Hillary Clinton targeted Bernie Sanders’s electoral appeal with some of her strongest language yet in a debate on Sunday night, seizing on Mr. Sanders’s recent policy shifts on universal health care and gun control to try to undercut his image as an anti-political truth teller.
Mrs. Clinton also repeatedly aligned herself with a former political rival, President Obama, as she sought to portray her current one, Mr. Sanders, as a fringe candidate who did not stand with Mr. Obama on major issues like Wall Street regulation. Mr. Sanders, in turn, gave no quarter as he criticized Mrs. Clinton as dishonest in her attacks.
With Mr. Sanders gaining on her before the Feb. 1 Iowa caucuses, Mrs. Clinton cast herself as the defender of Mr. Obama’s record and Mr. Sanders as playing into Republican hands with proposals like replacing the Affordable Care Act with a single-payer plan, which Mr. Sanders describes as “Medicare for all.”
“We’ve accomplished so much already,” she said. “I don’t want to see the Republicans repeal it.”
“That is nonsense,” Mr. Sanders said. “What a ‘Medicare for all’ program does is finally provide health care for every man, woman and child as a right.” He added that 29 million people still lack health insurance.
Mrs. Clinton was pointed in her critiques of Mr. Sanders but relatively restrained in tone and words as she sought to raise doubts about what many liberals see as Mr. Sanders’s greatest virtues: his integrity and consistency on policy issues.
She chose not to accuse him of “flip-flopping” on gun control bills as she had earlier on Sunday, but rather said at the debate that she was “pleased” he had “reversed” himself.
For Mrs. Clinton, it was enough to note Mr. Sanders’s changes in policy: By doing so, she raised doubts about his consistency, but stopped short of eviscerating his positions and potentially alienating a restless liberal base that largely favors Mr. Sanders.
Her tactics left Mr. Sanders appearing frustrated at times, such as when he called her “very disingenuous” on his gun record, or when he sighed audibly and rolled his eyes as she implicitly questioned his principles on health care.
When Mrs. Clinton pushed on his health care plan, which she said would “tear up” the president’s signature achievement, he shot back: “No one is tearing this up. We’re going forward.”
The competition to claim Mr. Obama’s political mantle was the dominant theme of the night, given that the Democratic race has become so close in Iowa and New Hampshire.
Mr. Obama remains widely popular among party members, particularly in the state that Mrs. Clinton now needs to win more than ever: South Carolina, which votes on Feb. 27. Should she lose the first two nominating contests, Mrs. Clinton and her team believe she can regain political momentum in the South Carolina primary, in part because of her strong support among African-Americans there.
Mrs. Clinton repeatedly reiterated her support for Mr. Obama’s agenda, while Mr. Sanders tried to present himself as the bolder choice to build on Mr. Obama’s legacy. But she stymied him at times: When Mr. Sanders criticized Mrs. Clinton for accepting more than “$600,000 in speaking fees” from Goldman Sachs, she used the moment to portray Mr. Sanders as opposed to Mr. Obama on the issue of Wall Street regulation.
The third candidate in the Democratic race, former Gov. Martin O’Malley of Maryland, who is far behind in most polls, showed some new life at the debate as he reminded the audience that Mrs. Clinton had evoked the Sept. 11, 2001, terrorist attacks previously to explain her Wall Street donations when she was a senator representing New York.
“Now you bring up President Obama here in South Carolina in defense of the fact of your cozy relationship with Wall Street,” Mr. O’Malley said. If Mrs. Clinton was trying to make Mr. Sanders look less than qualified for the presidency, Mr. Sanders repeatedly tried to address doubts about his electability, which a new Clinton television advertisement has questioned. At one point, he rattled off some of his strong poll numbers, not unlike the leading Republican candidate, Donald J. Trump.
“When this campaign began, she was 50 points ahead of me,” he said. “We were all of three percentage points. Guess what? In Iowa and New Hampshire, the race is very, very close.”
He added, “In polling, we are running ahead of Secretary Clinton against my good friend Donald Trump.”
