April 14, 2016 10:58 PM EDT

Hillary Clinton and Bernie Sanders say they both want universal health care. But they have different ideas about how to get there that cut to the core of their governing philosophies.

Vermont Sen. Sanders promises free health care for all, which some estimates say will add trillions of dollars to the national debt. “I disagree with that study,” Sanders said when confronted with numbers from the debate moderators Thursday night. He said that his “proposal, a Medicare-for-all single payer program, will save middle class families many thousands of dollars a year in their health care costs.”

Former Secretary of State Clinton said she agrees with Sanders lofty goals, but she advocates a more pragmatic approach. “I absolutely agree with the diagnosis,” she said. “The diagnosis that we’ve got to do much more to finish the work of getting universal health care coverage, something that I’ve worked on for 25 years… But I do think when you make proposals and you’re running for president, you should be held accountable for whether or not the numbers add up and whether or not the plans are actually going to work.”

Clinton said she wants to continue building on the Affordable Care Act, and that Sanders’ plan “would pose an incredible burden not just on the budget, but on individuals.”

“If someone promises you something for free, read the fine print,” Clinton quipped, saying it was a favorite mantra of her late father.

Sanders fired back: “Secretary Clinton will have to explain to the people of our country how it could be that every other major country on earth manages to guarantee health care to all of their people, spending significantly less per capita than we can,” he said. “I live 50 miles away from Canada, you know, it’s not some kind of communist authoritarian country. They’re doing OK.”

Write to Tessa Berenson at tessa.berenson@time.com.

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