13,000 Democratic activists, party volunteers and campaign supporters at a basketball arena in downtown Des Moines — beginning the three-month sprint to Iowa's first-in-the-nation caucuses.

The event amounts to the largest gathering of Democrats in an early voting state and was something of a dress rehearsal for the Feb. 3 caucuses. Candidates must now move beyond simply introducing themselves to voters and activists and focus on perfecting a grassroots strategy to ensure they mobilize strong support.

For candidates in the top tier, the event was a key test of momentum, while lagging contenders will face further questions about why they're staying in the race. That was on full display even before festivities began Friday, with former Texas Rep. Beto O'Rourke abruptly announcing he was dropping out of the contest.

Biden has promised not to "abandon" the signature health care law of President Barack Obama, under whom he served for two terms. Health care is arguably the top issue of the 2020 Democratic race and has created a stark policy divide between Warren and Vermont Sen. Bernie Sanders, who back Medicare for All, and more moderate candidates like Biden and Pete Buttigieg, mayor of South Bend, Indiana, who say the country is not ready to do away with private insurance.

Warren said: "If the most we can promise is business as usual after Donald Trump, then we will lose."

Like Biden, Buttigieg didn't mention Warren by name but said he supported "Medicare for all who want it" and promised to honor the decisions of those who aren't willing to sign up for government-sponsored health care. The 37-year-old mayor also offered a veiled swipe at Warren, Biden and Sanders — all in their 70s — by scolding other candidates for being content to "wait for action."

The damp, chilly streets outside the arena buzzed with other campaigns looking to hit their strides hours before Friday's event began. Supporters and campaign volunteers waved signs at busy street corners and congregated in chanting droves.

A New York Times/Siena College poll of likely caucusgoers released Friday found Warren, Sanders, Buttigieg and Biden bunched together at the top of the field in Iowa.

The night was not just about speeches but also about exhibiting support and enthusiasm. Biden packed the hall with members of the International Association of Fire Fighters, which has endorsed him. Sanders led a pre-event march that his campaign said featured 1,500 people. Warren supporters erected a giant likeness of Bailey, the senator's golden retriever, and fitted it with a collar featuring two pennies, recalling Warren's wealth tax of 2% on fortunes worth more than $50 million. Buttigieg had the largest presence planned for the event, buying up thousands of seats for supporters in the arena, hosting an overflow room in the hall.

The event has played decisive roles in past campaigns. In 1999, then-Vice President Al Gore effectively blocked former New Jersey Sen. Bill Bradley's advance with the chant during his speech "Stay and fight," a nudge at Bradley for leaving the Senate.

Four years later, Massachusetts Sen. John Kerry held off a dire challenge from Howard Dean at the event.

"We need answers, not just anger," Kerry said in a hit at the anti-war Vermont governor who had stirred passions on the left but worried others for challenging President George W. Bush during wartime. "Iowa, don't just send them a message. Send them a president."

More recently, then-Illinois Sen. Barack Obama threw down the gauntlet against national Democratic front-runner Hillary Clinton in 2007, declaring, "Triangulating and poll-driven positions, because we're worried about what Mitt or Rudy might say about us, just won't do."

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