IX.Caveats
A single-payer program such as that described in this report, has never been attempted on a broad scale in the
United States. Consequently there are little data on the likely outcomes of such a program that can be used to
estimate its impacts. In particular, the dramatic restructuring of the health care financing system in Maryland
could substantially alter consumer, employer and provider incentives, which could have a significant impact on
program costs. Our analysis also does not address any potential changes in the quality of care provided under
these reform proposals.

Although the analysis in this paper is based upon the best data and research now available, the estimates
should be considered illustrative of potential impacts rather than point estimates of actual outcomes. In fact,
our analysis indicates that the ultimate impact of the plan on government health spending, employer health
spending and wages is very sensitive to assumptions on employer and consumer behavioral responses under
the new incentives created by a single-payer program.

Furthermore, the estimates are based on projections of the rate of growth in health spending which are
themselves especially sensitive to a number of factors including general economic growth and health care cost
trends. Moreover, our analysis assumes that the global budgets under the program would be effective in
controlling health care cost growth in Maryland, even though such a large scale global budgeting program is
untested in the United States. Consequently, policy makers should recognize that any major health initiative is
likely to require continued refinements in program design and financing over time.

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