Pinstriped Medicine

"A small community hospital is not going to find it feasible to offer all of the services required by the members of a managed care provider," says Greg Pickard, a health care consultant for Deliotte & Touche.

"The implications of that for a lot of [providers] are dire. They don't have the economic power to go and negotiate with the big boys for contracts for high-ticket items."

Before he left the Board of Regents committee meeting that November day in the basement of the UCSF building that overlooks the city from Laurel Heights, Hellman reviewed his findings a final time with the regents.

"We believe the risks associated with any merger are associated with this one," he said. "And we believe the risks can be managed."

This is not a panacea for Stanford, nor for UCSF. Not with the tenuous and fluctuating state of affairs in health care. It is a business deal.

Of all the mergers of academic medical institutes across the country, none has involved two that were 40 miles apart. Most of the clinical operations will remain separate, while the smaller, specialty work is likely to be consolidated into one location with lesser overhead. If you need your brain reconstructed sometime down the road, you're likely to have little choice where to go; you probably will still be able to receive chemotherapy in both San Francisco and Palo Alto.

But in this deal, the particulars are less important than the bigger picture.

What happened here is that the chronic state of health care chaos sent academic medicine's leaders searching for a treatment. They found it in private business. But whether the cure proves worse than the disease will involve subtle post-traumatic care. The vital signs to be monitored: future doctor skill, advancement of medical science, the length of the health care industry's unemployment line, and the level of sickness among the poor.

The prognosis is uncertain.