Concussion Rules & All-Fault Insurance

The sport of American football has a problem with concussions, and the solution is simpler than anyone seems to realize. The problem is not just that football is a dangerous sport, since injuries are probably impossible to separate from professional athletics of any kind.  Soccer players get hurt.  Golfers get hurt. But football has a unique capacity for permanent spinal cord injuries that has to trouble anyone who watches and loves the game.

Just this last weekend, a young man who plays for the Rutgers team, Eric LeGrand, injured his neck when he tackled the ball carrier on a kick return. It was a tremendous and violent tackle, but all the high speed pressure impacted his neck. LeGrand is paralyzed now, and your heart just aches for him and his family. On Sunday, at least four NFL players suffered concussions due to hits.  Two of them were caused by unflagged hits by the same individual who plays defense for the Pittsburgh Steelers.

You have to wonder why someone hasn't invented a better helment.  Honestly, that challenge has been on my mind for the last year, ever since I read the Malcom Gladwell essay in the New Yorker about the growing confirmation of a link between playing football and brain damage:

In one case, a man who had been a linebacker for sixteen years, you could see, without the aid of magnification, that there was trouble: there was a shiny tan layer of scar tissue, right on the surface of the frontal lobe, where the brain had repeatedly slammed into the skull. It was the kind of scar you’d get only if you used your head as a battering ram. 

Paul Daugherty (SI) writes,

The evidence is circumstantial, but there is mounds of it. A study of 2,500 former NFL players done several years ago by the Center for the Study of Retired Athletes showed a direct correlation between Alzheimer's-like symptoms and depression and the number of concussions a player had suffered.

The haunting message from Gladwell's essay is that it's not just formal concussions that are causing brain damage, rather the repeated high-G impacts.  The constant battery of brain against skull during practices seem to be much more damaging than games.  This fact suggests new helmet technology may be the only solution.

Yet even a better helmet may not change the number of injuries we see (in games and overall).  Why?  Because people respond to incentives.  History shows that if you give people a safer piece of equipment, they will use it even more dangerously. So administrators who really aim to reduce injuries need to upgrade to a new set of rules that penalizes players who cause injuries.  Gregg Easterbrook has an excellent and lengthy column on this topic published just today:

For too long, NFL headquarters and sports commentators both have acted as though there is some gigantic mystery regarding why NFL players make so many dangerous helmet hits. Here's why in three words: because they can. The play is almost never penalized.

For too long, NFL headquarters and sports commentators both have acted as though there is some gigantic mystery regarding what to do about dangerous helmet hits. Here's what to do in three words: throw the flag!

Allow me to say that Easterbrook makes an excellent point, but that his conclusion - and the forthcoming rule change to be announced by the NFL on Wednesday - is not going to work.  Here's why. I don't disagree with Easterbrook that officials should be "throwing the flag" more often for violent hits.  Rules, and the enforcement of rules, are the ultimate ingredient in everything from how games are played to how economies grow.  The flaw is that penalizing a player hinges on the subjective judgement of referees.  Any system that uses subjective judgement of intent on the part of the offending party is likely to lose effectiveness over time. 

Was the helmet to helmet contact intentional? Inadvertent?  What if no concussion is caused?  What if a player accidentally snaps the femur of a wide receiver using a clean tackle?  What about what happened to Joe Theismann?

Football rulemakers in the NFL and NCAA should learn a lesson from the no-fault car insurance laws that were tried in various states starting in the 1970s. The promise of that particular rule change was that by taking tort claim litigation out of the mix, overall insurance costs would drop for minor accidents.  The premise was that determining fault caused more trouble than it resolved.  Face it, nobody wants to have a car accident, right?  Well, wrong.  It turns out that no-fault insurance rules didn't save much money overall, and may have led to proprotionally more negligence.  But like most failures, there is a lesson to be learned from this.  Incentives matter.

