Football is the king of sports, is the most popular and playable sport in the world. In the USA they play the same exact sport but with different name soccer, which is an acronym of the word Football Association. Although soccer was not very popular in 50’s or 60’s, in the 70’s and 80’s it gained some publicity from the creation of New York Cosmos and the arrival of some of the greatest soccer players of that time. In the early 90’s though soccer was recognized as the fastest growing college and high school sport in the US To begin with in 1992 the highest division in the American Soccer Pyramid was the APSL (American Professional Soccer League). David Litterer reports in his article that APSL in 1992 struggled with expenses and as a result 3 teams were dropped from the league, Albany, Penn-Jersey and Maryland. The league continued its existence with 5 more teams, Colorado Foxes, Tampa Bay Rowdies, San Francisco Bay Blackhawks and Ft Lauderdale Strikers. In the end Colorado Foxes won the championship by defeating Tampa Bay 1-0 in the APSL final. After the 1992 season Miami folded and San Francisco dropped out to join the USISL, leaving the league in a very precarious situation (Litterer). The League average attendance in 1992 was 2,104 during the season and 1,502 during the playoffs; these low attendances of people tell that even the top division of soccer in the US was still in the development stage of the sport with no proper publicity and with limited or no media coverage of the games. A main problem that APSL soccer clubs had in that time was revenue. Soccer clubs in 1992 did not have stadiums designed exclusively for soccer so they had to rent football or baseball stadiums. The fans could not fill up the stadiums and people always complained about the long distance between the stands and the field mostly in baseball games. Therefore the teams couldn’t take advantage of the tickets to the extent they wanted. The lack of soccer stadiums created frustration among the soccer fans across the country and didn’t benefit the development of the sport.
There were also indoor soccer leagues, the NPSL (National Professional Soccer League) was the top professional indoor soccer league in the US in front of MSL (Major Soccer League) in 1992. This league was consisted by 9 teams, 4 in the American division and 5 in the National Division. The league averaged 3,619 fans per game this year, marking eight years of slow, but steady growth. More importantly, the league was winning the bidding war against the MSL. Although they weren’t bidding as high as MSL for top players, they were able to keep their teams in much better financial shape, by going after high-quality second-string players with more modest salaries. (qtd. in “A History of USA Indoor Soccer”)
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The teams were good financial-wise and the league gained some reputation after 8 years of existence, While MSL indoor soccer had a steady growth in that year Indoor soccer in general faced a decline, Mainly because of the revival of outdoor soccer and the weakness to provide the US national team with indoor soccer players as it used to in the early 80’s.
Although professional soccer in the US was in the very start the US national team had an incredible success winning the inaugural USA Cup in June 1992 defeating Ireland and Portugal and tying the three-time World Cup Champion Italy. The tie was good enough to ensure US the title. John Harkes the goal scorer of the game showed his excitement after the game in The New York Times stating that they had to seize the opportunity of winning the best team because that game was being televised around the world. This result showed that Americans should be taken seriously from now on. After that result European Football Clubs started to appreciate American soccer players and many of them pursued a successful career in the European Leagues.
Moving to the year 2013 many things had changed and a new era for US soccer had began. The highest division now is the MLS (Major League Soccer), a league that was introduced in 1991-1992 and started in 1996. MLS is consisted of two conferences, the Eastern Conference with 10 teams and the Western Conference with 9 teams. The Champion of each Conference proceeds to the MLS Cup Final, with the winner to be the champion of the highest tier in US soccer.
The league in 2013 regular season achieved an average of 18,594 and the Seattle Sounders to have the highest average attendance of 44,038 (Mike Prindiville). This big difference between these chronological periods showed the massive development of the soccer industry in the US. In addition The Economist published an article stated that the attendance at the MLS matches was 5% higher than last season and is higher the attendance of NHL and NBA. This growth of spectators it’s a result of a business plan that created for future revenue and profitability.
Lode Kirk Junior stated that
By owning and operating their own stadiums rather than sharing profits with an outside source, MLS teams could control revenue from parking, concessions, tickets sales etc. These stadiums improved the MLS-going experience for fans with their regulation size soccer fields, seats that offered a better view thanks to their proximity to the pitch and an atmosphere which is similar to what soccer fans will find in European stadiums. Additionally, a crowd of 15,000 inside a 20,000-seat stadium looked much fuller than the same crowd at a 60,000-seat venue, improving the public’s impression of the game (qtd. in The American Soccer Guide 4).
