Taking heat After critics decry Orion heat shield decision, NASA reviewer says agency is correct "If this isnt raising red flags out there, I dont know what will." Eric Berger Dec 6, 2024 5:29 pm | 26 NASA's Orion spacecraft, consisting of a US-built crew module and European service module, is lifted during prelaunch processing at Kennedy Space Center in 2021. Credit: NASA/Amanda Stevenson NASA's Orion spacecraft, consisting of a US-built crew module and European service module, is lifted during prelaunch processing at Kennedy Space Center in 2021. Credit: NASA/Amanda Stevenson Story textSizeSmallStandardLargeWidth *StandardWideLinksStandardOrange* Subscribers only Learn moreWithin hours of NASA announcing its decision to fly the Artemis II mission aboard an Orion spacecraft with an unmodified heat shield, critics assailed the space agency, saying it had made the wrong decision."Expediency won over safety and good materials science and engineering. Sad day for NASA," Ed Pope, an expert in advanced materials and heat shields, wrote on LinkedIn.There is a lot riding on NASA's decision, as the Artemis II mission involves four astronauts and the space agency's first crewed mission into deep space in more than 50 years.A former NASA astronaut, Charles Camarda, also expressed his frustrations on LinkedIn, saying the space agency and its leadership team should be "ashamed." In an interview on Friday, Camarda, an aerospace engineer who spent two decades working on thermal protection for the space shuttle and hypersonic vehicles, said NASA is relying on flawed probabilistic risk assessments and Monte Carlo simulations to determine the safety of Orion's existing heat shield."I worked at NASA for 45 years," Camarda said. "I love NASA. I do not love the way NASA has become. I do not like that we have lost our research culture."NASA makes a decisionPope, Camarada, and othersan official expected to help set space policy for the Trump administration told Ars on background, "It's difficult to trust any of their findings"note that NASA has spent two years assessing the char damage incurred by the Orion spacecraft during its first lunar flight in late 2022, with almost no transparency.Initially, agency officials downplayed the severity of the issue, and the full scope of the problem was not revealed until a report this May by NASA's inspector general, which included photos of a heavily pock-marked heat shield.This year, from April to August, NASA convened an independent review team (IRT) to assess its internal findings about the root cause of the charring on the Orion heat shield and determine whether its plan to proceed without modifications to the heat shield was the correct one. However, though this review team wrapped up its work in August and began briefing NASA officials in September, the space agency kept mostly silent about the problem until a news conference on Thursday. The inspector general's report on May 1 included new images of Orion's heat shield. Credit: NASA Inspector General The inspector general's report on May 1 included new images of Orion's heat shield. Credit: NASA Inspector General "Based on the data, we have decidedNASA unanimously and our decision-makersto move forward with the current Artemis II Orion capsule and heat shield, with a modified entry trajectory," Bill Nelson, NASA's administrator, said Thursday. The heat shield investigation and other issues with the Orion spacecraft will now delay the Artemis II launch until April 2026, a slip of seven months from the previous launch date in September 2025.Notably the chair of the IRT, a former NASA flight director named Paul Hill, was not present at Thursday's news conference. Nor did the space agency release the IRT's report on its recommendations to NASA.In an interview, Camarda said he knew two people on the IRT who dissented from its conclusions that NASA's plan to fly the Orion heat shield, without modifications to address the charring problem, was acceptable. He also criticized the agency for not publicly releasing the independent report. "NASA did not post the results of the IRT," he said. "Why wouldnt they post the results of what the IRT said? If this isnt raising red flags out there, I dont know what will."The view from the IRTArs took these concerns to NASA on Friday, and the agency responded by offering an interview with Paul Hill, the review team's chair. He strongly denied there were any dissenting views."Every one of our conclusions, every one of our recommendations, was