Mr. Sanders did not break any new ground as he challenged Mrs. Clinton on policy, but instead tried to deepen his ongoing critique of her as an ally of wealthy and powerful interests: an argument that has resonated with many younger and liberal Americans in the early-voting states. He tried, for instance, to turn the debate over health care and the candidates’ positions on Wall Street into a referendum on big money in politics, an implicit criticism of the “super PAC” and wealthy donors supporting Mrs. Clinton’s campaign.
“It is whether we have the guts to stand up to the private insurance companies and all of their money, and the pharmaceutical industry,” he said. “That’s what this debate is about.”
For Mrs. Clinton, the debate was often as much about the past — the Obama years and, at times, her ties to her husband, former President Bill Clinton — as about her ideas for improving the lives of Americans. While Mr. Sanders repeated one or more of his liberal policy views at almost every turn, Mrs. Clinton tended to present herself as an inheritor of the Democratic Party’s traditional agenda on the economy, social safety nets and foreign policy. Asked what role Mr. Clinton would play in her administration, and whether his advice would be official or take place at the kitchen table, Mrs. Clinton did not make much effort to present herself as the fresh-thinking independent figure that Mr. Sanders claims to be.
Fact Checks of the Fourth Democratic Debate
The New York Times will be checking assertions made throughout the 2016 presidential campaign.
“Well, it will start at the kitchen table,” she said of her husband. “We’ll see how it goes from there.”
Mr. Sanders did not repeat his previous assertion that Mr. Clinton’s sexual misconduct was “totally disgraceful and unacceptable,” and instead pledged to focus on the issues, despite what he cast as the news media’s best attempts to insert scandal at every turn. “That question annoys me,” Mr. Sanders said. “I cannot walk down the street — Secretary Clinton knows this — without being told how much I have to attack Secretary Clinton.”
The two candidates, both under exceptional pressure in their final debate before the Iowa caucuses, were a study in contrasts. Mrs. Clinton seemed careful to be impassioned but not overly aggressive, while Mr. Sanders was his typically emphatic self, waving his hands frequently as his unmodulated voice rose at times to a near-holler. He smiled a few times, but it felt awkward. Mrs. Clinton laughed a few times, but it felt forced.
With the debate unfolding just blocks from the shooting last year at the Emanuel African Methodist Episcopal Church here, which left nine people dead, the topic of gun control arrived early and evoked emotional responses from all three candidates onstage. Mr. Sanders sought to defend his commitment to the issue, saying, “I have a D-minus voting rating from the N.R.A.”
Pressed on his shifting position on a provision of Senate legislation that would have held gun manufacturers and sellers accountable for crimes committed with firearms, Mr. Sanders said that while he supported parts of the bill, “a small mom-and-pop gun shop who sells a gun legally to somebody should not be held liable if someone does something terrible with that gun.”
Mrs. Clinton criticized Mr. Sanders for his votes on several gun control measures, including the so-called Charleston loophole that allowed Dylann Roof, the gunman in the church attack, to purchase his weapon. “Let’s not forget what this is about,” she said, her voice growing more impassioned. “Ninety people a day die from gun violence in this country.” She continued, “One of the most horrific examples, not a block from here, where we had nine people murdered.”
She also sought to damn Mr. Sanders with faint praise by saying she was “pleased” that he had reversed himself on supporting legal immunity for gun manufacturers and dealers. As she listed Mr. Sanders’s past votes and jabbed at him over the immunity issues, Mrs. Clinton implied that her main opponent had not thought through his bank-busting domestic agenda.
“I have actually documented every way that I’m going to pay for what I’m doing because I think the American public deserves to know,” she said. “I’m the only candidate standing here tonight who has said I will not raise taxes on the middle class. I want to raise incomes, not taxes.”
Mr. Sanders strongly denied that he was backtracking on his promise last month not to raise taxes to pay for his “Medicare for all” plan.
“No, it is not breaking my word,” he said. “It is one thing to say I’m raising taxes; it’s another thing to say we’re doing away with private health insurance premiums.” He added, “There are huge savings in what your family is spending.”
At the end of the debate, Mrs. Clinton had her best moment of the night as she described the contaminated drinking water crisis in Flint, Mich., and sharply criticized the state government for being negligent in protecting the health of that predominantly poor and African-American city.
“I’ll tell you what, if the kids in a rich suburb of Detroit had been drinking contaminated water and being bathed in it, there would’ve been action,” Mrs. Clinton said.
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