Instead of renting facilities as the soccer clubs used to do in the 90’s now most MLS teams have their Soccer Specific Stadiums and each team creates an amazing atmosphere that no other sport in the US can create.
Furthermore now all the MLS games are being televised with the broadcast rights deals to be valued $20 million, ESPN/ABC $7 million through 2014, NBC/NBC Sports Network $10 million per year through 2014, Univision/TeleFutura $10 million through 2014(Miller, Washington 219). Also MLS was the first professional sport league in the US to authorize advertising on game jerseys just like the clubs in Europe. These various deals with Adidas, Herbalife, Microsoft and many more brand companies gave a great financial comfort to MLS teams and to the effort of improving the league to the maximum.
As I said many things have changed in the soccer industry. One of the most important and obvious is the average player salary cap. Official information by NBC Sports journalist Liviu Bird stated that the average salary cap in the MLS is $148,693.26 with Clint Dempsey to be the highest paid soccer player with $5 millions a year. It’s almost ten times the amount that of the average salary of a player in 1992. This increase has given some publicity to the MLS worldwide with many international top players wanting to play in the US. A focal point in the history of US professional soccer was the “David Beckham Rule”. This rule gives the freedom to every MLS team to sign any player with no limitations in terms of salary. Therefore this new policy contributed to step closer into the MLS ultimate goals: improvement of the sport’s quality and also the signing of world-class international players (Kirk 4).
Another evidence of the huge development of US professional soccer is the list published by the World Soccer magazine one of the best sport magazines in the world about the Top 10 soccer leagues in the world. This magazine ranked USA-MLS in 7th place ahead of many great countries with prestigious leagues such as France, Netherlands, Argentina and Portugal (Benli). That’s a great recognition for the US soccer that shows the huge improvement of the level of play and also the media spotlights that started to shade the MLS from all over the world.
The US soccer is still evolving but undoubtedly there is a huge difference between the two periods (1992-2013). Back then soccer teams were struggling to find a fan base and to develop the sport in a decent level with no media coverage and sponsorship. 2013 found the US soccer in its best with a well-established professional league, media coverage and huge deals in terms of sponsorship. The development of US soccer brought many people into sport and according to FIFA (F?©d?©ration Internationale de Football Association) it has more registered players than any other country in the world making soccer the fastest growing sport in the US.
The Patient Protection And Affordable Care Act
Introduction
The three main objectives of the Patient Protection and Affordable Care Act, signed in October 2010, include the following: reforming the private insurance market, mainly for individuals and small group purchasers; expanding Medicaid to the working poor, whose maximum income is around 33 percent of the federal poverty level; and altering the way medical decisions are made in the country (Silvers, 2013).
These three objectives are primarily determined by private choices rather than government regulation, with the expectation that decisions will be made rationally based on incentives while constrained by other factors (Hall and Lord, 2014). Hence, it is assumed that for the production of a high value good, namely medical care access, the users will work jointly within the reforms at a price that is appropriate, the financing of which is done through risk sharing (Hall and Lord, 2014).
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Given this, the two aspects of the Patient Protection and Affordable Care Act – namely the private insurance market reforms and the Medicaid expansion – are critically evaluated in this paper. We will examine whether these two will be successful or not.
Private Insurance Market reforms
The first objective is based on the variations in the rules and the mandates for individuals (Silvers, 2013). The Affordable Care Act facilitates different insurance companies to take more risks through the provision of policies that are comparable to everybody with only slight changes (Jacobs et al, 2012). The Act does not allow the exclusion of pre-existing conditions or for policy cancellation, and constrains the rise in the rates. To enable this, it is mandatory for the insurance companies to enrol a representative section of the population so that the average risk assumed under the Affordable Act is realized. This necessitates the mandatory purchase of insurance by everybody. At the same time, it is not realistic to assume a mandatory purchase when there are affordability issues; this problem is solved through the requirement of subsidies in the Act (Hall and Lord, 2014).
The Act provides for a subsidy of more than 50 percent for the purchase of personal insurance for a middle-income family, thus facilitating very high purchasing power. This in turn ensures robust competition among the insurers through the rise in the purchasing power of individuals who were previously uninsured. The implicit assumption under the Act is the translation of this competition into lower premiums and provider pressures so that a high-quality value service is obtained (Reisman, 2015).
If there is a failure in the private markets to achieve these outcomes, these assumptions will not be valid. Studies have shown many significant problems in the organization and payment of the US health system, in the availability of information and choices, and in how capable the participants are in responding to the provision of incentives and pressures under the Act (Silvers, 2013). There can be a lot of problems associated with market failures arising from information asymmetry.