unanimously agreed to by our team," Hill said. "We went through a lot of effort, arguing sentence by sentence, to make sure the entire team agreed. To get there we definitely had some robust and energetic discussions."Hill did acknowledge that, at the outset of the review team's discussions, two people were opposed to NASA's plan to fly the heat shield as is. "There was, early on, definitely a difference of opinion with a couple of people who felt strongly that Orion's heat shield was not good enough to fly as built," he said.However, Hill said the IRT was won over by the depth of NASA's testing and the openness of agency engineers who worked with them. He singled out Luis Saucedo, a NASA engineer at NASA's Johnson Space Center who led the agency's internal char loss investigation."The work that was done by NASA, it was nothing short of eye-watering, it was incredible," Hill said.At the base of Orion, which has a titanium shell, there are 186 blocks of a material called Avcoat individually attached to provide a protective layer that allows the spacecraft to survive the heating of atmospheric reentry. Returning from the Moon, Orion encounters temperatures of up to 5,000 Fahrenheit (2,760 Celsius). A char layer that builds up on the outer skin of the Avcoat material is supposed to ablate, or erode, in a predictable manner during reentry. Instead, during Artemis I, fragments fell off the heat shield and left cavities in the Avcoat material.Work by Saucedo and others, including substantial testing in ground facilities, wind tunnels, and high-temperature arc jet chambers, allowed engineers to find the root cause of gases getting trapped in the heat shield and leading to cracking. Hill said his team was convinced that NASA successfully recreated the conditions observed during reentry and were able to replicate during testing the Avcoat cracking that occurred during Artemis I.When he worked at the agency, Hill played a leading role during the investigation into the cause of the loss of space shuttle Columbia, in 2003. He said he could understand if NASA officials "circled the wagons" in response to the IRT's work, but he said the agency could not have been more forthcoming. Every time the review team wanted more data or information, it was made available. Eventually, this made the entire IRT comfortable with NASA's findings.Publicly, NASA could have been more transparentThe stickiest point during the review team's discussions involved the permeability of the heat shield. Counter-intuitively, the heat shield was not permeable enough during Artemis I. This led to gas buildup, higher pressures, and the cracking ultimately observed. The IRT was concerned because, as designed, the heat shield for Artemis II is actually more impermeable than the Artemis I vehicle.Why is this? It has to do with the ultrasound testing that verifies the strength of the bond between the Avcoat blocks and the titanium skin of Orion. With a more permeable heat shield, it was difficult to complete this testing with the Artemis I vehicle. So the shield for Artemis II was made more impermeable to accommodate ultrasound testing. "That was a technical mistake, and when they made that decision they did not understand the ramifications," Hill said.However, Hill said NASA's data convinced the IRT that modifying the entry profile for Artemis II, to minimize the duration of passage through the atmosphere, would offset the impermeability of the heat shield.Hill said he did not have the authority to release the IRT report, but he did agree that the space agency has not been forthcoming with public information about their analyses before this week."This is a complex story to tell, and if you want everybody to come along with you, you've got to keep them informed," he said of NASA. "I think they unintentionally did themselves a disservice by holding their cards too close."Eric BergerSenior Space EditorEric BergerSenior Space Editor Eric Berger is the senior space editor at Ars Technica, covering everything from astronomy to private space to NASA policy, and author of two books: Liftoff, about the rise of SpaceX; and Reentry, on the development of the Falcon 9 rocket and Dragon. A certified meteorologist, Eric lives in Houston. 26 Comments

Forrester Principal Analyst Enza Iannopollo explains what the proposed regulations on artificial intelligence actually aim to do, what it means to enterprise CIOs' AI goals, and how to prepare today for the risks and compliance goals of tomorrow.

