Perhaps America's worst Christmas present in 1993 was given by
Maxis Business Simulations. With money from the Markle Foundation,
the company produced a computer game called SimHealth, which allows
you to design your own national health care system.
Building on computer simulations long used for determining how
industrial products will work before they're built, Maxis has
created a number of games.
One is SimLife, which allows the player to design genetic
mutations. SimAnt does the same for insect colonies. SimCity allows
you to try your skills in urban design.
Even tiny changes introduced by the player can create the most
amazing and far-reaching effects - in species, ants, or cities.
But a health care game? That's not so innocent. Consider:
First, players establish their basic priorities. The game
allows two: one about the degree of liberty versus equality to
build into the system, the other between efficiency and community
These are hardly the only basic choices to be made about health
care, or even the most important.
Second, players are given penalties for introducing any
inconsistencies into the program. They lose "political chips" for
doing so, which translate into lost votes - and ultimately lost
This happens to be the opposite of political reality - no small
fault in a simulation.
Third, players are allowed to test any variations they
introduce according to both optimistic and pessimistic assumptions
Thus, increasing certain kinds of health coverage can either
raise demand for care by small or staggering amounts, depending on
one's choice of assumptions.
As a game, it may be fun, though not particularly realistic.
But as a serious policy tool, it's both a snare and a delusion.
Computer simulations may work for testing whether or not an
airplane will fly, but they don't do well at all for the messy
worlds of economics and politics.
Even standard computer runs by the Office of Management Budget
and the Congressional Budget Office on the cost of specific changes
in the tax code are discouragingly inaccurate. And they examine
only simple numbers.
OMB and CBO wisely make no attempt to quantify the possible
range of taxpayer reactions to those changes - never mind trying to
calculate the effect of them on the rest of the economy.
They don't try because it can't be done. Policy makers may be
the poorer for lacking such information, but they are forced by the
limitations of human ability to do without. …