Simon F. Haeder, Texas A&M University

The U.S. health care system leaves much to be desired.

It is convoluted, fragmented, complex and confusing. Experts have also raised concerns about quality, and disparities are rampant. And, of course, it is excessively costly – far more so than in any other developed nation. Given these failings, it is not surprising that Americans are unhappy with their health care system.

As the public reaction to the killing of UnitedHealthcare CEO Brian Thompson has made clear, however, many Americans are perhaps most unhappy with their health insurers. Indeed, just 31% of Americans have a favorable view of the health insurance industry, according to a 2024 survey.

Yet, given the recent tragic events, as a health policy scholar, I think it would be prudent to take a step back and reflect on the broader health care system and how the U.S. got to this point.

Many sources of health care frustration

Few with any personal experience or professional expertise would describe U.S. health care as the gold standard of health care systems.

For a number of historical and political reasons, it is barely a “system” but rather a complex patchwork with countless different approaches to covering the costs of health care that include splitting the costs between individuals, employers and governments.

Governments also extensively regulate health and health care and, although in a diminished role today, serve as the providers of care through state and county hospitals as well as the Veterans Health Administration.

The result is a regulatory amalgam made up of countless entities. The Affordable Care Act reforms only added additional layers of laws and regulations to an already complex framework.

Yet, even beyond this general structure, Americans face many challenges. Indeed, no other health care system in the world is pricier. This involves costs for medical services but also extremely high administrative costs. Pharmaceuticals are just one example of the excessive financial burden carried by Americans.

For many Americans, these costs are too high, with an estimated 530,000 medical bankruptcies annually.

And despite that high price, concerns persist about quality and access.

In addition, the system tends to be highly inequitable and subject to countless disparities that make it harder for many poorer, rural and nonwhite Americans to access care.

The role of insurers

In the United States, insurers play a crucial role in connecting – and at times disconnecting – patients with the care they require.

They are also at the forefront of many of the starkest frustrations that Americans experience – even the ones they are not directly responsible for. While medical providers and pharmaceutical companies charge the world’s highest prices, it is generally up to insurers to tell patients how much they still have to pay or that their care won’t be covered. Insurers are also the ones who determine whether a drug is not covered or a doctor is “out of network,” meaning patients can’t get the specific treatment or care they desire.

To be sure, insurers are not just the messenger – they also add to many of the frustrations patients experience every day. For example, a patient may have to travel very far or wait a long time for an appointment if their provider network is too narrow or simply does not have enough providers. Moreover, the directories and searches that insurers use to show what providers are “in network” may be inaccurate, as they rarely get updated.

For many individuals, this can mean delayed or forgone care, which has major implications for their health and finances. For some, it can even lead to preventable deaths.

Some of the practices insurers are most infamous for, such as rescinding coverage over minor clerical issues and refusing to cover preexisting conditions, ended under the ACA. But some of these issues could return if the incoming Trump administration seeks to undo some of the ACA’s protections.

Even today, so called short-term, limited-duration health plans promise good coverage for lower premiums, but even basic items may not be covered. Many plans, for example, do not cover prescription drugs or even hospital emergency rooms.

Blame the system, not just the insurers

Why do insurers act the way they do? For many, the answer may seem simple: to make money. This, of course, rings true – insurers in the U.S. rake in billions of dollar. However, while they tend to be profitable, their margins generally range only from 3% to 5%.

But the story is more complicated than that. With government power limited, insurers are perhaps the only force in the U.S. health care industry trying to rein in rising costs in a health care system where everyone seeks to maximize their profits.

That means insurers take on the role of bad cop, doing things such as limiting access to certain care or doctors. But there are several prudent reasons for doing so; for instance, it’s in the public’s best interest when insurers do not cover drugs that have been shown ineffective or of low quality. And ultimately this does keep premiums lower than they would otherwise be. Of course, insurers and their CEOs profit handsomely in the process. And at times, their methods are ethically and legally questionable.

Ultimately, many if not most of the frustrations Americans experience with health care have their origins in a poorly designed system that is highly inefficient and offers countless opportunities for profit. Yet insurers are only one – perhaps the most visible – part of that broken system.

Simon F. Haeder, Associate Professor of Public Health, Texas A&M University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Marcos Fernandez Tous, University of North Dakota

Off the coast of Baja California in December 2022, sun sparkled over the rippling sea as waves sloshed around the USS Portland dock ship. Navy officials on the deck scrutinized the sky in search of a sign. The glow appeared suddenly.

