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UnitedHealthcare May Deny Emergency Visit Coverage

“Unnecessary use of the emergency room costs nearly $32 billion annually, driving up health care costs for everyone,” the company said in a statement on Monday. “We are taking steps to make care more affordable, encouraging people who do not have a health care emergency to seek treatment in a more appropriate setting, such as an urgent care center. If one of our members does receive care in an emergency room for a nonemergent issue, like pink eye, we will reimburse the emergency facility according to the member’s benefit plan.”

During the pandemic and for months of lockdown, non-Covid care, ranging from knee surgeries to mammograms to emergency room visits, fell. Insurers, including UnitedHealth Group, the company’s parent, reported robust profits throughout the crisis. While some experts worried that the delays in care would cause patients’ conditions to worsen, others argued the decline might provide evidence of unnecessary care like screenings.

United’s initial decision was viewed by some critics as a message directed at hospitals.

“They see this as a way to get the upper hand in their perpetual battle with providers,” said Jonathan Kolstad, a health economist at the University of California, Berkeley.

It was the latest example of the insurer clashing with doctors and hospitals, said Michael R. Turpin, a former United executive who is now an executive vice president at USI, an insurance brokerage that helps businesses find coverage. Most recently, United’s sparring with anesthesiologists resulted in lawsuits from a sizable physician-owned practice backed by private-equity investors, and the hospitals complain that United has adopted other policies that make it difficult for patients to get their care covered.

A few consumers are already battling insurers and some providers over billing for Covid vaccines, prompting the federal government to remind the participants that it is illegal to bill patients for those costs.

There is also increasing evidence that some of the people who didn’t go to emergency rooms during the pandemic would have been better off seeking care. A recent study in Health Affairs by researchers from the MIT Sloan School of Management, working with Boston Emergency Medical Services, found evidence of an increase in heart attacks that had occurred out of the hospital, particularly in low-income neighborhoods.

The people delaying care may be among those populations that are already the most vulnerable, according to a study by researchers from the Centers for Disease Control and Prevention, which studied the makeup of individuals who said they had put off care. “Avoidance of urgent or emergency care was more prevalent among unpaid caregivers for adults, persons with underlying medical conditions, Black adults, Hispanic adults, young adults, and persons with disabilities,” the researchers wrote.

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Ciencias

Betelgeuse Merely Burped, Astronomers Conclude

Betelgeuse, to put it most politely, burped.

In the autumn of 2019 the star, a red supergiant at the shoulder of the constellation Orion the Hunter, began to dim drastically to less than half its usual brightness, and some astronomers worried — or perhaps were hoping — that it would explode in a supernova.

Astronomers now say that dust was the culprit in the Great Dimming and that Betelgeuse itself was responsible for that dust. A giant blob of gas erupted from the star, the story goes, and then cooled off and condensed into solid particles that temporarily veiled their origin.

“We have directly witnessed the formation of so-called stardust,” Miguel Montargès, an astrophysicist at the Paris Observatory, said in a statement issued by the European Southern Observatory. He and Emily Cannon of Catholic University Leuven, in Belgium, were the leaders of an international team that studied Betelgeuse during the Great Dimming with the European Southern Observatory’s Very Large Telescope on Cerro Paranal, in Chile.

Parts of the star, they found, were only one-tenth as bright as normal and markedly cooler than the rest of the surface, enabling the expelled blob to cool and condense into stardust. They reported their results on Wednesday in Nature.

The research, they said, shows that such dust formation can occur very quickly and near a star’s surface. From there it can wind up anywhere; as the old saying goes, we are all made from stardust.

“The dust expelled from cool evolved stars, such as the ejection we’ve just witnessed, could go on to become the building blocks of terrestrial planets and life,” Dr. Cannon said in the statement.

Their new results would seem to bolster findings reported a year ago by Andrea Dupree of the Harvard-Smithsonian Center for Astrophysics and her colleagues, who detected an upwelling of material on Betelgeuse in the summer of 2019.

“We saw the material moving out through the chromosphere in the south in September to November 2019,” Dr. Dupree wrote in an email. She referred to the expulsion as “a sneeze.” She and Dr. Montargès were co-authors on each other’s papers.

