SIOUX CITY -- Four Democratic presidential candidates in a Sioux City forum vowed on Friday to drastically change the health care insurance system, increase pressure on big pharmaceutical companies to lower medicine prices and raise the amount of payroll taxes paid by higher-earning Americans.

The AARP forum with the participation of Democrats Elizabeth Warren, Beto O'Rourke, Andrew Yang and Marianne Williamson took place over two hours. There was a lot of agreement among the candidates about the health care system being tilted to benefit the profits of Big Pharma and health care conglomerates, and on solutions as well, but there were some differences.

Williamson, Warren and Yang all supported so-called Medicare for All, which has been a hot campaign topic in recent days. That's been widely embraced in the progressive wing of the Democratic Party, as first pitched by candidate Bernie Sanders, where all people could access the federal Medicare hospital insurance program, which now is for those age 65 and older.

O'Rourke was the sole forum candidate to not go so far as Medicare for All, citing his plan called Medicare for Americans, in which all people and businesses would have the choice to enroll in Medicare without eliminating private insurance. Those who like their private health insurance could keep it, said O'Rourke, a former congressman from Texas.

The Democrats are running to oust Republican President Donald Trump. One of the few direct references to Trump came in the final comment of the day, when entrepreneur Yang cited himself, to big laughs, as "the opposite" of Trump, "an Asian man who likes math."

The five forums, also organized by The Des Moines Register, are being held from Monday through Saturday in cities in Iowa, site of the first-in-the-nation presidential caucuses.

Twenty Democratic presidential candidates agreed to participate in the forums, with four in each event. About 200 AARP members at the Sioux City Convention Center saw each candidate, one at a time, use 25 minutes on stage to answer questions, first from the audience and then moderators.

Michelle Kuhlmann, of Sioux City, had not before seen any of the four candidates in person.

"I liked the way it was set up, without that debate style where they talk over each other," Kuhlmann said.

Kuhlmann said there have been many years of politicians discussing the need to financially shore up Social Security and bring down medicine prices. She's cautiously optimistic traction is at hand.

"I am hopeful because a lot of people are realizing how much drug companies are making," she said.

Warren, Williamson and Yang all agreed one way to get lower prices is for the government to begin manufacturing select medicines in which private firms aren't producing cheaper generic-style drugs. O'Rourke didn't embrace that possibility as enthusiastically as the other three, saying, "It may be an option."

Warren said strong action, such as allowing the importation of medicines made in other countries, should be pursued, to stem what she said is the relative free rein Big Pharma enjoys once they get patents to produce drugs.

"It is because the drug companies are paying the pipers in Washington, and they are calling the tunes," said Warren, a U.S. senator from Massachusetts.

"We have two Big Pharma lobbyists for every member of Congress," Williamson said.

To ensure the viability of the Social Security program to continue paying retirement and other benefits, all four candidates said they would increase the payroll tax cap on incomes over $132,900. Williamson said people routinely cite the need for patriotism, and "that includes economic patriotism," of higher earners needing to pay more of their incomes towards Social Security.

Yang said reports have shown half of Americans won't have enough money to comfortably retire.

"We are entering an age where being old and poor will be the norm in this country," Yang said.

AARP set up the forums to give voters information on where the candidates stand on issues important to older voters and their families, so they can make their own decisions on Election Day.

Also in Sioux City, the four candidates agreed on the need for the federal government to help boost rural broadband technology access and to get rid of a state-by-state system of deciding whether to allow medical marijuana as a means to relieve pain.

O'Rourke said some people with debilitating pain from longstanding health conditions would rather use medical marijuana than opioids, since those have resulted in addiction to those medications.

In addition to their forum appearances, Warren also held two other events in Sioux City and Orange City on Thursday and Friday, while O'Rourke has two events Saturday in Sioux City and Sioux Center.

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