Let me tell you a true story to make a point.  Years ago, a young male relative (call him Damien) was playing in my son's room during the Thanksgiving weekend.  Every half hour, my son would emerge in tears with another cherished, broken toy in hand.  Damien was having fun crashing the crap of stuff that wasn't his.  Protocol in these situations has it that Damien's parents did the punishment, but after the third toy went down, I intervened.  After each incident, Damien's parents asked, "Did you do that on purpose, young man?"  And each time, little Damien affected an angelic face, shaking side to side, "No, Mommy, it was accident."  So after toy number three (a replica metal B-17 bomber: propellers permanently snapped off), I got involved, using my angry economist voice.  "Darn it son, you are done playing in that room for the night.  I don't care if it was an accident or not.  Pay the price for negligence.  And if one more toy in that room is broken, you won't play there for the rest of the year."  Can you guess how this ends?  No toys have been broken in our house by Damien ever since.

The challenge for football is to make the health of opposing players part of the calculus of every player.  The NFL needs what I call all-fault insurance.  If Big Mike tackles the other team's quarterback who then leaves the game with an injury, Big Mike should leave as well.  Big Mike sits on the bench until the injured player returns, and if that's the whole ball game, then that's the whole ball game.  Changes the incentive structure, no?

With all-fault insurance, you get away from gray areas like penalties, fines, suspensions ... even flags. Take away the distinction between penalty and accident.  What you add is a concern for safety by all players for all players.  That's been missing from football, and it needs to be part of the game.

Sure, some folks will poke holes in the concept of all-fault insurance.  What if multiple players are involved in an injury?  Couldn't teams game the system, for example by sending in a C player offensive tackle to fake an injury agains an all-pro defensive end? If you want a treatise on how sophisticated the rule should be, we could hash that out here, but let's just consider one way to design this effectively.  Each team could make a rank-order list of their opponent's players, offense and defense, top to bottom.  I'd put Peyton Manning as Colt's top O player.  Then, when offense player ranked #7 goes down, the defense could sit the defender involved or its defender ranked #7 (but no lower).

The concept of the all-fault insurance rule change is what I hope the football gods will think about.  Are you really changing behavior with a rule, or are you putting the onus on officials to make judgment calls?  All-fault insurance will change incentives big time, and I guarantee that concussions would decline by 50 percent or more.

Comments

[Brett]

A convoluted and easy to manipulate system like you describe is overly complex and unnecessary.

This is not a difficult problem to solve. Just enforce the existing rules and punish rule-breakers. Increase the punishment until players respond.

Flag, Ejection, Fine, Suspension. Just increase the penalty until players respond.

"Any system that uses subjective judgement of intent on the part of the offending party is likely to lose effectiveness over time."

Why? You don't provide any reason for this statement.

Plus, the ability to review high definition slow motion video from 8 different angles of the offending action makes the subjectivity less important. Did the helmets collide? Yes or no.

[Chris M.]

I think people are failing to understand the true nature of American football; it is far closer to warfare, than it is to chess.

All the suggestions above are liability rules, imposed ex post. These rules seem illogical in this instance, because they require the players to make rational decisions, while their minds and bodies are acting almost wholly on instinct and experience.

In my humble opinion, the only real solutions to this problem are ex ante modifications to the game (i.e. a wider field, safer helmets, etc.). We can change the game and the way it's played, but we cannot expect to solve the problem by imposing rules that require rational choice, on humans who are arguably not acting rationally at the time they cause these injuries. So long as players have the weapon (the hard helmet), their instinct will not fail to put it to use it when the battle creates the opportunity.

Ex post rules may have some effect yes, but where the battle gets heavy (fourth quarter, playoffs, overtime, etc.), the mind gives way to instinct and experience, and players will do what is necessary to get the win. Taking away the weapon, or limiting the opportunities to use it, are the only ways to prevent the serious injuries at issue.

[Steve]

The nature of the game is what is causing the injuries, not the inadequacy of safety devices or maliciousness of the players. To make the sport safe, you must fundamentally change the sport. The physical laws of inertia describe the mechanism of the injuries, so mass and velocity together need to be addressed in the rulemaking (e.g. no player shall move faster than 8 mph, players weighing more than 12 stone shall not travel faster than 6 mph, and shall not contact a another player at an angle of incidence exceeding 90 degrees). Further, removing the helmet althogether may be an effective means of reducing the prevalence of concussion (see rugby). Alternatively, outlaw the contact-nature of the game and just play flag football.

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