The Faces of Rationed Medical Care

One of the most powerful arguments against Obama's national health care proposals lies in Ayn Rand's novel We the Living — the beautiful Italian movie version of which is now available for purchase on DVD.

In this essay the living (Barack Obama), the dead (Ayn Rand) and two fictional characters (Kira Argounova and Leo Kovalensky) come together to reveal the faces of government-controlled, necessarily rationed medical care.

There is no longer any doubt that the health care “reform” being promoted by Obama and his Democrat Party acolytes amounts to an eventual government monopolization of American medicine, with inevitable rationing of medications, procedures and operations which will fall most heavily on the elderly.

Indeed, Pat Buchanan recently made the powerful case that simply on the basis of population statistics, even with a lighter hand of government on the medical care valve than is currently proposed, elder care will be heavily triaged in favor of the young.

In her recent article “Ayn Rand and Socialized Medicine,” Erika Holzer argues that fiction is a powerful, albeit underutilized weapon in ideological battles: “The Ayn Rand novel so powerfully written that it causes the reader to ‘personally experience’ the horrors of bureaucrat-controlled health care is her first novel, We the Living. Whether or not you’ve ever read We the Living — first published in 1936 — I urge you to read (or re-read) it now. Better yet, read the book and [then] view the restored English-subtitled Italian-made movie of the same name.”

So far, the battle over Obamacare has been limited to non-fiction and editorial cartoons.

Fiction, let alone film, has not been deployed on the battlefield. Now, with the release of Ayn Rand’s We the Living on DVD, it can, and should, be. (For information about how to order the new DVD and a documentary about the film, visit

The jacket copy of Random House’s sixth printing of We the Living describes Rand’s novel as a portrayal of “the impact of the Russian Revolution on three human beings who tried to shape their own destinies: Kira, who wanted to be a builder, and the two men who loved her — Leo, an aristocrat, and Andrei, a Communist. But she was living in a totalitarian state.”

The doctor asked: “Are you his wife?”

Kira hesitated, then answered: “No.”

The doctor said: “I see.” Then, he added: “Well, I suppose you have a right to know it. Citizen Kovalensky is in a very bad condition. We call it incipient tuberculosis. It can be stopped — now. In a few weeks, it will be too late.”

“In a few weeks — he’ll have — tuberculosis?”

“Tuberculosis is a serious disease, citizen. In Soviet Russia — it is a fatal disease. It is strongly advisable to prevent it. If you let it start — you will not be likely to stop it.”

“What ... does he need?”

“Rest. Plenty of it. Sunshine. Fresh Air. Food. Human food. He needs a sanatorium for this coming winter. One more winter in Petrograd would be as certain as a firing squad. You’ll have to send him south.”

She did not answer; but the doctor smiled ironically, for he heard the answer without words and he looked at the patches on her shoes.

“If that young man is dear to you,” he said, “send him south. If you have a human possibility — or an inhuman one — send him south.”

To save the life of the man she loved, Kira began her quest to obtain medical treatment for Leo.

In the first State hospital she visited, the official in charge told her: “A place in a sanatorium in the Crimea? He's not a member of the Party? And he's not a member of a Trade Union? And he's not a State employee? You're joking, citizen.”

In the second hospital, the official said: “We have hundreds on our waiting list, citizen. Trade Union members. Advanced cases.... No, we cannot even register him."

In the third hospital, the official refused to see her.

There were lines to wait in, ghastly lines of deformed creatures, of scars, and slings, and crutches, and open sores, and green, mucous patches of eyes, and grunts, and groans, and — over a line of the living — the smell of the morgue.

There were State Medical headquarters to visit, long hours of waiting in dim, damp corridors that smelt of carbolic acid and soiled linen. There were secretaries who forgot appointments, and assistants who said: “So sorry, citizen. Next, please”; there were young executives who were in a hurry, and attendants who groaned: “I tell you he’s gone, it's after office hours, we gotta close, you can't sit here all night.”