A tiny spot at first, it gradually grew to a round circle falling at a great speed from the fringes of space. It was NASA’s Orion capsule, which would soon end the 25-day Artemis I mission around and beyond the Moon with a fiery splashdown into the ocean.

Orion’s reentry followed a sharply angled trajectory, during which the capsule fell at an incredible speed before deploying three red and white parachutes. As the mission finished its trip of over 270,000 miles (435,000 kilometers), it looked to those on the deck of the USS Portland like the capsule had made it home in a single piece.

As the recovery crew lifted Orion to the carrier’s deck, shock waves ruffled across the capsule’s surface. That’s when crew members started to spot big cracks on Orion’s lower surface, where the capsule’s exterior bonds to its heat shield.

But why wouldn’t a shield that has endured temperatures of about 5,000 degrees Fahrenheit (2,760 degrees Celsius) sustain damage? Seems only natural, right?

This mission, Artemis I, was uncrewed. But NASA’s ultimate objective is to send humans to the Moon in 2026. So, NASA needed to make sure that any damage to the capsule– even its heat shield, which is meant to take some damage – wouldn’t risk the lives of a future crew.

On Dec. 11, 2022 – the time of the Artemis I reentry – this shield took severe damage, which delayed the next two Artemis missions. While engineers are now working to prevent the same issues from happening again, the new launch date targets April 2026, and it is coming up fast.

As a professor of aerospace technology, I enjoy researching how objects interact with the atmosphere. Artemis I offers one particularly interesting case – and an argument for why having a functional heat shield is critical to a space exploration mission.

Taking the heat

To understand what exactly happened to Orion, let’s rewind the story. As the capsule reentered Earth’s atmosphere, it started skimming its higher layers, which acts a bit like a trampoline and absorbs part of the approaching spacecraft’s kinetic energy. This maneuver was carefully designed to gradually decrease Orion’s velocity and reduce the heat stress on the inner layers of the shield.

After the first dive, Orion bounced back into space in a calculated maneuver, losing some of its energy before diving again. This second dive would take it to lower layers with denser air as it neared the ocean, decreasing its velocity even more.

While falling, the drag from the force of the air particles against the capsule helped reduced its velocity from about 27,000 miles per hour (43,000 kilometers per hour) down to about 20 mph (32 kph). But this slowdown came at a cost – the friction of the air was so great that temperatures on the bottom surface of the capsule facing the airflow reached 5,000 degrees Fahrenheit (2,760 degrees Celsius).

At these scorching temperatures, the air molecules started splitting and a hot blend of charged particles, called plasma, formed. This plasma radiated energy, which you could see as red and yellow inflamed air surrounding the front of the vehicle, wrapping around it backward in the shape of a candle.

No material on Earth can stand this hellish environment without being seriously damaged. So, the engineers behind these capsules designed a layer of material called a heat shield to be sacrificed through melting and evaporation, thus saving the compartment that would eventually house astronauts.

By protecting anyone who might one day be inside the capsule, the heat shield is a critical component.

In the form of a shell, it is this shield that encapsulates the wide end of the spacecraft, facing the incoming airflow – the hottest part of the vehicle. It is made of a material that is designed to evaporate and absorb the energy produced by the friction of the air against the vehicle.

The case of Orion

But what really happened with Orion’s heat shield during that 2022 descent?

In the case of Orion, the heat shield material is a composite of a resin called Novolac – a relative to the Bakelite which some firearms are made of – absorbed in a honeycomb structure of fiberglass threads.

As the surface is exposed to the heat and airflow, the resin melts and recedes, exposing the fiberglass. The fiberglass reacts with the surrounding hot air, producing a black structure called char. This char then acts as a second heat barrier.

NASA used the same heat shield design for Orion as the Apollo capsule. But during the Apollo missions, the char structure didn’t break like it did on Orion.

After nearly two years spent analyzing samples of the charred material, NASA concluded that the Orion project team had overestimated the heat flow as the craft skimmed the atmosphere upon reentry.

As Orion approached the upper layers of the atmosphere, the shield started melting and produced gases that may have escaped through pores in the material. Then, when the capsule gained altitude again, the outer layers of the resin froze, trapping the heat from the first dive inside. This heat vaporized the resin.

