THE GOODS : Health-Care Game Beats Real Thing


Like all good Americans, you are surely tuning into C-SPAN every day to watch the health-care debate in Congress, making sure that you stay informed about all the issues involved in this topic so vital to our national interest.

No? Join the club.

The debate over health reform, while undeniably important, is not exactly up there with the Anita Hill testimony when it comes to dramatic television.

Anyway, after watching for just a few minutes you get the distinct impression that most legislators are, as usual, just playing games. Now you can play the health-reform game, too.


“SimHealth” is the computer-simulation game that asks the question “Is there a Hillary in the house?” From the same company that produced the popular “SimCity” and its futuristic sequel, “SimCity 2000,” this game allows you to devise a health-care plan on your home computer and then watch how it affects a community over 16 years.

In the computer-game world of galactic battles and spooky role-playing games, you might think there wouldn’t be much of a niche for entertainment based on health-care policies, and you’d be right. The creation of “SimHealth"--which is distributed by Maxis software, lists for $29.95 and is available only in the DOS format--was subsidized by the Markle Foundation, which has been supporting educational projects since 1927.

The game starts with a little on-screen vignette that shows you getting into a traffic accident. Your injuries are minor but require a visit to the emergency room.

You get so fed up with the bureaucracy and paper work, not to mention the high cost of the small amount of care you receive, that you decide to run for office on the platform of health-care reform.

You’re elected, and the fun begins.

“SimHealth” first asks you to make a few philosophical and moral decisions based on your feelings about liberty, equality, efficiency and community. These kinds of issues hardly ever come up in “Mortal Kombat.”

It’s no fair being totally in favor of all of these attributes. Being totally for liberty, for example, means you could do anything you please and this would clash with unlimited equality. And what is best for a community is not always the most efficient path.

Using a clever diamond-shaped graphic, “SimHealth” challenges you to strike a balance among these values. Then you start putting together your policies, determining how much business, individuals and government should contribute to national health insurance. You also make choices about cost controls and benefits.

“SimHealth” doesn’t oversimplify these issues for game play. In order to play a serious round of “SimHealth,” you’ll have to carefully study the options allowed.

Now you’re ready to see what effect your policies have. The community, represented by a graphic showing about 10 city blocks, includes a major hospital, a family-practice office complex, a high-tech medical-research firm, a city hall, a big insurance company and several small businesses. You begin your first term as mayor in January, 1992.

As the months go by, the condition of the buildings reflects your policies. If you overtax businesses, they crumble before your eyes, becoming abandoned eyesores. Allow ample patient benefits and the family-practice building adds floors to handle the high volume. Put a strict cap on doctors’ fees, and the doctors begin to move out.

You can continually change your policies (like any politician) to try and remedy the ills of your community, but every decision has its costs. Force insurance companies to cover some costly, new high-tech procedure and the ominous high-tech facility will get bigger. But the insurance building might soon be in need of repairs.

You don’t win “SimHealth” by devising the best possible health-care plan. This is the real world, so you win only if you keep getting reelected. To guide you, the game presents you with periodic polls to show what the citizenry thinks of your policies. Every four years it gets a chance to keep or replace you.

As the game years pass, whatever high ideals you had at the beginning get somewhat compromised:

Reduce benefits so the overcrowded medical facilities can improve care and cut down on waiting times? No, it might cost votes.

Force insurance companies to cover a new, somewhat experimental treatment? Sure, as long as it doesn’t cost too much.

Raise revenue by making people pay more of their Medicare costs? Are you nuts?

“SimHealth” is almost too real. Play it and you’ll soon be saying, “There must be a better way.”