At the end of the first two weeks she learned, as firmly as if it were some mystic absolute, that if one had consumption one had to be a member of a Trade Union and get a Trade Union despatchment [referral] to a Trade Union Sanatorium.

There were officials to be seen, names mentioned, letters of recommendation offered, begging for an exception. There were Trade Union heads to visit, who listened to her plea with startled, ironic glances. Some laughed; some shrugged; some called their secretaries to escort the visitor out; one said he could and he would, but he named a sum she could not earn in a year.

She was firm, erect, and her voice did not tremble, and she was not afraid to beg. It was her mission, her quest, her crusade.

She wondered sometimes why the words: “But he's going to die,” meant so little to them, and the words: “But he's not a registered worker,” meant so little to her, and why it seemed so hard to explain.

She made Leo do his share of inquiries. He obeyed without arguing, without complaining, without hope.

She tried everything she could. She asked Victor for help. Victor said with dignity: “My dear cousin, I want you to realize that my Party membership is a sacred trust not to be used for purposes of personal advantage.”

She asked Marisha. Marisha laughed. “With all our sanatoriums stuffed like herring-barrels, and waiting lists till the next generation, and comrades workers rotting alive waiting — -and here he's not even sick yet! You don't realize reality, Citizen Argounova.”

This “reality” — of government monopolization of medical care, of its favored allies receiving preferential treatment, of the disfavored being shunted aside, of the unconnected left to perish — is what Obamacare will inevitably lead to in the United States of America.

But, ironically, a possibility for Leo to survive did exist under the Soviet system, at least in theory, which will probably not be available under Obamacare.

It took a month, but at the end of a month, she was convinced that the door of the State sanatoriums was locked to Leo and that she could not unlock it.

There were private sanatoriums in the Crimea. Private sanitoriums cost money.

I will not give away Rand’s resolution of this part of the plot line, but instead simply note that informed opinion in the United States today believes that Obama’s ultimate plan is to monopolize entirely all medicine and pharmaceuticals under government control. Which is to say, monopolize entirely under government control the power to decide who lives and, especially, who dies: criminals, the elderly, Down syndrome fetuses, “three generations of imbeciles.”

In the scenes quoted above from her novel, Rand has written eloquently of what such monopolization did to Kira Argounova’s quest to save her lover’s life — words which can, and should, be used in the ideological/political battle that we’re now fighting.

But there is an even stronger tool available.

As Erika Holzer mentioned, We the Living is also a motion picture. In that film the scenes quoted above, and a similar one which precedes it, are depicted with heart-wrenching dramatic effect. They can be viewed in this video clip:

Those who would fight Obamacare and all that it necessitates and implies — and do so with maximum effectiveness through the use of powerful moving images — should assist all of us in promptly disseminating this video throughout the Internet.

Note: To learn more and purchase the newly-released 2-disc DVD of the We the Living movie, visit

Henry Mark Holzer is a professor emeritus at Brooklyn Law School and a constitutional and appellate lawyer. He provided legal representation to Ayn Rand on a variety of matters in the 1960s. His latest book is Keeper of the Flame: The Supreme Court Jurisprudence of Justice Clarence Thomas.

12 comments from readers  

To post comments, please log in first. The Atlasphere is a social networking site for admirers of Ayn Rand's novels, most notably The Fountainhead and Atlas Shrugged. In addition to our online magazine, we offer a member directory and a dating service. If you share our enjoyment of Ayn Rand's novels, please sign up or log in to post comments.
Wham!! Excellent endorsement, Dr. Holzer!
I watched the Italian movie version of We The Living in VHS format when I was in college, and was blown away by the beauty of the movie. I'm glad it is finally available on DVD!
What a great explanation of Ayn Rand's ideas, from someone who clearly knew her well. We The Living is my favorite rand book, and ihave a worn-out VHS of the movie.
I look forward to getting the DVD
David R
0 points
Mr Holzer, Thank you for great writing. Ayn Rand has long been my favorite author, one whose ideas and philosophy have changed my life for the better..I am grateful to see her works getting more attention. I would add to the "must" reading list, "Capitalism, The Unknown Ideal."

