For someone so hopeful about approaches to healthcare, Jeffrey Brenner is surprisingly apocalyptic. The founder of the Camden Healthcare Coalition envisages a fire-and brimstone future, in which a dysfunctional US healthcare system ends up eating itself alive.

“It’s going to get really ugly. We have ageing populations that will overrun our delivery systems,” he warns, citing the state Medicaid agency’s budgetary crisis in Arizona, which led to restrictions on organ transplants. “That’s rationing,” he points out, warning us to expect more of the same – much more. “It’s going to be hard to crash land this.”

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