I see a big business opportunity for an exchange that converts Ethereum (because Bitcoin fees are already quite a bit more than $5 for anything that resembles a speedy transaction) to whatever currency the receiving account is in.
I think the big exchanges spend a lot of time keeping their head down. Coinbase could trivially add automatic conversion to national currencies for given addresses, but stepping on the toes of paypal and western union is not a great idea. Crypto skates by on momentum, feel good PR and no one wanting to be responsible for bursting a bubble a lot of citizens are invested in ... they don't want to press their luck.
PS. coinbase killed instant exchange for sending bitcoins and they have never offered it for altcoins at all. Their new shopify integration service for merchants doesn't offer instant exchange to fiat any more at all, even though every merchant wants it ... they obviously don't want to step on the toes of CCs and Paypal nor get too much attention from regulators.