Enterprise Connect 2025

AI found a new way to entangle particles of lightluchschenF/ShutterstockQuantum entanglement just got easier, thanks to artificial intelligence. Researchers discovered a new procedure for creating quantum links between particles, and it could be used for building quantum communication networks in the future.This new method came as a surprise. Mario Krenn at the Max Planck Institute for the Science of Light in Germany originally wanted to use a physics discovery algorithm called PyTheus, which he and his colleagues developed, to reinvent an experimental procedure

A drunken forest in Alaska, where trees are tilting or collapsing to the ground due to permafrost meltGlobal Warming Images/ShutterstockMelting permafrost in Arctic forests may cause trees to tilt to the side in ways that slow their growth, reducing the amount of carbon these drunken forests store.The northern hemispheres boreal forest is a vast ecosystem that contains up to 40 per cent of all carbon stored on land. Rapid warming of the Arctic due to climate change is already affecting how these forests grow and thus how much carbon they store. It is also melting

This is today's edition ofThe Download,our weekday newsletter that provides a daily dose of what's going on in the world of technology. What Chinas critical mineral ban means for the US This week, China banned exports of several critical minerals to the US, marking the latest move in an escalating series of tit-for-tat trade restrictions between the worlds two largest economies. In explicitly cutting off, rather than merely restricting, materials of strategic importance to the semiconductor, defense, and electric vehicle sectors, China has clearly crossed a new line in the long-simmering trade war. But at the same time, it selected minerals that wont cripple any industrieswhich leaves China plenty of ammunition to inflict greater economic pain in response to any further trade restrictions that the incoming Trump administration may impose. Read more about what drove Chinas decision, how it affects climate tech and whats likely to happen next. James Temple This story is part of our MIT Technology Review Explains series. Let our writers untangle the complex, messy world of technology to help you understand whats coming next. You can read more from the series here. 3 things that didnt make the 10 Breakthrough Technologies of 2025 list Next month, MIT Technology Review will unveil the 2025 list of 10 Breakthrough Technologies. Every year, our newsroom looks across the fields we cover for technologies that are having a true breakthrough moment. This annual package highlights the technologies that we think matter most right now. In the meantime, here are three technologies that we considered including on the 2025 list but ultimately decided to leave off. And although these nominees didnt make the cut this year, theyre still worth keeping an eye on. Read the full story. Amy Nordrum The US Department of Defense is investing in deepfake detection Whats new: The US Department of Defense has invested $2.4 million over two years in deepfake detection technology from a startup called Hive AI. Its the first contract of its kind for the DODs Defense Innovation Unit, which accelerates the adoption of new technologies for the US defense sector. Hive AIs models are capable of detecting AI-generated video, image, and audio content. Why? Although deepfakes have been around for the better part of a decade, generative AI has made them easier to create and more realistic-looking than ever before, which makes them ripe for abuse in disinformation campaigns or fraud. Defending against these sorts of threats is now crucial for national security. Read the full story. Melissa Heikkil Donating embryos for research is surprisingly complex IVF is a success story for embryo research. But today, valuable embryos that could be used for research are being wasted, say researchers who gathered at a conference in central London earlier this week. The embryos studied in labs have usually been created for IVF but are no longer needed by the people whose cells created them. And theres a few reasons why embryos arent making it into research labs. Read the full story. Jessica Hamzelou This story is from the Checkup, our weekly health and biotech newsletter. Sign up to receive it in your inbox every Thursday. The must-reads Ive combed the internet to find you todays most fun/important/scary/fascinating stories about technology. 