U.S. Rep. Tom Reed has had to face his share of Democratic challengers in his bids for re-election, and as he attempts to earn a fifth term in Congress, candidate Tracy Mitrano challenged his notions of how health care can work for residents of New York’s 23rd Congressional District.

Mitrano opened by detailing her plan to implement Medicare for all. Her idea to slowly roll out a new plan would avoid a spike in taxes because residents without care who need it will be newly insured as the plan continues to develop. She highlighted her concern for nearly 30 million Americans who were without health insurance coverage in 2017 according to a report from the Census Bureau.

“(My plan) would provide universal coverage,” Mitrano said. “The greatest significance of what this plan would be (is) to give government the power to negotiate health care costs and drug costs. (Negotiation) is the only solution I know to bring (costs) down.”

Mitrano also said money could come from the reduction of advertising and administrative costs insurance companies put to use. Excessive compensation for CEOs and higher leadership of these companies was also criticized.

She defended claims from Reed, R-Corning, that she is an “extreme liberal” and socialist with her desire for universal health care. Mitrano said she supports increased competition among pharmaceutical companies so that prices on medications and treatments are lowered.

Mitrano said the number one issue the district faces is health care, and she has said throughout her campaign that her dedication to making people healthier will help encourage investors to make the district’s counties thrive economically as well.

She also said her plan would not raise taxes for the lower and middle class; rather, she would raise taxes on large corporations to pay for the program.

“I think your first question about health care is a clear contrast between Tracy and myself,” Reed said. “This is exactly the type of extremist behavior and programs that are going to bankrupt America even further.”

Reed called Mitrano’s plan “socialized medicine, no doubt about it.” He explained his opposition to government-run health care and hesitation to raise taxes on all Americans, which he said would have to be done to support Mitrano’s plan. He said what Mitrano wants comes with a $32 trillion price tag over 10 years, according to a Health Policy Center report, that not even corporations and the 1 percent of wealthiest Americans could foot the bill for if they were taxed far more than they are now.

“That is just not achievable,” Reed said. “I appreciate the utopic effort here.”

Reed said his focus would be on empowering patients and doctors by rewarding the latter for quality and efficient care, not just for how many people are taken care of regardless of how well they’re treated and how many treatments are given; Reed said he would do away with a fee-for-service payment model that encourages providers to provide a higher quantity of treatments over quality. This would also emphasize choice and control on the behalf of patients, Reed said.

“We haven’t done a good job of making sure that you reward providers for being efficient in their care,” Reed said.

Reed also expressed his desire for tort reform, which would equate to changes in the civil justice system to reduce how patients could bring litigation against health care providers if something goes wrong. Reed said he thinks defensive medicine drives health care costs up, and he argued that if tort reform is implemented, providers would be less likely to give patients costly procedures that may not be what they need only to avoid litigation from a patient turned plaintiff.

Mitrano took offense to the idea of further tort reform. She told the story of how her mother died due to medical malpractice when doctors caused her septic state after her intestines were knicked during a biopsy on her ovary and the process to take the case to court her family found difficult.

“(My father) would have been bankrupt 10 times over with the bills that would have come to his house,” Mitrano said. “Why should my father suffer for a mistake the resident made in the course of the biopsy.”

Reed said he wishes tort reform would target frivolous lawsuits; he said the reduction of those would help lower health care costs. He said possible insurance reform would help reduce costs as well.

“We need to bring mental health into the medical condition that it is,” Reed added.

Mitrano agreed with her opponent on the seriousness of mental health care but also criticized him for saying he’d be committed to an increase of technology and telemedicine use in health while not being fully committed to it.

Reed distanced himself from some of his contemporaries in the Republican Party and said he supports insurance covering treatment of Americans’ pre-existing conditions. Mitrano said support of those conditions being taken care of is good but challenged how earnest his support is of them since he voted against the Affordable Care Act. In response, Reed’s stance against government-mandated health care was made clear, saying he doesn’t think bureaucrats should make life-and-death decisions.

The two candidates do agree that the high costs of medications and health care costs need further negotiated and decreased. At an earlier date, Mitrano referenced a resident who buys his insulin in Canada because he can’t afford it in the U.S.

Reed brought up the importance of end-of-life care and how those who enter Medicare suitably go through counseling for palliative care, which he said would decrease health care costs.

“Seventy percent of the country wants to have (universal health care), and it’s a way we can deal with the opioid crisis,” Mitrano said.

Reed brought up what he views as an extreme position of his opponent: injection sites that some have said would help reduce crime related to opioid and heroin usage and get those addicted into treatment and reduce symptoms of withdrawal. In response, Mitrano said she would drop the idea because it sounded to her like the sites would not be a good fit for the district. Mitrano had recently gone on record on saying she’d like to see the sites implemented only if the communities in question wanted them and if they could be supervised by law enforcement.

Mitrano said she wants to attempt to bring both quality and affordability of care to the American people. She said the affordability was missing both before and after the ACA was signed into law. Mitrano wants large corporations and the upper-class to pay the same tax rate as others to help pay for newly implemented health care.

“Let’s empower doctors; let’s get government out of it,” Reed said.

Their disagreements on health care philosophy and how the math would allow either of their plans to work continued in a debate on how to improve the economy and reduce local underemployment.