Having experienced the transformation of Russia from a capitalist into a socialist country, Ayn Rand understood the meaning of such change all too well.

In her first novel, We the Living she explores the fate of Leo, a newly impoverished, unconnected (not a Union or a party member) young man suffering from tuberculosis. To continue living he needed treatment in a Crimean sanatorium and the waiting lists were just too long.

For do not be fooled. The care of rich and the well connected will not be much affected by Obamacare. As Barack Obama himself noted, had Medicare failed to pay for his grandmother operation, he would have paid for it himself. The rest will be stuck with care based not on their individual condition but of"best practices." This is how Leo's girl friend Kira describes such care to Communist party member, Andrei;

Hundreds. Thousands. Millions, Millions of what? Stomachs, and heads, and legs, and tongues and souls. And it does not matter if they fit together. Just millions. Just flesh. And they - it - had been registered and numbered, you know, like tin cans on a store shelf. I wonder if they are registered by the person of the pound?

How prescient. It seems that overweight persons (or those with similarly unfashionable vices) will pay more and, who know, perhaps they will be denied care because the treatments given to them may not be as efficacious dollarwise as that given to thin people.

No, we are not going to have death panels. Nothing that straight forward. The poor are merely going to have statistically mandated treatment. The well off will simply pay more for private care. The well connected will receive private quality care for free. That is how things were for those who, according to the Beatles, were"lucky" enough to live back in the good old USSR.

You may well wonder if somebody faced with same choices, will opt to do what Kira did, sell themselves (in one manner of another) to a rich or well connected person? I am sure that ever more expensive presents designed to soften the heart of physicians will become routine here as it is in other countries where medicine is socialized. Pity.

These Emanuel brothers are becoming scary - White House health-care adviser Ezekiel Emanuel blames the Hippocratic Oath for the 'overuse' of medical care.