Portside

Dylan Scott covers health care for Vox. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo and STAT before joining Vox in 2017.

There was nothing remarkable about the play that led to Buffalo Bills defensive back Damar Hamlin collapsing on the field during Monday Night Football. A Cincinnati Bengals player caught the ball over the middle, ran upfield, and collided with Hamlin in a rendition of a play that football fans have seen countless times.

But this time, Hamlin staggered to his feet, wobbled, and dropped. We learned later that his heart had stopped. The game, between two of the NFL’s best teams, was suspended, but only after the teams reportedly balked at the league’s suggestion that they regroup and finish the game. (The NFL has denied this; the journalists who reported it stand by their reporting.) It felt like a seminal moment for a sport beleaguered by questions about the dangers it poses to its players.

But the odds are against any long-term impact. America’s most popular sports league will still conclude its regular season next week, followed by three rounds of playoffs, all leading to the Super Bowl on February 12, which will inevitably be the most watched TV show in the United States of the entire year.

That’s because the NFL’s grip on the American consciousness is ironclad. The worst-case scenario — a player dying after one of the violent hits that are football’s hallmark — nearly came to pass on Monday night, but this weekend’s games will kick off unabated.

A uniquely American concoction of capitalism and culture has allowed football to continue to thrive, even as the dangers it presents to players, both professional and amateur, have become clearer. Football remains the biggest hit on TV.

It is dangerous. It is corrupt. It is also a visual spectacle and thrilling competition. Every season brings new and returning characters, dangling plot lines and out-of-nowhere twists, and a dramatic climax on Super Bowl Sunday.

To lose football would be to lose a part of ourselves. Rooting for the Ohio State Buckeyes and Cleveland Browns was integral to my childhood, as much as going to church and school. It was part of my identity.

Football is not inevitable. There are signs of slippage, if you look closely enough. But no precipitous collapse. And the NFL, ever mindful of maintaining its dominance, has worked tirelessly to keep it that way.

So the game plays on — with Damar Hamlin, another casualty, left in its wake.

Why Americans love football

Americans love television as much as any people in the world, and the NFL is our favorite show: 75 of the 100 most-watched television programs in 2021 were NFL games. The Super Bowl routinely pulls in 100 million viewers or more in the United States. For many of them, that might be the only game they watch all year. But they watch.

Chiefs fans celebrate at the Power and Light District in Kansas City, Missouri, as the Kansas City Chiefs defeat the San Francisco 49ers in the Super Bowl on February 2, 2020. 

Kyle Rivas/Getty Images

The game we call football is fundamentally and uniquely American. It’s an amalgamation of what the rest of the world calls football (but what we call soccer) and rugby; the first recognized game was played in New Jersey between two college squads in 1898, and it evolved and grew in popularity from there.

But unlike the other signature American sports, baseball and basketball, football has not found quite the same success abroad.

That isn’t for lack of trying. The NFL now routinely holds regular-season games in London and operated a European offshoot until 2017. Some small fandoms are emerging in the United Kingdom and Germany. But there has been nothing comparable to basketball’s EuroLeague, which now regularly produces stars who move to the NBA, or Japan and South Korea’s baseball leagues. Even Olympic basketball has occasionally yielded to American dominance; football doesn’t have nearly enough international appeal to even be considered for a place in the world’s most historic and varied athletic competition.

Attempts have been made to explain why Americans seem so beguiled by this particular game. Europeans are more familiar with and attached to football’s predecessors, soccer and rugby, and the fandoms for those sports have their own dark underbellies. But in the United States, the fall calendar for many people revolves around high school football on Friday nights, College Football Saturdays, Sunday Night Football, Monday Night Football. It is simply woven into our social fabric.

But it wasn’t always this way. Baseball was for a long time regarded as America’s pastime, the subject of wartime patriotism. Football’s preeminence requires more explanation than mere inertia and ubiquity. Murray Ross delivered maybe the best one I have read in his essay “Football Red and Baseball Green: The Heroics and Bucolics of American Sport” from 1971, published by the Chicago Review.

In his telling, football was a thoroughly modern game compared to baseball, a sport once so synonymous with America that it’s been said the country fought World War II to protect Mom, apple pie, and baseball. Football is a gladiatorial combat between demigods, defined by conquests and the finely tuned cooperation of its gameplay: 11 men on the field with their own specific task and working toward a common goal.

Baseball — which football overtook by the late 20th century — is, by contrast, pastoral and individualized, Ross wrote. And whereas baseball looked back to a time before industrialization, with its expansive setting and leisurely pace, football embraced the modern age of specialized toil under the pressure of a clock steadily ticking down.

I can’t say I was all that conscious of the ways football’s subtext mirrored that of the developed economy I was growing up in. What I remember are SportsCenter highlights and the 2003 Orange Bowl, when my home state’s Buckeyes triumphed in a nail-biter to win the national championship. I remember all the pain and the occasional bliss of my stolen-and-resurrected Cleveland Browns fandom. It has been a common touchstone with my friends and family, as I moved across the country and back again.

It can be fun to watch, too. Its gameplay is more methodical than basketball’s, allowing the viewer to catch their breath between plays, but faster-paced than baseball’s, with the 60-minute game time adding urgency to every action. It allows the game to maintain a clearer narrative: You don’t know if an RBI single in the first inning will really affect a game’s final outcome, but you can be more confident that a 4th-and-1 in the first quarter might prove important.

