Every Republican in the House of Representatives voted recently to repeal President Obama’s 2010 health-care overhaul, and if Matthew A. Doheny had been in office, he would have joined them.

But his Nov. 6 opponent, Rep. William L. Owens, D-Plattsburgh, says that Republicans like Mr. Doheny haven’t offered a plausible alternative to fixing America’s health-care system, with its skyrocketing costs and millions of uninsured.

“In terms of health care reform, the thing that’s most troubling to me, the bill that was acted on this week, there was nothing in terms of replacement in that bill,” said Mr. Owens, who voted against repealing the law that he voted to approve in 2010. “Nothing.”

Mr. Doheny doesn’t agree.

And if he wins in 2012, and Republicans take over the Senate and presidency, repealing the bill will become a real possibility. The Supreme Court’s decision to uphold the law as constitutional has forced opponents to try to defeat it legislatively, but first, they will need to defeat its proponents politically. But Democrats like Mr. Owens aren’t taking the criticisms lying down.

Mr. Doheny says he favors an “incremental” approach that would include medical malpractice reform, selling health insurance across state lines and changes to the employer-based health-care system, perhaps phasing it out.

The approach would avoid the “job-killing” burdens of Mr. Obama’s health care reform, but Mr. Owens said it wouldn’t do enough to keep costs down and improve care, in one case doing more harm than good.

On medical malpractice reform. Mr. Doheny said that doctors need to stop practicing “defensive medicine” — ordering unnecessary tests because they’re afraid they’ll get sued if they don’t.

But Mr. Owens said that Mr. Obama’s health-care law does have “pilot” provisions for tort reform, like specialized courts to deal with medical claims.

He also downplayed the effect that tort reform could have, saying it only represents 1 percent of health-care costs.

“It just sounds like my opponent believes that government has the solution, and lawyers are a key part of that,” Mr. Doheny said.

On opening state lines, Mr. Doheny said that New Yorkers should be able to buy health-insurance plans based in any state in the country. Right now, people in New York can’t buy health insurance plans based in Vermont, for example, because the Vermont policy doesn’t conform with New York’s relatively strict standards.

Allowing cross-state purchases would bring down costs for health care recipients and allow them to tap into the best ideas nationwide, Mr. Doheny said.

“I want to be able to go ahead and be able to tap into a true intrastate market,” he said.

But Mr. Owens said that’s not a wise idea.

“They’d go to the state that has the most lax standards, and there would be significant issues that could arise,” he said.

On employer-based coverage, Mr. Doheny said that the employer-based health coverage system is less than ideal. Businesses with more than 50 employers are required to provide health insurance for their employees right now, and if Mr. Obama’s health care reform goes into effect, all Americans will be required to pay health insurance.

Mr. Doheny said that the nation should incrementally look at changing the employer mandate, and immediately getting rid of the individual mandate.

“That’s something I want to see worked on,” he said. “That’s not an answer for tomorrow.”

Doing so would increase flexibility of health insurance in an age when most people aren’t spending their entire lives in one job, Mr. Doheny said.

In the meantime, the government should look to give incentives for employers to provide health care for employees, instead of punishments if they don’t, he said.

One of the reasonings behind the individual mandate is that if someone suffers life-threatening injuries and he or she doesn’t have health insurance, the emergency room has to care for them anyway, often at an expense to the hospital, which in turn sends up the cost of health care for those who have it.

On the most basic level, Mr. Doheny disagrees with the main thrust of Mr. Obama’s health care overhaul, which proponents say could mean nearly universal health coverage to all Americans.

The ideal, Mr. Doheny said, is “universal to people who want it. That is a goal that is worthy. If people who just don’t want insurance or don’t want to pay for it, that’s a different story.”

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