The reality is created by policy. The AMA zealously protects MDs and (Medicare-funded) fellowships as a cartel exempt from antitrust laws. Any they fight PAs and NPs tooth and nail.

I understand that. I think it's morally repugnant and a sign of an ethically bankrupt society. I also have very strong feelings about the amount of debt we place doctors into as well as the fact that we place all the burden for malpractice on them vs. putting some of that burden on the insurance companies and administrative overhead that create the policies that make malpractice more likely. Doctors wouldn't have to be artificially scarce in order to make giant salaries if they weren't almost all in exorbitant amounts of educational debt. The lack of political will the US has to take care of sick people is a disgusting symptom of our infrastructural and institutional collapse.

Is a healthcare system where nobody cares about the desires and will of the patients a healthcare system or a sinecure producing machine for people who know anatomy and physiology?

I personally will likely be fine. I did a stint in a medical library and am literate in medical research (and can therefore take on a lot of the work that doctors previously did when they had more time with patients - I can show up to appointments/procedures with very clear recommendations and advocate for them in a way that is respected as I have the credentials to be taken seriously by medical professionals). I also have a medical doctor + several NPs in my family and can be tended to outside the system if it does collapse. I'm worried about everyone else and the society in which we're raising our children and grandchildren.