News p 216p 270 Uwe Reinhardt, the American health economist, thinks that all health systems may eventually converge to a three tier system that offers high quality, fee for service care to the very rich; insurance based managed care to the expanding middle class; and rough and ready care for the poor. The United States and much of South American already have such a system. Could it happen in Britain? The current media frenzy over the latest NHS crisis prompts speculation on how the NHS might end. Most institutions on the scale of the NHS end not with a bang but with a whimper, and the current “crisis” will probably pass like so many before it as the media move on to other stories. The NHS will not simply collapse. Nor is any government in the foreseeable future likely to seek a radical solution and privatise the service. But one possible endgame is that the middle classes lose confidence in the service and begin to make other arrangements. If comfortable Britain begins to seek health insurance and private care on a large scale resources …