Donald Trump called the Affordable Care Act a "disaster" that he wants to repeal and that Hillary Clinton would make health care even worse.

"She wants to go to a single-payer plan, which would be a disaster," Trump said during the presidential debate at Washington University in St. Louis Oct. 9. "Somewhat similar to Canada. And if you ever noticed the Canadians -- when they need a big operation when something happens, they come into the United States in many cases because their system is so slow, it's catastrophic in certain ways. But, she wants to go to single payer which means the government basically rules everything."

Does Clinton want to move the United States to a single-payer system for health care?

Clinton’s health care plan

Converting Obamacare to a single-payer program would make it, like Medicare, a federal health insurance program run by the federal government. Under a single-payer system, the government provides health care for everyone. Currently, Obamacare promotes policies supplied by private insurance companies.

Some Democrats — including, at one time, Barack Obama — pushed for a single-payer system. But there wasn’t enough support for that, and ultimately Congress approved a plan that allows different insurance plans offered in "marketplaces" by individual states and the federal government.

During the vice presidential debate, Trump’s running mate Gov. Mike Pence made a similar claim that Clinton and and Tim Kaine "want to expand (Obamacare) into a single-payer program." We rated that claim Mostly False. For our fact-check of Pence, Trump spokesman Dan Kowalski pointed us to the health care page on Clinton's website.

It indicates "that she supports a 'public option' for Obamacare," Kowalski said. "A 'public option' is a single-payer-like option for health care delivery."

Here is exactly what she said on her campaign website about a public option:

"Defend and expand the Affordable Care Act, which covers 20 million people. Hillary will stand up to Republican-led attacks on this landmark law—and build on its success to bring the promise of affordable health care to more people and make a "public option" possible. She will also support letting people over 55 years old buy into Medicare."

So Clinton does want a public option, but she is calling for adding the public option to the existing options.

Clinton has consistently said, including during the Oct. 9 debate, that she wants to protect Obamacare from being repealed by the Republicans.

She has called for expanding it to include tax credits, eliminating the out-of-network hospital charges many plans levy, and reducing prescription drug costs by removing the ban that prevents the federal government from negotiating drug prices and allowing Americans to important their drugs from countries with cheaper prices.

We previously asked the Trump campaign if they had seen any statements from Clinton or Kaine indicating that converting Obamacare into a single-payer system was their eventual goal.

Kowalski responded that "Hillary has committed fully to the public option," and as evidence he directed us to comments Clinton made in 1994 when she was first lady.

At the time, she predicted that if Congress didn't pass health care reform soon, "I believe, and I may be totally off base on this, but I believe that by the year 2000 we will have a single-payer system. I don’t think it’s — I don’t even think it’s a close call politically."

Later in her answer Clinton says there are three ways to get universal health coverage, only one of which is a single-payer system. The other two: an employer mandate or an individual mandate, which is how Obamacare works.

WikiLeaks speech excerpt about single-payer

A few days after the vice presidential debate, WikiLeaks published emails from Clinton campaign chairman John Podesta.

A Jan. 25 email from Clinton campaign research director Tony Carrk to Podesta contained excerpts of Clinton’s paid speeches to Wall Street banks. (For months Clinton has faced calls to release the speeches but hasn’t done so.)

One excerpt related to single-payer systems was from remarks she gave to "ECGR Grand Rapids" on June 17, 2013. She gave a speech to the Economic Club of Grand Rapids in Michigan that day.

"If you look at countries that are comparable, like Switzerland or Germany, for example, they have mixed systems. They don't have just a single-payer system, but they have very clear controls over budgeting and accountability. If you look at the single-payer systems, like Scandinavia, Canada, and elsewhere, they can get costs down because, you know, although their care, according to statistics, overall is as good or better on primary care, in particular, they do impose things like waiting times, you know. It takes longer to get like a hip replacement than it might take here."

We can’t fully evaluate Clinton’s speech because WikiLeaks published only excerpts. (We asked the Clinton campaign for a fully copy but did not get a response to that request.) However, Clinton praised single-payer because she says it keeps costs down, but she also said that it imposes wait times. And she also praised systems like Switzerland for having clear budget controls and said they don’t have single payer.

Clinton campaign spokesman Josh Schwerin sent us a brief fact-check in Politico that was headlined: "No, Clinton has not been after single payer for years."

One final note: Trump has been all over the map on single-payer health care if we trace his comments back to his first race for president in 2000.

"The Canadian plan also helps Canadians live longer and healthier than America. … We need, as a nation, to reexamine the single-payer plan, as many individual states are doing," Trump wrote in his 2000 book The America We Deserve.

Other times in the past couple of years he has praised it, but he has also said he doesn’t support it. His campaign plan on his website emphasizes "free market principles."

Our ruling

Trump says Clinton "wants to go to a single-payer plan" for health care.

She has consistently said she would fight efforts to repeal Obamacare and would try to improve it. She said she wants a public option to be "possible" but she has not called for moving to a system of only single payer.

Clinton has not called for a single-payer plan. At times, she has praised the health care systems of other countries that have a single-payer plan, but she has not advocated that plan for the United States. We rate Trump’s claim False.

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