I agree that you can handhold the rz or rb (I did handhold my rb in Manhattan for a whole day- what joy) but look, we're being asked to compare to a leica R, that is way smaller. Worlds apart. The shooting style will be completely different. I mean, the strength of 35mm is mobility, you can move around like a bumble bee. That is not a strength of an rz or rb. The strengths of these MF systems in my opinion are smoothness, detail and tonality approaching LF. You don't want to have to work at higher ISO just because you are shooting MF handheld.
Regarding what you give up when handhold an rz or rb, here is a short list that comes to mind:
-you can't quickly switch backs while you work. That is a big loss. If you're handholding you have to put the whole thing down... or tuck it very carefully under one arm? If the camera is mounted on a stand or tripod, that operation can be done in about 3 seconds without any change to the focus or the position of the camera. Of course, one of the really great things about the rzs and rbs is that you can go from film back to polaroid etc. very quickly. That, for me is one of *the* features of these systems. Makes a difference when you have a time-dependent subject.
-at least on the rb (N.b. I don't know about the latest innovations on the rz), you need a dual cable release to do MLU, so if you are trying to do that handheld you run out of hands! I like to use one hand for framing and focusing and one to trigger. If you are handholding then you have one hand to brace, one to focus, and the grip doesn't have an MLU detent (again, at least on my rb) so you have then have to get that double cable release in one of your hands somehow. That is a pain. And at least in my experience, MLU makes a really big difference. Those leaf shutters are marvelous... but not so much when you have all that mirror slap! Yes there is substantial mass damping but still you're not going to get past 1/60 or so without MLU and putting the thing in a support. Just for fun I'll try it later today. Anyway I almost always use MLU, I refuse to be forced to higher ISO just because of mirror slap.
There are other issues like altering the balance in your hands as you bellows focus... might bug some people but be fine for others. Also the rotating back function is fantastic, but it's also much easier to do when the camera is supported. Yes all these things can be done handheld but why, if you are in an indoor environment?
I use my rb with a metering prism, that is a bit heavy but that is my preferred way to work, and especially for a someone migrating from 35mm, I suspect that this would also be preferred. And it does add weight. The rz/rb are fine at waist level on a strap but not so nice to hold at eye level, in my opinion. That's a factor if you like a prism, as I do.
Anyway, obviously these things are very individual. I am merely reporting my general feelings based on my experiences with an rb. Rz would be a bit easier with all that electronica and slightly lighter weight, but it's still a far cry from the mobility of a 35mm slr in my opinion. After having tried a camera stand for a little bit, I have to say, it's a lot more fun that handholding. Again We are talking about indoor operation, right? Not street photography.