After regulatory and economic uncertainties slowed hospital transactions at the start of the Trump administration, deals began to pick up as 2025 wound down. The first six months of 2026 then saw the second-most announced hospital M&A transactions of any half-year stretch since COVID. Federal healthcare payment cuts are leading systems to once again look for shelter in scale. However, the exuberant resurgence in dealmaking may serve as cover for a more concerning question: is M&A the only strategic muscle health systems know how to flex? Any system unable to change its position in a market or its relationship with its consumers can always tell itself that tapping into a new market, or joining a larger system, will change its fortunes. The more difficult work of realizing that value through the integration of capabilities into collective efficiencies, or the creation of “systemness,” is too often overlooked and underrated.