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About the time that I reentered the Bruce family, an event occurred of disastrous import to the colored people. The slave Hamlin, the first fugitive that came under the new law, was given up by the blood-hounds of the north to the bloodhounds of the south. It was the beginning of a reign of terror to the colored population. The great city rushed on its whirl of excitement, taking no note of the "short and simple annals of the Poor." But while fashionables were listening to the thrilling voice of Jenny Lind in Metropolitan Hall, the thrilling voices of poor hunted colored people went up, in an agony of supplication, to the Lord, from Zion's church. Many families, who had lived in the city for twenty years, fled from it now. Many a poor washerwoman, who, by hard labor, had made herself a comfortable home, was obliged to sacrifice her furniture, bid a hurried farewell to friends, and seek her fortune among strangers in Canada. Many a wife discovered a secret she had never known before—that her husband was a fugitive, and must leave her to insure his own safety. Worse still, many a husband discovered that his wife had fled from slavery years ago, and as "the child follows the condition of its mother," the children of his love were liable to be seized and carried into slavery. Every where, in those humble homes, there was consternation and anguish. But what cared the legislators of the "dominant race" for the blood they were crushing out of trampled hearts?

Take Canada again: why does Canada have the health-care program it does? Up until the mid-1960s, Canada and the United States had the same capitalist health service: extremely inefficient, tons of bureaucracy, huge administrative costs, millions of people with no insurance coverage―exactly what would be amplified in the United States by Clinton's proposals for "managed competition" [put forward in 1993].21 But in 1962 in Saskatchewan, where the N.D.P. is pretty strong and the unions are pretty strong, they managed to put through a kind of rational health-care program of the sort that every industrialized country in the world has by now, except the United States and South Africa. Well, when Saskatchewan first put through that program, the doctors and the insurance companies and the business community were all screaming―but it worked so well that pretty soon all the other Provinces wanted the same thing too, and within a couple years guaranteed health care had spread over the entire country. And that happened largely because of the New Democratic Party in Canada, which does provide a kind of cover and a framework within which popular organizations like unions, and then later things like the feminist movement, have been able to get together and do things.

Consider the automobile industry. For a century after 1894, most of the cars manufactured in North America were made in Michigan. Since 2004, Michigan has been replaced by Ontario, Canada. The reason is simple: health care. In America, car manufacturers have to pay $6,500 in medical and insurance costs for every worker. If they move a plant to Canada, which has a government-run health care system, the cost to the manufacturer is around $800 per worker. In 2006, General Motors paid

Of course, even that day may come. The idea of mandatory contraception has been bruited about at the state level for drug-abusing or welfare-abusing mothers; and it is not hard to imagine that with the federal government counting on Obamacare cost savings from contraception that it could become as mandatory as having health insurance. And if gay marriage really is a civil right, how long will the federal government allow churches to opt out from respecting it? Obama’s supposed respect for the integrity of religious “sacraments” isn’t worth taking seriously. Under the nanny state of the left, nothing remains “private” for long. Should Obama win a second term, one can imagine his friends at Planned Parenthood calling for forcible sterilizations to “save costs” and gay groups calling for “hate crime” fines to be levied on Catholic priests who refuse to bless gay unions. Already in Canada and Western Europe, nonconformists can be dragged before judges for harboring the “wrong” thoughts. The French actress Brigitte Bardot has been “tried” several times for criticizing Islam. So was the late author Oriana Fallaci, who stood trial in Italy for “defaming Islam.” Do not kid yourselves: it could happen here. In a second term, the Obama administration will bring that day much closer.

HMOs have been so successful that they now occupy a dominant position in the market for health care in the United States. Approximately forty-five million Americans are uninsured. Of the remainder, about half are enrolled in some type of HMO. Most others receive some sort of managed care plan. Less than 10 per cent of Americans still have classic fee-for-service private health insurance (down from more than 70 per cent in the late ’80s). So even though many people equate HMOs with private health care, these sorts of corporations exist only because of the failure of private markets to supply appropriate health care. HMOs succeed precisely because they are more efficient than insurance markets. There should be no illusions about the character of these organizations—they are giant bureaucracies. The largest of them, Kaiser Permanente, employs over eleven thousand physicians and has more than six million subscribers in the state of California alone. This makes Kaiser larger than most of the government-run health care systems in Canada. And while the Canadian system is extremely decentralized, Kaiser Permanente is a single, vertically integrated corporation.

But insurance is nothing more than a name we give to risk-pooling arrangements that are organized through private markets. When these markets fail, it is possible to pool risks in other ways. The corporation provides a perfect example of how people can arrange to share risks without the mediation of explicit market mechanisms. For example, there are many types of production processes that call for very specialized skills. The division of labour is itself an enormous source of efficiency gains. Unfortunately, acquiring highly specialized skills can be extremely risky for an individual, because the future is uncertain. While I may know that there is adequate demand for my skills now, I have no idea what things will be like five years down the road. As a result, no one may be willing to invest the time and energy needed to acquire specialized skills, because it is too risky. This efficiency loss could be avoided if it were possible to buy some kind of insurance that would compensate people when there was some fluctuation in the demand for their skills. Unfortunately, no one would ever want to sell this type of insurance because of obvious moral-hazard problems—people would lose all incentive to market or upgrade their skills. So private markets will simply fail to provide this type of insurance. Corporations, however, are able to provide such insurance to workers through bureaucratic means.

The key concept is efficiency. The primary function of the Canadian welfare state is not to redistribute wealth— it does almost none of that. Government is involved in the economy because, in many cases, the state is able to deliver goods and services more efficiently than the market. From highways and pest control to health insurance and pensions, government is able to get the job done better. Thus the welfare state, far from being an unstable compromise between capitalism and socialism, is a perfectly logical arrangement—one that is designed to promote the overall efficiency of our economy.

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private insurance and away from Medicare. The result would be “two-tier medicine,” a term that is as pejorative in Canada as “socialized medicine” is in the United States. Many fear that if Canada did move to two-tier medicine, the rich might get better care, with less waiting, than the poor. The rich getting better access to health care—that’s a fact of life that we take for granted in the United States. But in Canada, such a result would violate the powerful egalitarian impulse that is a crucial element of the national culture.

There are thirty-seven million people in the United States without any form of medical insurance. Every other leading industrial nation in the world—Germany, Italy, France, Japan, England, Canada, and all the others—supplies health care to all its citizens, at a fraction of what the world’s richest country spends for inadequate health care. It’s our national shame.