1 Internet detectives are racing to identify UnitedHealthcare CEOs killer Its yet another example of online sleuths inserting themselves into active investigations. (WP $)+ Similar firms are removing their leadership pages for fear of copycat attacks. (404 Media)+ Online reaction to the killing demonstrates how hated health insurers are. (NY Mag $) 2 NASA has delayed its return to the moonyet again Its pushed back its planned mission from 2026 to mid-2027. (CNN)+ The agency has safety concerns and says its next test flight needs to be overhauled. (WP $)+ Whats next for NASAs giant moon rocket? (MIT Technology Review)3 OpenAI is charging $200 a month for a ChatGPT Pro subscription Access to its o1 reasoning model sure doesnt come cheap. (TechCrunch)+ Heres what you get for that hefty fee. (Wired $)4 Google Search is getting a makeover in 2025 And Id be prepared to bet a lot of money that AI is involved. (NYT $)+ AI search could break the web. (MIT Technology Review)5 Spotify Wrapped is a flop Its oddly free of actual data, and contains bizarre summaries. (Rolling Stone $)+ Pink Pilates Princess Roller Skating Pop, anyone? (NYT $)+ Wrappeds AI-generated podcast makes for a bleak listening experience. (Vox)6 Whats next for Chinas manufacturing industryFT $)+ How Trumps tariffs could drive up the cost of batteries, EVs, and more. (MIT Technology Review)7 How to turn human poo into medicine The first microbiome-related product for cancer care is on the horizon. (Bloomberg $) + How bugs and chemicals in your poo could give away exactly what youve eaten. (MIT Technology Review)8 Meet the final devotees of the NFTAfter the bubble bursts, only the true believers remain. (NYT $) + I tried to buy an Olive Garden NFT. All I got was heartburn. (MIT Technology Review)9 Want to live sustainably? Retrofit your home It reduces emissions and could save you money in the long run. (Knowable Magazine)+ Is this the most energy-efficient way to build homes? (MIT Technology Review)10 Winter isnt what it used to be Water, water everywhere. (The Atlantic $) Quote of the day I think the leaders of the industry should look at this and ask: Why does everybody hate us so much that when one of us gets killed in an assassinationwere not hearing sympathy from the general publicwere hearing scorn? Matthew Holt, a healthcare commenter, reflects on what the online reaction to the killing of UnitedHealthcares CEO reveals about the US publics attitude to health insurance firms, the Washington Post reports. The big story What is AI? July 2024 AI is sexy, AI is cool. AI is entrenching inequality, upending the job market, and wrecking education. The AI boom will boost the economy, the AI bubble is about to burst. AI will increase abundance and empower humanity to maximally flourish in the universe. AI will kill us all. What the hell is everybody talking about? Artificial intelligence is the hottest technology of our time. But what is it? It sounds like a stupid question, but its one thats never been more urgent. If youre willing to buckle up and come for a ride, I can tell you why nobody really knows, why everybody seems to disagree, and why youre right to care about it. Read the full story. Will Douglas Heaven We can still have nice things A place for comfort, fun and distraction to brighten up your day. (Got any ideas? Drop me a line or tweet 'em at me.) + This year produced some incredible songs. Here are just a few of the best.+ Would you consider growing your own toilet paper? Meet the brave souls giving it a go. + Theres only one Willem Dafoea master of the craft.+ Congratulations are in order for Wisdom, the worlds oldest known wild bird who has just laid an egg at the ripe old age of 74.

Next month, MIT Technology Review will unveil the 2025 list of 10 Breakthrough Technologies. Every year, our newsroom looks across the fields we cover for technologies that are having a true breakthrough moment. This annual package highlights the technologies that we think matter most right now. We define breakthrough in a few waysperhaps theres been a scientific advance that now makes a new technology possible, or a company has earned regulatory approval for a vital medical treatment. Maybe a consumer device has reached a tipping point in its adoption, or an industrial technology has passed the critical pilot phase with flying colors. In the 2025 edition, which comes out in January, youll see some of the latest advances in automation, medicine, and the physical sciences (just to name a few) that we expect will have a major impact on our lives. In the meantime, here are three technologies that we considered including on the 2025 list but ultimately decided to leave off. Though these nominees didnt make the cut this year, theyre still worth keeping an eye on. We certainly will be. Virtual power plants Virtual power plants are energy systems that link together many different technologies to both generate and store power. They allow utility companies to connect solar panels and wind turbines with grid batteries and electric vehicles, and to better manage the flow of power across the grid. During times of peak electricity usage, software linked to smart meters may one day automatically decide to power someones home by drawing electricity from a fully charged EV sitting in a neighbors garage, thereby reducing demand on the grid. The software could also work out how to compensate the EV owner accordingly. In the US, an estimated 500 virtual power plants now provide up to 60 gigawatts of capacity (thats about as much total capacity as the US grid will add this year). Some such systems are also up and running in China, Japan, Croatia, and Taiwan. But lots more virtual power plants would need to be configured before they start to affect the grid as a whole. Useful AI agents AI agents are all the rage