-the increase in patients coming to the ER I hope will decrease due to the availability of preventive health care measures, or at least I hope. I like the idea of everyone having health insurance some of my friends call me a socialist, but I have seem too many patients die in the acute care setting needlessly waiting too long to get care over having no insurance. I saw a man die of a bad tooth abscess he tried to pull himself for lack of insurance, being poor or without a job does not mean you have to die. He was 32. And we pay for these uninsured anyway. I want to see a rearrangement of the insurance industry and a cap on costs that medical services and insurance companies charge. I hope this happens when more of us have insurance. The new health care model Medicare has issued with quality vs quantity or value based purchasing is going to effect nursing in a big way. The hospitals are going to be paid less or more depending on core measures being met, and those dreaded hcahps, then I believe in 2014 some of the pay will depend on if the patient survives past 30 days of discharge. I can’t complain that this bill will make us even more short staffed, it will be up to the hospitals ect. To hire more staff and even tho they spout nursing shortage we all know nurses out of work right now and that is ridiculous, so maybe they will be able to work. I’m praying this doesn’t decimate the health care industry as a whole by overloading it, but if it does there isn’t much we can do about it anyway, just keep on providing good care to our patients and hope and pray for the best is my only advice.