Every play is its own story in a miniature, each snap an adrenaline rush. The offense and defense burst into action when the ball is hiked. Sophisticated blocking patterns slowly reveal an open hole for the running back. Or the receiving corps runs finely tuned routes to break free of the defense’s coverage, while the quarterback withstands an assault from the defensive line before trying to uncork a pinpoint pass to his target. You might see a fake punt or a flea flicker, in which a running back takes the ball from the quarterback and then tosses it back to him to attempt a long pass. Or the defense could turn the tables by intercepting a pass or forcing a fumble, a plot twist that sends the action screaming in the other direction.

It is violent, yes. But it is also balletic and complex, every drive its own game of chess between two teams. The players must not only possess the kind of preternatural athletic ability that makes any high-level sports competition compelling but also act in unison to achieve their goal. It makes for beautiful and tension-filled television viewing, edge-of-your-seat thrillers in which the outcome has not already been predetermined by a screenwriter.

Taven Bryan, left, of the Cleveland Browns reacts after Greg Zuerlein of the New York Jets made a 57-yard field goal during the fourth quarter of the game at FirstEnergy Stadium in Cleveland, Ohio, on September 18, 2022. 

Nick Cammett/Getty Images

The NFL has another advantage for fans: more parity. Unlike the MLB and NBA, where wealthy “glamour” teams can dominate because of their spending advantages or their locales, pro football distributes its revenue evenly among its 32 teams and strictly controls their payrolls, giving each a fairer shot at attracting and keeping talent. Even for my woeful Cleveland Browns, there is a real chance they could turn things around and contend for a Super Bowl, if only they find the right coach or the right quarterback. For lower-rung MLB and NBA teams, those hopes are much fainter because of the disparities in revenue and prestige.

And the NFL’s season demands appointment viewing by design. For your favorite team, there is one game a week, usually on Sunday. With only 17 games in the regular season, each individual NFL game carries more import than the typical game of an MLB (162 games) or NBA (82 games) regular season. There are no filler episodes.

Even today, aware as I am of the physical dangers and moral hazard for supporting owners who bilk cities for millions to build new stadiums they don’t need or coaches and players accused of all sorts of wrongdoing, I do still tune in more Sundays than I don’t.

How the NFL has staved off the death of football

That makes me part of the problem. The NFL continues to defy any claims of its impending doom, in part because people like me are still tuning in.

The league has worked hard to keep our attention. It has been desperate to stave off the brain damage backlash, which was driven deeper into the public consciousness by shocking stories involving star players, such as retired San Diego Chargers linebacker Junior Seau’s death by suicide (and the subsequent revelation he had CTE) and Indianapolis Colts quarterback Andrew Luck’s sudden retirement in his prime to avoid any further injury. There have been enormous settlements in lawsuits involving former players who alleged the league hid the risks of playing football from them.

And football, the game, is facing a more uncertain future. Participation in tackle football among children ages 6 to 12 dropped by nearly 18 percent from 2008 to 2021, while baseball and basketball held steady and soccer soared. Half of US adults now say the sport is inappropriate for youths.

But football, the television show, is still thriving, and, barring a dramatic change, it will continue to do so. The product isn’t going away: The decline in youth participation has not been universal, and in some of its cultural strongholds like the Southeast, more kids have been playing football in the last decade. The NFL should continue to have a pipeline of new stars for the foreseeable future.

The league has been canny in keeping the game afloat. It has altered its rulebook and made an already cinematic game even more fluid and exciting, with the bonus of doing so in the name of player safety. It has instituted rules to protect quarterbacks, its biggest stars, from dangerous hits to their legs and head. If a wide receiver cuts across the middle of the field to catche the ball, defensive players are barred from hitting the other player in particularly rough ways, such as leading with their helmet.

That may make the game marginally less dangerous. But a notable side effect is that it makes the game easier for offenses. Defensive players have to think twice about landing punishing blows, unless they risk a penalty, and that shift along with new concepts in how offensive plays are designed has opened up the game. Quarterbacks are throwing more passes, for more yards, and teams are scoring more touchdowns than they did in the 2000s and earlier. League-wide scoring hit a record high in 2020, though it has dropped off a bit in the past two seasons.

The NFL has also long indulged in subtle marketing campaigns to entwine itself with the military (making football, by definition, patriotic) and to soften its image, such as previous breast cancer awareness campaigns that saw modern-day gladiators and their frumpy, grumpy coaches wearing dashes of pink.

Isaiah Likely of the Baltimore Ravens takes the field with a member of the US military before the game against the Carolina Panthers at M&T Bank Stadium in Baltimore, Maryland, on November 20, 2022.

 Scott Taetsch/Getty Images

Where gambling was once verboten in all professional sports after the Black Sox and Pete Rose scandals of the last century, the NFL, like the NBA and other leagues, has embraced it. First indirectly, via fantasy football (for which the league runs its own platforms), and now more overtly, including NFL deals with sportsbooks and partnerships with online betting sites.

All of which serves to have fans put skin in the game. Murray Ross wrote more than 50 years ago that, while we might be able to imagine settling under a major leaguer’s fly ball and catching it, it’s impossible to believe we could actually hold on to a pass from an NFL quarterback while absorbing a hit from a linebacker in the same way. The NFL has found a way to make us a part of the action. Fans are more invested than ever.

The game today looks very different from the game Ross was writing about. But at its core, it is still American football. Those reforms didn’t prevent Damar Hamlin’s injury. Enormous men running at breathtaking speed over very short distances and colliding with one another cannot be made entirely safe.

May Hamlin recover quickly. But he won’t be the last player to experience such a trauma. Until America stops watching, there will always be another game on.