When the capsule dipped into the atmosphere the second time, the gas expanded before finding a way out as it heated again – kind of like how a frozen lake thaws upward from the bottom – and its escape produced cracks in the capsule’s surface where the char structure got damaged. These were the cracks the recovery crew saw on the capsule after it splashed down.

In a Dec. 5, 2024, press conference, NASA officials announced that the Artemis II mission will be designed with a modified reentry trajectory to prevent heat from accumulating.

For Artemis III, which is planned to launch in 2027, NASA intends to use new manufacturing methods for the shield, making it more permeable. The outside of the capsule will still get very hot during reentry, and the heat shield will still evaporate. But these new methods will help keep the astronauts cozy in the capsule all the way through splashdown.

Chonglin Zhang, assistant professor of mechanical engineering at the University of North Dakota, assisted in researching this article.

Marcos Fernandez Tous, Assistant Professor of Space Studies, University of North Dakota

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Libby Richards, Purdue University

You’ve probably heard “Don’t go outside in the winter with your hair wet or without a coat; you’ll catch a cold.”

That’s not exactly true. As with many things, the reality is more complicated. Here’s the distinction: Being cold isn’t why you get a cold. But it is true that cold weather makes it easier to catch respiratory viruses such as the cold and flu.

Research also shows that lower temperatures are associated with higher COVID-19 rates.

As a professor of nursing with a background in public health, I’m often asked about infectious disease spread, including the relationship between cold and catching a cold. So here’s a look at what actually happens.

Many viruses, including rhinovirus – the usual culprit for the common cold – influenza, and SARS-CoV-2, the virus that causes COVID-19, remain infectious longer and replicate faster in colder temperatures and at lower humidity levels. This, coupled with the fact that people spend more time indoors and in close contact with others during cold weather, are common reasons that germs are more likely to spread.

The flu and respiratory syncytial virus, or RSV, tend to have a defined fall and winter seasonality. However, because of the emergence of new COVID-19 variants and immunity from previous infections and vaccinations decreasing over time, COVID-19 is not the typical cold-weather respiratory virus. As a case in point, COVID-19 infection rates have surged every summer since 2020.

Virus transmission is easier when it’s cold

More specifically, cold weather can change the outer membrane of the influenza virus, making it more solid and rubbery. Scientists believe that the rubbery coating makes person-to-person transmission of the virus easier.

It’s not just cold winter air that causes a problem. Air that is dry in addition to cold has been linked to flu outbreaks. That’s because dry winter air further helps the influenza virus to remain infectious longer. Dry air, which is common in the winter, causes the water found in respiratory droplets to evaporate more quickly. This results in smaller particles, which are capable of lasting longer and traveling farther after you cough or sneeze.

How your immune system responds during cold weather also matters a great deal. Inhaling cold air may adversely affect the immune response in your respiratory tract, which makes it easier for viruses to take hold. That’s why wearing a scarf over your nose and mouth may help prevent a cold because it warms the air that you inhale.

Also, most people get less sunlight in the winter. That is a problem because the sun is a major source of vitamin D, which is essential for immune system health. Physical activity, another factor, also tends to drop during the winter. People are three times more likely to delay exercise in snowy or icy conditions.

Instead, people spend more time indoors. That usually means more close contact with others, which leads to disease spread. Respiratory viruses generally spread within a 6-foot radius of an infected person.

In addition, cold temperatures and low humidity dry out your eyes and the mucous membranes in your nose and throat. Because viruses that cause colds, flu and COVID-19 are typically inhaled, the virus can attach more easily to these impaired, dried-out passages.

What you can do

The bottom line is that being wet and cold doesn’t make you sick. That being said, there are strategies to help prevent illness all year long:

• Wash your hands often.

• Avoid touching your face, something people do between nine and 23 times an hour.

• Stay hydrated. Eight glasses a day of water is a good goal, but that could be more or less depending on lifestyle and the size of the person.

• Eat a well-balanced diet. Dark green, leafy vegetables are rich in immune system-supporting vitamins, while eggs, fortified milk, salmon and tuna have vitamin D.

• Stay physically active, even during the winter.

• Get adequate sleep.

• Clean hard, high-touch surfaces in your home often.

• If your nose or throat gets dry in the winter, consider using a humidifier.

• Get your annual flu and COVID-19 vaccine.

Following these tips can ensure you have a healthy winter season.

This is an updated version of an article originally published on Dec. 15, 2020.

Libby Richards, Professor of Nursing, Purdue University

This article is republished from The Conversation under a Creative Commons license. Read the original article.