KING OF PRUSSIA, PA.—The latest villain of Donald Trump’s presidential campaign: Canada’s health care system.

Trump’s Republican running mate, vice-presidential candidate Mike Pence, knocked the Canadian system during an appearance with Trump on Tuesday, following Trump’s inaccurate criticism in a radio interview last week.

Canada’s government insurance program has emerged as a late-campaign foil for the Trump campaign even though he has expressed strong support for it in the past. He has begun targeting Canada’s program as he has tried to turn public attention to problems with Obamacare, a much different program that involves government subsidies for insurance plans purchased from corporations.

Speaking in a hotel ballroom in an important suburb of Philadelphia, Pence, the governor of Indiana, falsely suggested that Democratic candidate Hillary Clinton is proposing a Canada-style “single-payer” system.

“She actually went to Canada and gave a speech that came out not too long ago,” he said. “She told Canadians and business groups that she wanted to get, and I’m quoting, ‘universal health care coverage like you have here in Canada.’ Well, we don’t want the socialized health care they have in Canada. We want American solutions.”

In that January 2015 speech, at Saskatoon’s Arts and Convention Centre, Clinton did not seem to be suggesting she wanted America to adopt Canada’s system. Rather, while defending Obamacare, she said she wanted all Americans insured.

“I’m hoping that whatever the shortfalls and glitches have been … those will be remedied and we can really take a hard look at what’s succeeding, fix what isn’t, and keep moving forward to get to affordable, universal health care coverage like you have here in Canada,” she said, the Canadian Press reported at the time.

Clinton is proposing to add a “public option,” or a government-run insurance plan, to the current system, but it would supplement, not replace, the existing hodgepodge of private and public insurance.

Speaking to Rush Limbaugh last week, Trump falsely said Canada’s system is a “disaster in terms of cost” — America’s is far more expensive — and that, when Canadians “want an operation, they come to the United States to get the operation.” Fewer than 1 per cent of patients leave the country for operations.

Trump’s rhetoric is a marked flip-flop from his previous words about Canada’s system — even during the current campaign. During the first Republican primary debate, in August 2015, Trump broke with party orthodoxy and said, “As far as single-payer, it works in Canada. It works incredibly well in Scotland.”

He was even more effusive in a 2000 book. “We must have universal health care,” he wrote. “I’m a conservative on most issues but a liberal on this one.”

“The Canadian plan also helps Canadians live longer and healthier than Americans,” he wrote. “There are fewer medical lawsuits, less loss of labor to sickness, and lower costs to companies paying for the medical care of their employees.”

The Tuesday event was billed as an address about Obamacare. But Trump, who has long vowed to “repeal and replace” the system, did not offer new details on the replacement component on which he has always been evasive.

He said again that the centrepiece of his replacement plan would be tax-free “health savings accounts.” But he quickly transitioned to his regular stump speech, and he did not say how the accounts would work, whether he would help people who would lose their Obamacare coverage, or even what savings accounts are.

“Trump’s plan for replacing (Obamacare) with Health Savings Accounts has always confused me. His HSA proposal is actually quite modest,” health care expert Larry Levitt, of the Kaiser Family Foundation, wrote on Twitter.

Pence spoke in slightly greater detail. He said they would help people avoid “hardship” by allowing some sort of “transition period for those receiving subsidies” under Obamacare. He said repeatedly, though, that the replacement plan would rely on “the power of the free market.”

“That’s the American way,” he said.

Both Pence and Trump slammed Obamacare as a disaster. It has returned to the political fore in the last week and a half, in the wake of the Obama Administration’s announcement that average premiums for insurance purchased on Obamacare “exchanges,” or markets, would rise more than 20 per cent next year before subsidies.

They held their event in one of the most important battleground regions in the country. To win the presidency, Trump very likely needs to win Pennsylvania. To win Pennsylvania, he needs to do much better than he is doing in the largely affluent, politically divided suburban communities around Philadelphia.

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The latest poll of the state, by Franklin and Marshall College, found Clinton up by 11 points — and by a gargantuan 36 points, 64 per cent to 28 per cent, in those suburbs.

There was better news for Trump in some other polls, which suggested that his standing has improved in the wake of FBI Director James Comey’s Friday disclosure of a new investigation into Hillary Clinton’s emails. In North Carolina, Clinton led by one point in the Elon University poll in which she led by six in late September. In the ABC/Washington Post tracking poll, Trump took his first lead since May, 46 per cent to 45 per cent.

Trump vowed to call a “special session” of Congress to repeal Obamacare. That is not necessary, since Congress would be in session when he became president.

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