BURLINGTON, Iowa — U.S. Sen. Bernie Sanders said Saturday that South Bend, Indiana, Mayor Pete Buttigieg's "Medicare for all who want it" health care hybrid would be "unfair" to working families. 

Sanders' "I wrote the damn bill" quote about "Medicare for All" has become a cheer line on debate stages and in rallies, and his decades-long consistency on supporting universal health care coverage is a draw for many of his supporters.

Buttigieg, like many candidates seeking the Democratic nomination for president, outlined a health care plan that stops short of Sanders' goal. Instead, Buttigieg proposes giving people a choice between buying into a public option of health care coverage or purchasing private insurance. And that's its fatal flaw, Sanders said. It would overload the government with the most expensive patients, he said.

"When you talk about having a system where you're going to have private insurance and you're going to have (a public) option going in, the rich and the healthy will go into private insurance, the poor and the sick will go into Medicare and cost that system an enormous amount of money," Sanders said. "So it's a failed idea in my view."

He chastised the prescription drug and health care industries as creating a "dysfunctional, cruel system that is very, very expensive." He asked attendees for stories about health care costs, and they shared tales of high costs for inadequate care. When an attendee asked about Buttigieg's plan, Sanders called it "unfair."

"If Buttigieg or someone else wants to maintain that system, I think it's really unfair to the working families of this country," Sanders said. "I'm just suggesting to you we can substantially lower health care costs for working families."

Buttigieg surged to the lead in the most recent Des Moines Register/CNN/Mediacom Iowa Poll, released in November. Sanders was No. 3, tied with former Vice President Joe Biden. U.S. Sen. Elizabeth Warren was in second. Warren, Sanders and Biden were all within a percentage point of each other, according to the poll.

Nick Coltrain is a politics and data reporter for the Register. Reach him at ncoltrain@registermedia.com or at 515-284-8361.