Remember the financial meltdown? Sure you do. Who could forget the fall of the house of irrational exuberance? Andrew Ross Sorkin captured the zeitgeist in his best-seller Too Big to Fail. From Lehman Brothers to AIG, the size and interdependence of the world's most powerful financial institutions brought modern finance to its knees. For a CFO to look up from the balance sheet and realize there was less than 30 days of cash on hand had to be terrifying.

Could the same thing happen with healthcare consolidation? As was pointed out in recent blog by my colleague Sarah, HLI's resident M&A guru (follow her @SarahWilsonHLI), healthcare reform is making strange bedfellows from former rivals. I?ve seen some of it firsthand. In my previous life in advertising, I was on the team charged with branding the community's stronger, faster, smarter health system: a marriage of historically Southern Baptist and Catholic hospitals that was on the rocks before the ring came out.

But two things.

Soon, the only deal left may be Warren Buffett's acquisition of United and HCA.

A merger does not a friendship make. Let's face it: no matter how the parties spin it, we all know there's always a ?merge-or? and a ?merge-ee,? ?the prom queen and, well, the rest of us. Put another way, it's like rival employees who, fearing the loss of their jobs, decide to move in together to save money. Sure, they can pitch in together for beer, but how healthy of an environment is that?

Lastly, there is a reason why everyone is asking the ?If-it-didn?t-work-in-the-?90s, why-will-it-work now? question: Isn?t it possible that some of these deals just don?t make sense? Rather than having entities that are too big to fail, will we end up with behemoths that may be too big to succeed? Innovation requires a certain amount of agility. And how many of these mega deals do we really have left? The ocean is increasingly filled with nothing but big fish, and, soon, the only deal left may be Warren Buffett's acquisition of UnitedHealth Group and HCA.

It's a simplistic argument. I realize. But remember: everyone was betting on Enron and they were literally making it up as they went along. A little time and a lot of gutted 401(k)s later, Playboy was putting out its Women of Enron issue. Who might be the next unfortunate centerfolds if the smartest guys in the healthcare room broker some really bad deals

For more on the good, the bad and the ugly of healthcare reform, follow me on Twitter: http://twitter.com/#!/LauraBeermanHLI

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