But Edward Guinan, of Villanova University, who has followed Betelgeuse intently, was more measured in this enthusiasm. Three other studies favor the growth of cool regions on the surface of the star to explain the significant decrease in light.

Betelgeuse is a so-called red supergiant, 887 times as large as our own sun. Its surface, like the sun’s, resembles boiling oatmeal as blobs of gas rise, conveying heat and energy. Such blobs on the sun are often described by American astronomers as comparable in size to Texas.

“In France, we say that the sun’s convective cells are as big as France,” Dr. Montargès said in an email. “It’s really funny to see each country comparison.”

But on Betelgeuse, he said, those blobs are half as wide as the star itself, 350 million miles across. There are only a few of them at any given time.

Betelgeuse also undergoes a 400-day cycle of pulsation, dimming and brightening, although usually not nearly to the extreme it just exhibited.

Dr. Montargès and Dr. Cannon began to observe Betelgeuse in 2019 with a special instrument called SPHERE on the Very Large Telescope, which allowed them to follow changes on the surface of the distant star in high resolution.

“For once, we were seeing the appearance of a star changing in real time on a scale of weeks,” Dr. Montargès said in his statement. In late 2019 they observed that one part of the star was only one-tenth as bright as it had been the year before and about 300 to 500 kelvin — 80 to 440 degrees Fahrenheit — cooler than the rest of the star.

Dr. Montargès and his colleagues reason that the boiling star ejected a blob of gas months if not years before the Great Dimming. The gas cloud was about as big as the star. It hung around Betelgeuse as gas because the region around the star was still too warm for the cloud to condense into dust until the next cycle of shrinkage and cooling.

“Then the photosphere cooled,” Dr. Montargès noted, “probably in the initially bright region that ejected the clump.” That would have lowered the ambient temperature in the cloud enough for dust to nucleate and shroud its birthplace.

“This adventure with Betelgeuse was really exciting,” Dr. Montargès said.

And so, for now, Betelgeuse is back to normal — whatever “normal” means to a star on the brink of doom. That the star will eventually blow up is certain. Betelgeuse, pronounced “beetle-juice” and also known as Alpha Orionis, is at least 10 times and maybe 20 times as massive as the sun. If it were placed in our solar system, it would engulf everything out to Jupiter’s orbit.

Red supergiants are stars in the last violent stages of their evolution. Betelgeuse has already spent millions of years burning primordial hydrogen and transforming it into helium, the next lightest element. The helium is burning into more massive elements. Once the core of the star becomes solid iron, sometime within the next 100,000 years, the star will collapse and then rebound in a supernova explosion, probably leaving behind a dense nugget called a neutron star.

That will be quite a show. The last bright supernova in our galaxy was occurred in 1604 and was as bright as Venus in the sky, Dr. Guinan said.

He said that he still glanced at Betelgeuse every day but that lately he had become convinced that an even larger supergiant known as VY Canis Majoris is more likely to blow first.

“I have been observing since 1980,” he said, “and I am now 79 and don’t have much more time left to see these supernovae.”

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Ciencias

Who’s Afraid of Big Numbers?

“Billions” and “trillions” seem to be an inescapable part of our conversations these days, whether the subject is Jeff Bezos’s net worth or President Biden’s proposed budget. Yet nearly everyone has trouble making sense of such big numbers. Is there any way to get a feel for them? As it turns out, there is. If we can relate big numbers to something familiar, they start to feel much more tangible, almost palpable.

For example, consider Senator Bernie Sanders’s signature reference to “millionaires and billionaires.” Politics aside, are these levels of wealth really comparable? Intellectually, we all know that billionaires have a lot more money than millionaires do, but intuitively it’s hard to feel the difference, because most of us haven’t experienced what it’s like to have that much money.

In contrast, everyone knows what the passage of time feels like. So consider how long it would take for a million seconds to tick by. Do the math, and you’ll find that a million seconds is about 12 days. And a billion seconds? That’s about 32 years. Suddenly the vastness of the gulf between a million and a billion becomes obvious. A million seconds is a brief vacation; a billion seconds is a major fraction of a lifetime.