right now. These AI-powered helpers will, supposedly, schedule our meetings and book our trips and carry out all kinds of tasks online on our behalf. Agents employ generative models to learn how to navigate websites and desktop software (and manage our passwords and credit card details). They will perhaps interact and coordinate with other peoples agents along the way. And there is real development power behind themSalesforce just launched a platform where companies can make their own customer service agents, and Anthropics Claude model is gaining the ability to navigate a computer by using a mouse and keyboard, just like people. However, many challenges remain in getting these agents to know what you mean when you make specific requests, and enabling them to carry out the necessary actions reliably. Given the formidable hurdles, we think it may be a little while before they are good enough to be truly useful. AI agents may be coming, but not just yet. eVTOLs The acronym is a mouthful, but you can think of electric vertical takeoff and landing (eVTOL) aircraft as being kind of like electric helicopters. Most versions in development are not designed to be personal vehicles; theyd be flown by pilots to transport commuters in from the suburbs, or whisk visitors downtown from the airport. Someday, these air taxis may fly themselves. Theres been real progress toward getting eVTOLs off the ground. Earlier this year, manufacturer EHang received the first Chinese certificate to mass-produce this type of vehicle, and it has begun taking orders. South Korea and the UAE have put policies in place to allow eVTOLs to operate there. And in the US, Archer recently earned its FAA certification to begin commercial operations. Then, in October, the FAA finalized rules for training pilots and operating eVTOLsmarking the first time in decades that the agency has approved such rules for a new category of aircraft. Interest and momentum have built in recent years. Major players in the aviation industry, including Boeing and Airbus, have invested in startups or funded internal R&D projects to develop these futuristic aircraft. However, no eVTOL company has actually begun commercial operations yet, so well keep watching for that. Join us for a special live Roundtables event "Unveiling the 10 Breakthrough Technologies of 2025"Register to attendorsubscribe for access.

Netflix's new thriller series "Black Doves" follows a spy who hunts for her lover's killer.It stars Keira Knightley and "Paddington" voice actor Ben Whishaw.The streaming service renewed "Black Doves" months before the first season premiered.Netflix's new series "Black Doves" is taking off on the streamer.The London-based spy thriller was met with critical praise when it dropped on Thursday, receiving a 97% rating on the review aggregator Rotten Tomatoes.The show stars Keira Knightley as Helen Webb, an operative for the Black Doves, a private espionage agency that gathers secrets and sells them to the highest bidder. She's also married to the UK government's defence secretary, something she uses to the advantage of her company.However, she embarks on a revenge mission with her old mentor, Sam Young (Ben Whishaw) when the man she's been having an affair with is assassinated shortly before Christmas.Knightley's role as a spy is a little different from what audiences might expect from her, and in a recent interview with the Los Angeles Times, the actor said that the series would've impressed her younger self."My teenage self is thrilled with this. Sometimes you have to listen to your teenage self and go, 'This one's for you,' you know. I think she would have found this very cool," she said.Fans who have binged the six-episode series already will be keen to know whether Webb and Young will return for more shady shenanigans. Here's what we know about "Black Doves" season two.'Black Doves' season 2 was confirmed in August 2024 Ben Whishaw and Keira Knightley in Netflix's "Black Doves." Ludovic Robert/Netflix The streaming service seemingly had a lot of faith in "Black Doves," because it announced that it had renewed the series for a second season back in August 2024, several months before it premiered.The streaming service has not yet announced a release date or production timeline for the new season, so it's unclear how long of a wait fans will have.The ending of "Black Doves" leaves Webb and Young in a precarious place. In season two, their hunt for the person responsible for killing Jason Davies (Andrew Koji) will lead to more problems that will no doubt have to be solved with lots of guns and bloody murder.Showrunner and creator Joe Barton told Variety that he's in the middle of writing "Black Doves" season two, which might involve exploring Webb's backstory further using material cut from the first season."We're still early in the process. I'm writing the first episode still, and we're kind of feeling our way through it," Barton said. "We filmed some flashbacks, which didn't make the final cut, of young Helen and her stepdad and her sister Bonnie. I think that would be really interesting to find out more about.""Black Doves" is streaming on Netflix.

