Designing a system where you can't even see a doctor, unless a nurse-gatekeeper allows you to get past her, is one way of differentiating what the masses will get from what the elite will get.

Healthcare organizations are replacing insurance companies. Since they can't charge that premiums that will support the system continuing as it is, they will have to cut costs. Taking away a lot of choice is exactly what they are doing - and have to do - because there is no incentive for individuals to not always go to the best, and most expensive, provider.