Comparisons to ordinary distances provide another way to make sense of big numbers. Here in Ithaca, we have a scale model of the solar system known as the Sagan Walk, in which all the planets and the gaps between them are reduced by a factor of five billion. At that scale, the sun becomes the size of a serving plate, Earth is a small pea and Jupiter is a brussels sprout. To walk from Earth to the sun takes just a few dozen footsteps, whereas Pluto is a 15-minute hike across town. Strolling through the solar system, you gain a visceral understanding of astronomical distances that you don’t get from looking at a book or visiting a planetarium. Your body grasps it even if your mind cannot.

Likewise, vast sums of money become more comprehensible if they are reframed in terms of more familiar amounts. In a 2009 blog post, the mathematician Terry Tao rescaled the entire United States federal budget to the annual household spending for a hypothetical family of four. In Dr. Tao’s rescaling, a $100 million line item in the budget became equivalent to a $3 expenditure for the family.

Research in psychology and science education supports Dr. Tao’s strategy. In 2017, cognitive scientists found that students could grasp extremely long time periods — say, between the extinction of dinosaurs and emergence of humans — more readily if they created a personal timeline of the most significant events in their lives and rescaled it to progressively longer time spans: all of American history, all of recorded history and so on. These students were also better than controls at estimating numbers in the billions, an ability that is vital to understanding geological time, astronomical distances or the bewildering sums in the federal budget.

To that end, we thought it could be instructive to update Dr. Tao’s exercise, this time using the numbers in Mr. Biden’s proposed 2022 budget. For simplicity, the total money entering the federal budget — call it “income” — has been scaled to be $100,000. Meanwhile, as the graphic shows, this hypothetical nation-family spends about $144,000 a year, exceeding the budget by about $44,000. Most of the expenditure goes to four big-ticket items: about $29,000 to pay for Social Security, $18,000 for Medicare, the same for Defense and around $14,000 for Medicaid.

Taken together, these four items add up to almost $80,000 in expenses for our nation-family. In addition, we must still pay off the interest on the national debt, for another $7,000, plus $36,000 on other assorted mandatory programs. So exceeding the budget by as much as Mr. Biden is proposing leaves only about $22,000 to spend on the other things we care about, the so-called nondefense discretionary spending.

When the numbers are reframed this way, the trade-offs become clearer. Want to increase funding to historically Black colleges and universities? Mr. Biden does, and he is asking the nation-family to chip in 36 cents (in these rescaled terms) to that end. What about former President Donald J. Trump’s border wall? Our nation-family spent about $388 on it in 2021. In comparison, Mr. Biden is proposing to spend $255 next year to ensure clean, safe drinking water in all communities and $5 to expand school meal programs. These choices are political ones, but at least now we can wrap our minds around how much money we’re talking about.

Why not employ a more typical diagraming strategy, like a bar chart? Well, a bar chart would reduce most items to barely visible slivers. Sometimes such large numbers are recast as percentages of the whole, but that approach suffers from the same drawback, generating confusingly small figures, like 0.01 percent. As Dr. Tao recognized, $100,000 trades on a scale with which most people are intimately familiar. Few among us, alas, will ever be a billionaire, much less a trillionaire. But we can all reasonably budget like one.

Aiyana Green is an undergraduate majoring in policy analysis and management in the College of Human Ecology at Cornell University. Steven Strogatz is a professor of mathematics at Cornell University and the author, most recently, of “Infinite Powers: How Calculus Reveals the Secrets of the Universe.”

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Ciencias

Climate Change Batters the West Before Summer Even Begins

A heat dome is baking Arizona and Nevada, where temperatures have soared past 115 degrees this week and doctors are warning that people can get third-degree burns from the sizzling asphalt.

At Lake Mead, which supplies water for 25 million people in three southwestern states and Mexico, water levels have plunged to their lowest point since the reservoir was filled in the 1930s. In California, farmers are abandoning their thirstiest crops to save others, and communities are debating whether to ration tap water.

In Texas, electricity grids are under strain as residents crank their air-conditioners, with utilities begging customers to turn off appliances to help avert blackouts. In Arizona, Montana and Utah, wildfires are blazing.

And it’s not even summer yet.

“We’re still a long way out from the peak of the wildfire season and the peak of the dry season,” said Daniel Swain, a climate scientist at the University of California, Los Angeles. “Things are likely to get worse before they get better.”

