The health care system in Maryland could soon look more like that of Switzerland or Germany than Virginia or Pennsylvania, and if successful, it could be a step toward a single-payer structure that could move to other states. In what's called an all-payer system, the state will control and budget hospital costs, cap what hospitals may charge and reward hospitals that provide quality rather than quantity of care. Only Vermont and Massachusetts have anything as radical in the works. "We need to shift away from our near exclusive focus on treating illness and move to a balanced approach that encourages prevention and wellness," Maryland Gov. Martin O'Malley said in a press release announcing the program in January.