President Joe Biden made several verbal missteps Thursday in the opening minutes of his debate with his Republican rival, Donald Trump, as both took the stage seeking to define their presidential rematch.

Biden had a raspy voice, struggling repeatedly to clear his throat, and had a halting delivery as he tried to defend his economic record and criticize Trump. Biden appeared to lose his train of thought while giving one answer, drifting from an answer on tax policy to health policy, at one point using the word “COVID,” and then saying, “excuse me, with, dealing with,” and he trailed off again.

“Look, we finally beat Medicare,” Biden said, as his time ran out on his answer.

Trump picked right up on it, saying, “That’s right, he did beat Medicaid, he beat it to death. And he’s destroying Medicare.”

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