Every Republican in the House of Representatives voted recently to repeal President Barack 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 Republicans like Mr. Doheny haven’t offered a plausible alternative to fixing America’s health-care system, with its skyrocketing costs and tens of 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. Nothing,” Mr. Owens said last week. He voted against repealing the law, which he voted to approve in 2010.

Mr. Doheny disagrees.

And if he wins election to Congress in November, and Republicans take over the Senate and presidency, repealing the bill will become a real possibility. The Supreme Court decision upholding most of the law as constitutional has forced opponents to try to defeat it legislatively, but first they will have to defeat its proponents politically. Democrats such as Mr. Owens aren’t taking the criticism lying down.

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

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

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

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

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

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

On opening state lines to the insurance industry, Mr. Doheny said New Yorkers should be able to buy health insurance plans based anywhere 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 interstate 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 interstate market,” he said.

But Mr. Owens said that is 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 the employer-based health insurance system is less than ideal. Under the new health law, businesses with more than 50 employees will have to provide health insurance for their employees or pay a penalty, and all Americans will be required to obtain health insurance.

Mr. Doheny said the nation should consider incrementally 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 consider 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 doesn’t have health insurance, the emergency room has to care for the person anyway, often at the expense of the hospital, which in turn increases the cost of health care for those are insured.

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

The ideal, Mr. Doheny said, is “universal to people who want it.”

“That is a goal that is worthy,” he said. “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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