There is a chance that brokers in the health insurance field might receive premiums from the clients, mainly small businesses, as well as payments from the insurance providers without considering the quality of the contract for the engaging firms by the providers. Consequently, the premiums obtained by the health insurance brokers will be higher than the physicians in primary care, while the small businesses that are insured will not know this (Hall and Lord, 2014). Hence, it is not guaranteed that competition among the insurers might translate into lower premiums and pressurize the providers for conducting high-quality service.
Another constraint is the existing distortions that restrict competition, including the lack of supply of physicians and the limits to competition created by pharmaceutical patents etc. (Hall and Lord, 2014). All these potential distortions to competition can result in process reorganization, alternative compensation negotiation, chances of using more efficient technology, and various other practice changes that can create significant market barriers to obtain the desired outcomes of the private insurance market reforms under the Affordable Health Care Act.
Medicaid expansion
The main component of the Medicaid reforms is its expansion to the working poor, people who were earlier uninsured (Medicare Payment Advisory Commission, 2013). There were concerns regarding the expansion of Medicaid in some states, causing the blockage of said expansion and resulting in doubts regarding its effectiveness and effects on the working force mobility (DeVoe, 2013).
At the same time, big businesses strongly supported expanding Medicaid due to the fact that the payment for uncompensated health care would be reduced (Chang and Davis, 2013). The perceived benefits for employers through the expansion of Medicaid included lower premiums, cost reduction, and job expansion (DeVoe, 2013).
Despite these, the main concern about Medicaid expansion is the chance of trapping low-wage workers into a low-quality program since there are no advantages associated with the existing low-income jobs (DeVoe, 2013). Thus, without specific mandates and coverage for small businesses and low-income jobs, how far Medicaid expansion will benefit those with low-income jobs is an area of concern. Another major issue associated with obtaining the benefits of Medicaid expansion is the surplus incentives for perverse payment (Reisman, 2015).
The incentives can vary from the fee payment for different services to individuals, and the Medicaid schedule of fees for the specialized services with biased updates (Reisman, 2015). All these create information asymmetries in the market, restricting competition to get the desired outcomes through Medicaid expansion. Implementation challenges associated with Medicaid expansion include difficulties accessing the uninsured, the chances of many not having English as their primary language, and the likelihood of many uninsured having diminished mental capacity (Rosenbaum, 2011).
All these create significant challenges for implementing the expansion of Medicaid to the working poor. Hence, state agencies and the state’s insurance exchanges, which implement Medicaid, must overcome several obstacles to execute the expansion and achieve desired outcomes. Before overcoming these barriers, achieving the target of providing access to insurance for the working poor, whose maximum income is around 33 percent of the federal poverty level, will be challenging.
Conclusion
In this essay, the two main components of the Affordable Health Care Act, signed in October 2010, were discussed. The discussion shows that although many benefits can derive from the reforms, market failures might prevent competition, arising from the reforms, from achieving its desired targets. Though there are many reforms that can benefit the poor, the fundamental structural defects of the US health care system remain unchanged, which could constrain the achievement of the desired outcomes. Hence, institutional reforms need to be implemented in such a way that market failures will be reduced, and then other reforms in the market can be pursued. Without the implementation of these institutional reforms, the reforms mentioned under the Affordable Health Care Act will not succeed.
References
Chang, T. and Davis, M. (2013). Adult Medicaid beneficiaries under the Patient Protection and Affordable Care Act compared with current adult Medicaid beneficiaries. Ann Fam Med, 11(5), 406-411.
DeVoe, J.E. (2013). Being uninsured is bad for your health: Can medical homes play a role in treating the uninsurance ailment? Ann Fam Med, 11(5), 473-476.
Hall, M.A. and Lord, R. (2014). Obamacare: What the Affordable Care Act means for patients and physicians. BMJ, 1-10.
Medicare Payment Advisory Commission. (2013). Data Book: Health Care Spending and the Medicare Program. Washington, DC, 97.
Reisman, M. (2015). The Affordable Care Act, Five Years Later: Policies, Progress, and Politics. Perspective, 4(9), 575-600.
Rosenbaum, S. (2011). The patient protection and affordable care act: Implications for public health policy and practice. Law and the Public’s Health, 126, 130-135.
Silvers, J.B. (2013). The Affordable Care Act: Objectives and Likely Results in an Imperfect World. Ann Fam Med, 402-405.