Trump's choice of NASA Administrator suggests he wants to shake up the agency's status quo.Jared Isaacman, a billionaire and SpaceX astronaut, is a mascot of the commercial space age.He might push for getting humans to the moon and Mars faster, but he'll have to go through Congress.President-elect Donald Trump has made a bold choice for NASA's new leader.Trump announced in a Truth Social post on Wednesday that his choice for NASA Administrator is Jared Isaacman a CEO, fighter-jet pilot, and two-time SpaceX astronaut.Isaacman is not exactly a traditional pick. For one, he would be the first billionaire to lead the agency. More importantly, though, he's on the cutting edge of the new commercial space age, where private companies are becoming the biggest actors in space. Jared Isaacman at SpaceX in Hawthorne, California. SpaceX/Business Wire via AP Photo Some past NASA administrators were former NASA astronauts. Others were former executives from the aerospace industry. Many were politicians including Trump's last NASA chief, Jim Bridenstine, and the current administrator, Bill Nelson.Isaacman is none of those things. He has, however, flown to space in a Crew Dragon spaceship, conducted the first-ever commercial spacewalk in a brand-new SpaceX spacesuit, and plans to fly on future missions with the company aboard its Starship mega-rocket, no less.The nomination, which still has to be confirmed by the Senate, suggests that Trump wants to shake things up at NASA. Jared Isaacman stands at the hatch of Crew Dragon during the world's first commercial spacewalk. SpaceX "He certainly has the potential to be a disruptor," Leroy Chiao, a former NASA astronaut and International Space Station commander who now works in consulting, told Business Insider. "I think it's a great pick. It's much better than just status quo another retiring member of Congress."It's also another signal that Trump might make a big push to put the next humans on the moon, and even the first humans on Mars.Speeding up the road to MarsIsaacman's enthusiasm for space exploration isn't his only bona fide. He also has a businessman's mindset and a close relationship with Elon Musk. The two share the goal of getting humans to Mars.Chiao hopes Isaacman can speed up the process.Indeed, in a post on X accepting the nomination, Isaacman wrote that NASA would help make humanity "a true spacefaring civilization.""Americans will walk on the Moon and Mars and in doing so, we will make life better here on Earth," he added.NASA is already working on it. The Artemis programsend astronauts back to the moon for the first time in over 50 years, and eventually to use the moon as a jumping-off point to send people to Mars.However, Artemis is years behind schedule and billions over budget, largely due to technical and programmatic challenges with the giant Space Launch System that NASA is building for moon missions. Many industry commentators see SLS as a waste of government funds, when NASA could instead lean on commercial heavy-lift rockets like Starship. NASAs Space Launch System (SLS) rocket with the Orion spacecraft aboard, at the Kennedy Space Center in Florida. NASA/Steve Seipel "Frankly, we have been at the status quo of this exploration program in one form or another over the last several presidents since 2004," Chiao said, "and we're not even close to launching the first astronaut on a new vehicle."In fact, NASA just pushed back the launch date for its first crewed Artemis mission, set to fly around the moon using SLS. On Thursday the agency delayed the mission by another seven months, to April 2026, citing issues with the system's Orion spaceship.That's the slow-moving status quo that Trump might aim to shake up.To that end, efficiency may be a top priority for Isaacman. That could mean reassessing Artemis entirely or cutting back some of NASA's centers and facilities nationwide, according to Abhi Tripathi, a former NASA engineer and SpaceX mission director who now leads mission operations at the UC Berkeley Space Sciences Lab."I definitely think SLS will be on the chopping board," Tripathi told BI.First, though, Isaacman will have to go through Congress."He is going to ruffle a lot of feathers," Chiao said.Pushing through CongressCongress can be a formidable wall for anyone trying to revolutionize NASA.In places like Alabama and Southern California, a status quo NASA fuels the work of legacy aerospace contractors like Boeing and Northrop Grumman."The majority of members of Congress want jobs in their district, and they look at the space program primarily through that lens," Tripathi said.Plus, he added, "the lobbying arms of all of those big contractors will be basically camped outside their congressional representative's office, asking them to thwart any big plans that would change the status quo greatly."It'll all come to a head when the Trump White House makes its budget proposal. That's when Congress will approve or deny any cuts or reprioritizations that Trump and his NASA Administrator try to make.If Trump wants to put boots on Mars fast, he'll have to convince individual Congress members to push those changes through."I think Jared is a very smart and capable individual," Tripathi said, "but his ability to wield power will completely depend upon how much his president will back him up."