Global warming, driven by the burning of fossil fuels, has been heating up and drying out the American West for years. Now the region is broiling under a combination of a drought that is the worst in two decades and a record-breaking heat wave.

“The Southwest is getting hammered by climate change harder than almost any other part of the country, apart from perhaps coastal cities,” said Jonathan Overpeck, a climate scientist at the University of Michigan. “And as bad as it might seem today, this is about as good as it’s going to get if we don’t get global warming under control.”

With temperatures expected to keep rising as nations struggle to rein in their planet-warming emissions, the Western United States will need to take difficult and costly measures to adapt. That includes redesigning cities to endure punishing heat, conserving water, and engineering grids that don’t fail during extreme weather.

This month has offered glimpses of whether states and cities are up to that task and has shown they still have far to go.

From Montana to Southern California, much of the West is suffering from unusually high temperatures. Some 50 million Americans face heat-related warnings. Records have been tied or broken in places like Palm Springs, Salt Lake City and Billings, Montana.

As 115-degree temperatures cooked Phoenix’s Roosevelt Row Arts District on Tuesday, Timothy Medina, 58, was perched on a black metal platform 12 feet above the sidewalk, finishing the blue lettering of a sign for a coffee shop. “It’s brutal — that heat against the wall,” he said. “Let me take a quick swig of water.”

Construction workers, landscapers and outdoor painters like Mr. Medina have few options but to bear the heat. He wore jeans to avoid burning his skin, along with a long sleeve fluorescent yellow shirt and a $2 woven hat. But soon the heat was winning.

“I start feeling out of breath, fatigued,” he said.

Extreme heat is the clearest signal of global warming, and the most deadly. Last year heat killed at least 323 people in Maricopa County, which includes Phoenix, a record by far.

Outdoor workers are particularly at risk, along with older people and anyone without adequate shelter or access to air conditioning.

Across the country, heat waves are becoming more frequent, lasting longer and occurring earlier in the year, according to the Environmental Protection Agency. Severe heat early in the spring can be especially dangerous because it catches people off guard, experts say.

Cities like Phoenix are struggling to keep up. While the city runs air-conditioned cooling centers, many were shut down last year amid the pandemic. And ensuring that the centers are accessible to everyone is a challenge.

Kayla and Richard Contreras, who sleep in a blue tent on a baking sidewalk in a homeless encampment near downtown Phoenix, said the cooling centers were not an option because they have a dog and they worried about leaving their belongings unattended in their tent.

They said they knew 10 homeless people who died in the heat last year.

Mr. Contreras, 47, fills water bottles from the spigots of homes he walks by. Ms. Contreras, 56, said she saves food stamps to buy popsicles on the hottest days. “This is what keeps us alive,” she said, as she handed an orange popsicle to a friend. “I feel like I’m in Hell.”

Sundown brings no relief. In Las Vegas, where the National Hockey League playoffs are taking place, forecasters expected the mercury to push past 100 degrees when the puck dropped Wednesday evening.

Last month, the Phoenix City Council approved $2.8 million in new climate spending, including creating a four-person Office of Heat Response and Mitigation.

“That’s a good start, but we’re clearly not doing enough yet,” said David Hondula, an Arizona State University scientist who studies heat’s consequences. Drastically reducing heat deaths would require adding trees and shade in underserved neighborhoods and increasing funding to help residents who need help with energy bills or who lack air conditioning, among other things, he said.

“Every one of these heat deaths should be preventable,” he said. “But it’s not just an engineering problem. It means tackling tough issues like poverty or homelessness. And the numbers suggest we’re moving in the wrong direction. Right now, heat deaths are increasing faster than population growth and aging.”

Severe heat waves also pose a challenge for power grids, particularly if operators don’t plan for them. Rising temperatures can reduce the efficiency of fossil-fuel generators, transmission lines and even solar panels at precisely the moment that demand soars.

This week, the Texas power grid was stretched near its limit as electricity demand set a June record just as several power plants were offline for repairs. Grid operators asked Texans to keep their thermostats at 78 degrees to conserve power.

Victor Puente, 47, stood on Tuesday under the shade of the porch on his blue wooden home in Pueblo de Palmas, outside the border city of McAllen, Texas. He said he tries to shut off his air-conditioner during the day to conserve energy, so that it might be available for sleeping.