I also believe that this war of ideas is lost if we do not get the Public Schools, Colleges and Universities to at least equally present Ayn's ideas (along with those of the Founding Fathers!), rather than being "useful idiots" for Leftist's propaganda.

After all, what we learn from history, is that we don't learn from history!

If you "see" any socialists (of any style!), be afraid!
If you don't "see" any socialists (of any style!), be very afraid!

Thanks again!
I am a Canadian senior and have lived under Medicare since 1968 when it became official, and all private insurance plans, which were working beautifully, were disalowed by Government edict. If we could point to horrendous medical conditions it would be a simple matter to argue against Socialized Medicine; but it is insidious, on the surface it looks good, seems to be working just fine.

There are obvious problems, waiting time for important medical treatment is a major difficulty. Much worse, but hidden, is flagrant abuse. E R's are flooded with inconsequential problems, like slivers, and running noses. In Canada there was never a need nor a reason to institute Medicare. Over 90% of the people were insured. So why was it imposed? That is the question and the explanation. Control of produced wealth.

All wealth produced in Canada is now Public Domain. Medicare is so brutally expensive, last year, with a mere 30 million people, only 19 million who pay taxes, Medicare cost some 170 Billion Dollars. Inflation of the currency supply, (fiat Currency) is so rampant, that a dollar is actually worth no more than 5 cents, and prices to absorb this inflated supply are constantly rising from week to week. Just go shopping and check it out. Money represents the life of the man who produced it. If it is counterfeit, so is the value of his life. The man who produces wealth for a "master" and benefits little from it himself, is a 'Slave!"

That is what Obama wants, control of man's life through the control of his privately produced wealth. Obama despises America, He abhors the Constitution, he Cannot live with the fact that The Once Free America was living proof of the Evil and impotence of his Marxist Ideology. The very same reason Islam hates the Jews. It does not matter to him that without the power and glory that was America to the whole world, there is no more Firewall, and communism, the only possible evil will reign supreme. I understand he is trying to break the law which prohibits more than 2 terms for President. What does that signify?
Hereâ??s my take on the situation in Australia after 30 years of socialized medicine:

The rich people are fine. They still have private hospitals and (wickedly expensive) private health insurance.

The rest of us have access to reasonably good health care. But it is not â??freeâ?. In addition to our taxes we pay a levy of 1% (and sometimes 2%) of our annual salary. Our percentage of GDP spent on health is also increasing exponentially.

The number of public servants employed to administer our health system is horrifying. There's more public servants than doctors!

Hereâ??s the problems:

- The doctors in the public system are slaves. Most medical specialists live 2 lives. In private practice they make money. In the public system they provide their services at a fee decided by the government. Doctors, after initially putting up a fight, now seem to go along with this.

- The waiting lists in public hospitals are shocking. Urgent cases get treated yet people can die waiting for heart bypass operations. Cancer patients wait months for radiotherapy. If your case is not urgent, and you donâ??t mind waiting 12 months, the system works fine.

- Iâ??m no medical historian, but I suspect every significant breakthrough in medical science in the last 30 years has come from America. There is no money available in any socialist state to fund medical research (including pharmaceutical science), never has been, never will be.

Good luck!
This could indeed be a powerful tool for use against the threat of "Obamacare."

Might I suggest uploading the film to YouTube, making it accessible to a vast audience at no cost. I think Ms. Rand would, in this kind of situation, approve of charity -- because it is a charity born of rational self-interest.
By comparing Obamacare with the fictional situation presented in We The Living is quite commendable. Who is running this sight, Gail Wynand? Or Rupert Murdoch?
(profile not found)
0 points
Too many of Ayn Randâ??s disciples are misapplying her philosophy to todayâ??s issues. She was not an extremist who would support every Right Wing cause purpose voiced today. Rather she was a thoughtful, introspective person who believed strongly in individual rights, in personal achievement, and in rational thinking as the basis for freedom. I believe she would support a definition of freedom as â??the right to be free from the tyranny of the state, as well as the right to be free to pursue those things that each of us cares to pursue as we seek to reach our potential.â? She would not support equality of outcomes, but she would support equality of opportunity.

