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Donald Trump: Single-payer "works well in Canada"

Scott Olson/Getty Images

Update: Coverage of second Republican debate.

Donald Trump gave Canada's health-care system a surprising compliment at the Republican primary debate on Thursday night.

"It works well in Canada," Trump said when pressed to explain his previous support for single-payer health-care systems, while saying that it wouldn't work well in the United States at this point.

So how well does Canadian health care actually work?

The OECD tends to give Canada's system high marks on outcomes in its regular look at international health-care systems. "Canada’s survival rates for breast and colorectal cancer are among the highest in the OECD," the international organization noted in its 2011 report. "Canada also does well in primary care, preventing costly hospital admissions from chronic conditions such as asthma and uncontrolled diabetes."

Where Canada does not do well is on wait times, which tend to be longer than in other countries, especially to see specialists or obtain an elective surgery.

A Commonwealth Fund survey in 2010 found that 36 percent of Canadians wait six days or longer — or never get an appointment – when sick.

And there actually is something to Trump's remarks about it being harder for the United States to create a single-payer system at this point in time than it was for Canada decades ago.

The fact that America hasn’t taken serious steps to control health spending makes it particularly hard for the country to move to a single-payer system in the future. Our health-care system costs $2.8 trillion annually, about 17.7 percent of the entire economy. This is much more than any single-payer system anywhere in the world costs. Take Canada, where 11.2 percent of all spending goes toward medical care.

That's the irony of America's health-care system: Its incredible failure to control costs makes change that much harder, because so many powerful players profit so handsomely from the status quo, and because rearranging the financing creates so many losers.