“The last thing we need is to lose electricity for long stretches,” he said.

In California, where temperatures have hit 110 degrees, the grid operator has warned it may face challenges this summer in part because droughts have reduced the capacity of the state’s hydroelectric dams.

Andrew Dessler, a climate scientist at Texas A&M University, noted that strains on the grid illustrate the nonlinear effects of climate change. “Most people might not notice that it’s getting a bit hotter each year,” he said. “But then the temperature reaches a certain threshold and all of the sudden the grid goes down. There are a whole bunch of these thresholds built into our infrastructure.”

This spring, the American West has been in the grips of a severe drought that has been more widespread than at any point in at least 20 years, stretching from the Pacific Coast, across the Great Basin and desert Southwest, and up through the Rockies to the Northern Plains.

Droughts have long been a feature of the West. But global warming is making things worse, with rising temperatures drying out soils and depleting mountain snowpack that normally supply water during the spring and summer. Those parched soils, in turn, are amplifying this week’s heat wave, creating a blast more severe than it otherwise would be.

“It’s a vicious cycle,” said Dr. Swain of U.C.L.A.

Dry conditions also suggest a potentially devastating fire season, coming a year after California, Oregon and Colorado saw unusually destructive blazes.

The drought has strained water supplies throughout the West, shriveling reservoirs. In one California lake, the water became so shallow that officials identified the wreckage of a plane that had crashed into the lake in 1986.

The Inverness Public Utility District in Marin County, California, will vote next week on whether to impose rationing for 1,100 customers, assigning each household a set amount of water. It would be a first for the town, which last July asked residents to stop washing cars and filling swimming pools.

The drought has forced farmers to take drastic measures. Sheep and cattle ranchers are selling this year’s stock months early, and some dairy farmers are selling their cows rather than come up with 50 gallons of water each animal needs per day. Farmers are planting fractions of their usual amount, or leaving part of their land fallow.

“We’ve been through droughts. This is one of the driest we can remember,” said Dan Errotabere, 66, whose family has grown fruits, vegetables and nuts near Fresno for a century. He is keeping 1,800 acres fallow and cut back on garlic and tomatoes to divert water to almond and pistachio trees.

The effect on farms could cause supply issues and higher prices nationwide, said Mike Wade, the executive director of the California Farm Water Coalition. California produces two-thirds of the country’s fruit and one-third of its vegetables.

Many California farmers are already using micro-irrigation, drip hoses and other water conservation methods. “We’ve stretched every drop,” said Bill Diedrich, a fourth-generation farmer in Fresno County.

Agricultural communities are in peril if the crops and trees die without water.

“When you are operating a longstanding family farm, you don’t want to be the one to lose it,” said Eric Bream, the third generation in his family to run a citrus farm in California’s Central Valley. Today he still has enough water. But “tomorrow everything could change on a dime.”

Elsewhere in the West, states are bracing for the prospect of further cutbacks.

Lake Mead, which was created when the Hoover Dam was finished in 1935, is at 36 percent capacity, as flows from the Colorado River have declined more quickly than expected. The federal government is expected to declare a shortage this summer, which would trigger a cut of about one-fifth of water deliveries to Arizona, and a much smaller reduction for Nevada, beginning next year.

Experts have long predicted this. The Colorado Basin has suffered through years of drought coupled with ever-increasing consumption, a result of population and economic growth as well as the expansion of agriculture, by far the largest user of water in the West.

“We need to stop thinking of drought as a temporary thing to get through,” said Felicia Marcus, a visiting fellow at Stanford University’s Water in the West program, noting that global warming is expected to reduce the Colorado River’s flow even further.

Many cities have been preparing. Tucson is among the nation’s leaders in recycling wastewater, treating more than 30 million gallons per day for irrigation or firefighting. Cities and water districts in California are investing billions in infrastructure to store water during wet years to save for droughts.

Still, experts said, there’s a lot more that can be done, and it’s likely to be costly.

“The Colorado River basin is ground zero for climate-change impacts on water supplies in the U.S.,” said Kevin Moran at the Environmental Defense Fund. “We have to plan for the river that climate scientists tell us we’re probably gong to have, not the one we want.”

Edgar Sandoval and Catrin Einhorn contributed reporting.

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