Although she was a strong supporter of capitalism, it is unlikely that she would support how it has become distorted from its original goals, and how in combination with unjust inheritance laws, a virtually zero tax on wealth, old boy networks in hiring practices, and mass marketing propaganda have produced gross inequality in both incomes and wealth. Would she have supported 10 percent of Americans owning 71 percent of all net wealth, while the next 40 percent owned the remaining 29 percent of wealth, and the bottom 50 percent owned no net wealth at all? I doubt it.

Would she have supported our #1 world rankings in homicides, in number of imprisonments, in obesity, in mental illnesses and drug addictions, in teenage pregnancies, in infant mortality rates, in low trust, in low social mobility, in low math and literacy scores, and in our low life expectancies among industrialized nations? I doubt it.

In terms of health care, would she have supported a system that is increasing in costs three times as fast as normal inflation, one with 47 million Americans without health insurance at all, and with Medicare and Medicaid due to go bankrupt in the next 8 years? I doubt it.

Might she have equated our invasion of Iraq with Hitlerâ??s â??lebensraum?â? Quite possibly. Might she have disapproved of tax cuts to the wealthy without corresponding spending cuts as ill-advised? Almost certainly.

Would she have approved of our increasingly huge budget and trade deficits since 1980, our falling dollar, and an ever increasing gap between the â??havesâ? and â??have notsâ? with less and less opportunity for the individual to improve his/her social or economic status? I doubt it.

Would she have supported the "rubber stamp� Right Winger Clarence Thomas to be a Justice on the Supreme Court? Almost certainly not.

Why not let Ayn Rand rest in peace, praise her intellect and her principles, and stop trying to put her stamp of approval on causes and outcomes that she neither created nor did she foresee.
Based on the title of this article, I was expecting to hear about some real victims of contemporary health care rationing... not the plight of fictional characters.

An attempt to use fiction to persuade in the healthcare debate is nothing more than an appeal to emotion--the same unreasoning tactic the bleeding-heart liberals have employed ad nauseum to advocate it.

Further, equating liberals to corrupt communist officials (or Nazis or babykillers, for that matter) is disingenuous at best. At worst, it reinforces the caricature of conservatives as a bunch of wacky, out-of-touch, knee-jerk-reactionaries.

The imagery in the film is unlikely to resonate with those who are not already convinced of the conservative position on this issue. Circulating this video will just be so much preaching to the choir... though I'd be willing to bet that's probably the whole point, given Mr. Holzer's involvement with this movie. Playing up a tangential connection between the film and a hot-button issue will no doubt contribute more to sales of those newly-released DVDs than it will to any political cause.

The movie itself is wonderful, and fully capable of standing on its own merits. Employing it in this manner to make spurious comparisons, however, cheapens both the film and the case against government involvement in healthcare.
Henry Holzer is always an eloquent and compelling speaker and author- another Keeper of the Flame. As a friend and former student he has always been an inspiration.
As a Dentist who has practised both privately and in public services, i think this only one side of the argument. My colleagues who work for health insurance schemes will tell you that it is the policy to do the cheapest quickest medical intervention at every point of consultation. Who protects the patient? A bigger question for all Americans should be: Who pays for healthcare? the individual or the state? Once this question is answered preferably by a national referendum then the most suitable model can be decided.
To post comments, please log in first. The Atlasphere is a social networking site for admirers of Ayn Rand's novels, most notably The Fountainhead and Atlas Shrugged. In addition to our online magazine, we offer a member directory and a dating service. If you share our enjoyment of Ayn Rand's novels, please sign up or log in to post comments.