It is very much an extant problem. What you have mapped out isn’t a hypothetical dystopia; it is the active, operational architecture of contemporary healthcare across both private and public systems. The fusion of austerity/artificial scarcity with individual consumer "choice" is the dominant mechanism used to manage, ration, and deny treatment today.

The real-world execution of this logic manifests prominently through two distinct structural frameworks:

1. The Corporate/Insurance Model: "Algorithmic Deniability"

In privatized or insurance-heavy systems (like the United States), this loop has been fully automated through Revenue Cycle Management (RCM) and insurance-side AI.

[Insurance Provider AI] -> Scans claims and issues instantaneous, bulk denials
         ↓
  [The Patient] --------- -> Told they have the "choice" to appeal the decision
         ↓
[The Rational Trap] ----- -> The administrative friction is made so high that 
                             dropping the claim becomes the "rational choice."

• The Artificial Scarcity: Claim denial rates from payers have spiked dramatically, reaching an industry-wide average of nearly 12%. Insurance algorithms are trained to find minor coding discrepancies or invoke narrow "medical necessity" definitions to reject coverage instantly.

• The Rational Choice Intersect: The system does not explicitly say "you cannot have this treatment." Instead, it says, "We have denied this coverage, but as an autonomous consumer, you have the right to file a multi-stage, bureaucratic appeal."

• The Outcome: The system relies on the fact that a sick, exhausted, or cognitively drained patient will make the "rational calculation" that chasing an appeal for months is an impossibly high expenditure of energy for an uncertain reward. The structural denial of care is successfully reframed as the patient's individual decision to give up.

2. The Public Model: "Managed Care and Lifestyle Gating"

In public, taxpayer-funded systems facing severe fiscal constraints, the loop operates under the banner of "Demand Management" and "Prevention-First Economics."

Under intense pressure to find billions in efficiencies, regional health boards and Integrated Care Boards (ICBs) increasingly resort to service redesigns and structural rationing.

• The Artificial Scarcity: Rather than funding services to meet total population demand, care is rationed through waitlists, narrowed eligibility criteria, or the closure of localized clinics.

• The Rational Choice Intersect: To justify these restrictions, the language of public health is systematically shifted toward "personal responsibility" and "lifestyle choices." If a patient requires an orthopedic intervention or certain specialized medications, access may be gated behind strict biophysical or behavioral benchmarks.

• The Outcome: If the patient cannot meet these thresholds within an environment of manufactured stress and resource scarcity, the system's failure to provide timely care is laundered. The narrative becomes: “We offered you the path to treatment, but you chose not to optimize your health metrics, so the delay is the consequence of your choice.”

The Ultimate Convergence: The "Consumer" Patient

Across both systems, medical documentation and policy guidance have aggressively swapped out the word "patient" for "consumer" or "service user."

The Semantics of Subversion: A patient is someone who is suffering, vulnerable, and owed a duty of care. A consumer is an autonomous agent making transactional decisions in a marketplace.

By forcing the sick to view themselves as consumers navigating a landscape of scarcity, the system achieves an extraordinary ideological victory. When a patient cannot get a diagnostic scan, cannot afford a life-saving drug, or deteriorates on a multi-year waiting list, they are left with the crushing internal narrative that they simply failed to master the system—that they didn't push hard enough, choose the right insurance tier, advocate for themselves correctly, or live a sufficiently optimized life.