Support independent journalism that matters become a Vox Member today.The shooting of UnitedHealthcare CEO Brian Thompson was met by many people online with a morbid sense of inevitability. The often callous nature of the US health care system has long been a point of wide discussion, with evidence piling up that the way the country provides medical services is costly in both money and human life. The health industrys executives insurers, pharma, even hospitals have become popular villains. The killing of a human being is morally repugnant full stop. But many people still found themselves asking: If it turns out, as may well be the case, that the shooter was primarily motivated by the injustices of American health care, would that be surprising?On the same day as the shooting, news that a different insurer would restrict coverage for anesthesia during surgeries went viral, serving as a kind of cosmic confirmation of this line of thinking. A health insurance executive is shot in New York City over (it is assumed) the industrys avaricious practices, while another insurer affirms the worst stereotype with such a seemingly arbitrary limit on peoples benefits to be given anesthesia during surgery.The reality, however, is more complicated. As Voxs Eric Levitz covered, this policy would not actually result in higher bills for patients; it is instead the kind of cost control that policymakers will often vouch for when public attention is elsewhere, something meant to rein in high payments to health care providers. But public and political outrage didnt stop to make that connection, and the insurer quickly reversed the policy.Put every aspect of this tragic episode together and you have the rotten core of American health care. The cruelties of the US medical system and the ongoing blame game between the private industries that profit from it have left patients angry and confused and looking for someone, anyone, to blame, fairly or not. There is not one man nor even one industry responsible for the failures of US health care. The finger-pointing is a distraction. Every party bears responsibility. The only way forward is to reckon with that collective failure. We need to begin working toward a more rational and just system if we are to have any hope of creating a world in which Thompsons shooting would be truly unimaginable.The distracting health care blame gameAt the dawn of the modern American health care system, the private industries that compose much of the medical sector were allies. Physicians in particular were fierce defenders of private insurance in the middle of the 20th century. The American Medical Association and its compatriots greatly preferred the country to cover most people through private employer-sponsored insurance over a government program and fiercely lobbied to smother the latter in the crib. They tolerated the creation of Medicare and Medicaid in 1965 to cover populations that were otherwise uninsurable, but would come together again to stop the Clinton health reform effort in the 1990s.Everybody involved was invested in maintaining a free-ish market system. Hospitals and pharmaceutical companies could raise prices, and the insurance plans could pass on those increases to employers, whose health benefits were tax-free thanks to Congress, which made those hikes more tolerable. Medicare and Medicaid limited their spending, but the private portion of the market created the opportunity to increase profits, and they stuck together whenever the status quo was threatened. At least for a while.But prices have continued to spiral upward, accelerated by the aging of the baby boomers and by important but costly advancements in medical science. Today, as everyone knows, health care in the US can be prohibitively expensive even for people who have insurance. Almost four in 10 Americans say they have skipped necessary medical care over the costs, and millions carry medical debts from past cases.The passage of Obamacare over industry opposition was the first sign that the private sectors political vise grip was loosening, with the Obama White House successfully dividing the industry against itself, targeting insurers and hospitals for cuts while in effect buying off pharmas opposition. The more recent Inflation Reduction Act contained a provision allowing for Medicare to negotiate prices with drugmakers, which would lower costs and allow the program to cap seniors out-of-pocket costs. That would have been unthinkable a generation earlier when Big Pharma lobbied Congress to prohibit such a policy. Lawmakers of both parties continue to look hard at how to overhaul the health system to reduce costs.That political realignment has turned the insurer, pharma, and hospital industries against each other. I have been covering health care for more than a decade, since shortly after the ACA passed. The battle lines have become clearer over that time, to the point where every sector is blaming the others for patients frustrations with the medical system:Hospitals blame drug companies (for charging high prices that they must pass on to payers) and insurers (for restricting benefits and leaving patients exposed to uncovered bills)Drug companies blame insurers (for charging patients high out-of-pocket costs for medications) and hospitals (for exploiting technical programs like 340B to artificially boost their profits); they also blame the pharmacy benefit managers (PBMs) who coordinate among drug manufacturers, plans, and pharmaciesInsurers blame hospitals and drug companies (for charging too much money for their services and products, which patients bear through higher premiums and out-of-pocket costs)Patients blame everybody (for the high costs they face and the hassles of navigating this