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Donald Trump and Hillary Clinton sparred over the issue of so-called “Obamacare” during the second presidential debate, with the Republican presidential nominee comparing it to the Canadian health care system which he characterised as “slow” and “catastrophic.”

Clinton and Trump discussed how they would bring down the cost of healthcare premiums after the Affordable Care Act was passed, otherwise known as “Obamacare.”

“[Clinton] wants to go to a single payer plan which would be a disaster, somewhat similar to Canada.” Trump said during the debate in St. Louis. “And if you ever notice the Canadians, when they need a big operation, when something happens they come into the United State in many cases. Because their system is so slow it’s catastrophic in certain ways.”

Keep our country's name out of your mouth, @realDonaldTrump. — Norm Kelly (@norm) October 10, 2016

Trump’s comments appear to be a reversal from his stance on single payer healthcare systems after praising Canada during the first GOP debate last August.

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“As far as single payer, it works in Canada,” Trump said. “It works incredibly well in Scotland. It could have worked in a different age, which is the age you’re talking about here.”

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However, Trump hammered Obamacare during the debate Sunday calling it “very bad, very bad health insurance.”

While Clinton agreed that premiums were high, she added that it’s a good thing that millions of more people now have access to health insurance compared to before the Affordable Care Act was passed.

Was Trump correct when he said Canadians travel south when needing a major operation?

An estimated 52,000 Canadians left the country to receive non-emergency health care in 2014, according to a report from the Fraser Institute up from 41,838 in 2013.

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The Fraser Institute, a right-leaning think-tank in B.C., has long been a supporter of increasing private health care in Canada.

The study suggest a lack of available resources, the desire for more advanced health care facilities and longer wait-times as a reason for seeking treatment in the U.S.

However, the Canadian Institute for Health Information, a federally funded non-profit organization, found that wait times to see a doctor in an emergency room have steadily dropped over the last five years.

Does Hillary Clinton want a universal system?

According to the Associated Press, it’s actually Vermont Sen. Bernie Sanders — not Clinton — who supports a Canada-style government-run health care system.

Clinton’s health care proposals have called for an expanded role by the government in health, but has never said she would dismantle the current system, which is a hybrid of employer-sponsored coverage, government programs like Medicare and Medicaid, and individually purchased insurance.

Clinton said if elected president she would push for a government-sponsored insurance plan in the health care markets created by President Barack Obama’s health care law, as an alternative to private insurance. But those markets currently cover about 11 million people, while about 155 million have job-based coverage.

*With files from the Associated Press