Why we must temper our unregulated free-market philosophy in health care

Quick, name the most watched, financially successful and competitive sports league in the United States?

The NFL. Right?

Now, name the most tightly regulated, transparent sports league, one that has a multilayered system of wealth redistribution and the one of the strongest unions of any profession in the United States? The NFL.


This is not a coincidence

Major problems with concussions and Roger Goodell’s persona and salary aside, the NFL offers a tremendous lesson in wealth redistribution by structuring fairness and transparency into its system to ensure competitiveness. Whether this is by design or default, this wealth redistribution model has been massively successful. Every year the Super Bowl sets a new record for viewership. Some of this is marketing, but it is mostly because the competition is so fierce that we have no idea who is going to emerge as champion.

In the NFL, wealth redistribution occurs every year through several mechanisms. There is a draft ensuring that the worst performing team has the opportunity to obtain the best college prospects. There is revenue sharing, which equally distributes the annual income from TV and merchandizing. There is a salary cap, which keeps teams in bigger cities or with richer owners from outspending small market teams. This forces teams to cut loose more senior, high-value players enabling a redistribution of talented veterans. Finally, each team must spend up to 94 percent of its cap money. A greedy owner simply cannot buy the cheapest talent, lose every game and horde his or her share of the annual revenue. These measures ensure that the only variables separating success from failure are the owner and his or her ability to select the general manager, the coach, and front office.


Lots of that in the NFL. We Americans have no appetite for cheating in our sports, and we do not want to leave outcomes to chance from honest mistakes. Thus, the NFL has pioneered the field of instant replay. We may heckle the refs, but we have great trust in the officiating system. Do you ever hear conspiracy theories about who really won the Super Bowl? Do we ever question the authenticity of those results? No, we do not.

By contrast, European football is a lesson in the perils of trickle-down economics and the lack of wealth redistribution. There is no draft, no revenue sharing, no salary cap, no minimum as to how little any team must spend on players, and no union. There are typically three of four elite clubs in every league that win the vast majority of championships. They get richer, and the poor teams stay poor.

European football also does something else that we do not do in the NFL or in our other major sports leagues. It punishes the losers. The bottom three teams (or 15 percent) are relegated to the B league. The revenue stream is cut off to these teams exactly when they need it the most to build themselves back up.

Corruption? Lots of that. Exhibit A is FIFA. Oh, and did I mention there is no instant replay? Not surprisingly, conspiracy theories abound regarding the influence of officiating on the outcome of matches. Is it any wonder there is no public trust?

The contrast in competitiveness resulting from these two approaches is stark.

Since its beginning 87 years ago, 60 teams have played in the 20-team Spanish Primera Division. This means 40 of those teams are now in the B or the C league. In that time, the top 3 teams (Barcelona, Real Madrid and Athletico Madrid) have won 78 percent of the championships. In the last 50 years, they have won 83 percent of the championships. The same general numbers also hold true in the Italian and German Leagues. Is it any wonder most of their stadiums are empty on match day?

By contrast, the 103-year-old NFL has had 37 teams play in its league. A number of those teams folded early on. However, of those 37, 31 won an NFL, AFL or Super Bowl championship. Over its entire history, the top 3 teams (Green Bay, New York Giants and Chicago Bears) have won only 30 percent of all the championships. If we examine the Super Bowl era, three different teams emerge as dominant: Pittsburgh, Dallas, and San Francisco. Yet these three teams have only won 32 percent of the Super Bowls. These percentages are well below the 83 percent mark in the Spanish Primera Division over the same period.

Furthermore, in the Super Bowl era, 19 of the current 32 NFL teams (59 percent) have won at least one championship and all but four have played in a Super Bowl. Is it any wonder the stadiums are full?

If our sports reveal who we are, we do not like elitism. We disdain unregulated libertarian markets. We believe in multilayered wealth distribution, transparency and fairness. Perhaps most importantly because we do not relegate the worst teams to perennial failure, we believe in mercy, forgiveness and second chances. We also believe in building systems that are structured to ensure fairness, transparency, and competitiveness.

So if this is who we are, why don’t we crave this same fairness in two institutions that are critical for ensuring our competitiveness as a nation: public education and health care systems?

In our current system, if you are wealthy, you have access to the best these systems have to offer. If you are in the working or middle class, one bad illness or hospital bill can destroy your meager personal wealth. Such a financial hit will dramatically limit your children’s educational opportunities and earning potential because it will limit your ability to pay for the best possible education.

As in the Spanish Primera Division, the outcomes of our current approach will be stark. Rather than promoting societal competitiveness, it will stratify an uneven economic class structure: one that is unsustainable and will ultimately lead to our economic collapse.

If we are to avoid this fate, we need to reconfigure our society and philosophy to ensure that the benefits and opportunities of these two institutions are equally accessible and their riches equally and continually redistributed.

Finally, we must temper our naked, unregulated free-market philosophy with mercy, forgiveness and second chances for that bottom 10 to 15 percent. We need to help those in rural, rustbelt states and the inner cities that are being left behind. We need to bring them along and not relegate them to society’s B or C league at the moment they need resources the most.

Peter F. Nichol is an associate professor of surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.

Image credit: Shutterstock.com

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