The inability of middle-class people to pay for boob jobs doesn't mean providers have to shift their focus to real medicine for the middle class. Maybe they'll shift their focus instead to boob jobs for the rich.
True, the rich are a smaller market than the middle class. But if the cost controls in real medicine are too tight, providers can make up in profit margins what they lose in volume. So, as we're revising our health-care system, let's try not to drive too many doctors and health companies out of real medicine. They might have something less important to do.