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large and complex assemblage of interdependencies. Any change to one part could create multiple, hard-to-predict effects throughout the system. When making changes to a fragile system that serves so many, the watchword should be caution.

Of the long list of possible federal budget cuts released on January 17, the suggestion to eliminate the tax-exempt status for interest payments on municipal bonds is an item of particular concern. While it is too early to wager on any of the items on the list, the implications of this move for not-for-profit hospitals would be severe.