complicated system).That is how you end up with misguided outrage over Anthems anesthesia policy. The doctors paint it as insurers cracking down on patients, when it is actually the plan trying to lower its overall costs and thereby save patients money. It becomes hard to do anything to reduce costs, leaving the frustrations with the system to metastasize until we see what we saw after the killing of UnitedHealthcare CEO Brian Thompson.The collective failure of US health careTo be clear, health insurers have earned plenty of scorn. Before the ACA, they would simply refuse to cover people with expensive medical conditions. They are more constrained now that the ACA is law, but there is a constant stream of new reporting on novel tactics by insurance plans to deny patients coverage. Theyre even using AI to do it. UnitedHealthcare has been the subject of recent ProPublica exposs for, among other examples, the companys use of algorithms to deny claims for mental health services.The same goes for drugmakers, who are sitting on the sidelines for the moment. There are some merits to their criticisms of health insurers, PBMs, and hospitals and how those entities pilfer money in the drug reimbursement process. But pharma companies also overstate how much the high prices they charge are necessary to fund research and development for new cures. They deflect when pressed on how they exploit loopholes in patent law to keep their monopolies on prices for popular medications like the diabetes drug Humalog.The insurance and drug industries are right to cite hospitals and physicians as the biggest drivers of US health care costs. Most doctors are very generously compensated, and they have limited entry into their fields, which reduces the number of doctors and makes health care harder to access and more expensive per patient.Yet providers have their own justifiable complaints about how health insurers deploy their networks to restrict coverage, such as prior authorization and other bureaucratic hurdles that providers must jump in order to receive compensation for caring for their patients. US doctors may make more, but they also spend more time and money on administrative tasks than their peers in other countries.And round and round it goes.People are fed up. The health care industry enjoyed a brief spike in popularity during the pandemic, but its approval rating as measured by Gallup has fallen back to 31 percent, with 51 percent disapproving. The share of Americans who approve of the quality of health care available to them has fallen to an all-time low. Only 18 percent of the American public views the pharmaceutical industry favorably; 60 percent hold a negative opinion. Most people say theyre happy with their insurance plan, but they are less likely to approve of their coverage if they have high bills, and most people still report problems using their benefits, according to KFF.Providers enjoy the highest approval ratings, which may be why many people instinctively opposed the Anthem policy. But while the US public remains mostly fond of nurses, its opinion of doctors and hospitals has been dropping: for physicians from 81 percent in 2003 to 69 percent in 2023, for hospitals from 70 percent to 58 percent in the same period. The passage of the No Surprises Act, which targeted hospital billing, was a sign of their political clout softening.The failure of American health care is a collective one, the result of the system being pulled together haphazardly over many decades, rather than thoughtfully planned from the start. Even the public often has contradictory desires, wanting both more choice and guaranteed coverage. The conflict between those two impulses helps explain the difficult struggle to reform US health care and the history of voters punishing politicians who do try to change the system.There has been some progress. The uninsured rate remains too high, but it is about as low as it has ever been after a decade of the ACA. Medicare can negotiate drug prices, and seniors out-of-pocket costs for medications are now capped for the first time. Much more work needs to be done, and it will require cutting through the industrys finger-pointing: Every sector demands some kind of reform. Only by looking at the system as a whole and figuring out how to make it economically viable while also providing necessary care for all who need it can we save this system that has fallen behind those of other rich nations. There are many different ways to achieve a version of universal health care. The US still has to decide that is in fact what it wants, as every other developed European and Asian country has. Many of their people have no concept of a world in which people go bankrupt over medical bills, something that is an everyday reality in the US.No one person is to blame for all of the nations health care problems, not even a CEO. These issues were festering long before most of us were born. No one person has all of the answers either. But it has long been clear that the overall system is deeply flawed. There must be better policies across all the industries that make up what we call the American health care system to fix it.Youve read 1 article in the last monthHere at Vox, we're unwavering in our commitment to covering the issues that matter most to you threats to democracy, immigration, reproductive rights, the environment, and the rising polarization across this country.Our mission is to provide clear, accessible journalism that empowers you to stay informed and engaged in shaping our world. By becoming a Vox Member, you directly strengthen our ability to deliver in-depth, independent reporting that drives meaningful change.We rely on readers like you join us.Swati SharmaVox Editor-in-ChiefSee More: