[LGR theme music]
[roar]
[sips] Aaahh!
[typing]
Looking back at classic Maxis titles,
there are a few that really stand out to most people.
SimCity, SimAnt, SimCity 2000, SimTower.
But one that is almost completely forgotten is SimHealth,
The National Health Care Simulation.
This was released by Maxis and The Markle Foundation in 1994,
developed by a team calling themselves Thinking Tools, Inc.
It's forgotten for a few reasons,
the biggest being... uh, it's actually a long story,
so let me just start at the, uh...
start.
The Markle Foundation is a non-profit organization
founded in 1927 and is based in New York City.
Their focus is advancing health and national security
through the use of information and technology.
During the early Clinton administration,
there was ongoing battle raging over healthcare reform,
coming to a head in Summer of 1994.
During that same time, Maxis had been seeing tons of success
with simulation titles like SimCity,
so with Markle's agenda, Maxis' simulation expertise,
and the goings on in Congress,
it was a perfect storm of timing.
And with a $350,000 grant from Markle,
Maxis Business Solutions got to work on SimHealth in 1993,
exclusively for MS-DOS PCs.
Before release, a preview version of SimHealth was given to journalists
and those involved in the healthcare debate at a press conference on Capitol Hill
in November of 1993.
Then right before Summer of 1994,
SimHealth was made available for purchase to the public
by way of phone and mail-order,
forgoing the usual wide retail release of other Maxis titles.
According to The Markle Foundation,
it only sold a few thousand copies
and was simply "not entertaining enough"
to ever see the regular store shelves.
It came in this box,
which is a bit thinner than other Maxis titles,
and it's actually the same size as the SimCity 2000 expansions released that year.
I've also come into possession of this odd version
which I've dubbed the "Silver Box."
It's got different artwork, a different subtitle,
different screenshots on the back, and it's dated 1993
instead of 1994.
I have a feeling this is either an early version available from The Markle Foundation
or perhaps even the 1993 preview version.
I don't really know for sure.
So, that's the backstory. Let's get into the game.
SimHealth comes with the game on two high-density 3.5-inch floppy disks,
as well as a helpful and witty-written manual
penned by none other than Michael Bremer,
who is famous for doing the documentation
for practically every Maxis game,
from SimCity on through The Sims.
Being released shortly after SimCity 2000,
Maxis ended up using many of that game's assets in SimHealth,
starting with the installation program.
As such, the requirements were a bit high for the time,
requiring VGA graphics and 4 MB RAM minimum.
Once the game starts, you're greeted with a classical tune
and a cool title screen by Bruce Ariss,
who is known for painting murals in California in the 1930s
alongside the social reform policy questions of those days.
From here, you can choose to read a bit about the game,
start a new game, or take the tour.
I highly recommend taking the tour,
as it's a very easy-to-use interactive tutorial of SimHealth
and all of its features.
It's worth noting that an easy way to tell if you're playing the preview version or not
is to try the tour,
since the preview version lacks all of the tutorials
and will give you an error message.
The preview version also requires SVGA and has better graphics.
Not really sure why they downgraded to VGA 16-color mode.
The tour is also a good introduction to the SimHealth recording function.
During the simulation, you can choose to record your activity
and then play it back with or without notes,
which was meant to be used for classroom and presentation purposes.
You can even view built-in demonstrations of various politicians'
proposed healthcare plans.
You can start a new game at any time–
and okay, now pay attention,
because the most exciting part of SimHealth is about to occur.
[tires screech, cars crash]
[ambulance siren]
Yes, you see a nasty wreck at an intersection
and it is revealed that you were one of the passengers in the car.
After being taken to the hospital and being poked and prodded in ways
that really irked you to no end,
you are then overcharged on top of all that
and decide is enough is enough
and proceed to run for political office
on the platform of healthcare reform.
From here you get another musical ditty
in the options letting you choose your stance and goals.
This will determine the entire outcome of the simulation.
You are judged not by the values you select–
a balance of community, efficiency, liberty and equality–
but rather how well you stick to those values
over the course of sixteen years.
You're given some background on each of these options,
as well as the ever-useful What and Why buttons in the top-right corner,
which are context-sensitive query tools.
After selecting your values, you are automatically elected
and a simulation begins.
The main street view here is called...
uh... Main Street,
and as you can see, it uses many of the graphics from SimCity 2000
to represent different parts of SimHealth.
It also serves as a vivid yet ambiguous representation
of how your policies are affecting America at large.
You have the policy office, police station,
insurance headquarters, courthouse,
medical technology building,
small businesses, big businesses,
resident citizens, primary care and specialists,
and of course, the hospital.
And for some reason that initial crash of yours
never disappears from this screen,
just staying there, rotting,
reminding you that the good times are over
and it's all serious political loveliness from now on.
These buildings serve as a more interesting representation
of the policy-making interface at the top of the screen.
And they'll also change in appearance in congruence
with the effects of your active policies.
Enact big policies that will benefit big business but hurt smaller clinics,
big businesses will get even bigger
and the clinics will soon be smaller and in shambles.
This is a really basic way to judge your performance,
although it's made pretty clear there are no right or wrong answers,
only results.
That is, the entire point of SimHealth
is to manipulate the healthcare system
by simulating the years 1992 to 2008,
and every couple of years it will be re-election time.
And you will either win or lose the election,
depending on how you've performed since the last election.
This is shown through polls, as well as the condition of your Main Street.
Even if you make it all the way to 2008,
all you get is a score based on mostly
how much you've held to your initial principles.
In fact, you can just set your promises,
set the game speed to max,
and a notification will have to be clicked here and there
and the entire sixteen years will be over
in about sixteen minutes.
Obviously, you are meant to do more than that,
but that gives you an idea of what SimHealth really is.
You'll notice I haven't called it a game once, and there's a good reason for that.
It's not a game whatsoever.
It's really an economics model simulator
that happens to have a fancy UI slapped on top of it.
This is really obvious when you check out the Assumptions menu.
This should be a familiar sight to anyone who paid even a little bit of attention
in their introductory economics class.
These assumptions are set at the beginning of the simulation
to allow, disallow or tweak certain data from entering the model
that SimHealth uses to decide the effects of your policies.
Anyone who's worked with economics or statistics knows
that any model is only as good as your assumptions,
so it's nice to be able to tweak these
for a larger variety of potential models.
Of course, you can't actually see the math
that's behind the models in the first place,
so there are some limitations to SimHealth's calculations and possibilities.
That said, what it's meant to do it does very well.
A typical gameplay routine consists of you starting off in the Policies Room
and choosing the basis for your healthcare system.
You can then refer to the then- current U.S. model as a basis
and then change it from there to your heart's content.
You can also choose from the Universal New York Care system
or even the Canuck healthcare system.
[MIDI version of "O, Canada" plays]
And you can also fine-tune individual benefits,
cost control and insurance funding sources.
Fun times.
But there are only so many choices you can make
in any given policy-making session,
which is determined by your overall performance.
For every action, you are either given or charged a certain number of chips.
Each policy change costs a certain number of these chips.
There's also a budget to maintain, but honestly, who cares?
It doesn't really seem to affect anything.
It's not used as a currency, it's just another one of those things
to let you know how you're doing.
You're probably going to go into the red anyways.
And as long as you have the chips and keep getting re-elected,
just keep passing legislation and hope the populous endures.
Each of these options are represented
by the bar of icons across the bottom of the screen,
which provides easy access to each of your policies.
Otherwise, all you'll want to do is wait around for something wild to happen,
like ambiguous new technologies and cures that you'll decide whether or not
to include in your healthcare system,
budget reports, health conferences and elections every two years,
which are not interactive – it just lets you know the results.
You really can be as involved or uninvolved as you'd like.
As long as you're in office, it's all good.
And then if you last sixteen years, it's all over,
and you're scored based on how well you've held onto your principles.
Eh, you might be thinking, "Wow, this looking frickin' boring."
And you'd be right.
I'd blame it on the bland subject matter, but
urban planning isn't exactly the most entertaining subject, either,
and I find SimCity very enjoyable, whereas this I do not.
And SimHealth is a very well-made simulation of healthcare policies
and making a very tedious set of models
very approachable, simple to manipulate and see results.
On those merits, it's really stood the test of time.
In fact, it's still being used by schools like Penn State
in their HPA 101 class.
But if you start the program having played other Maxis titles,
you're really setting yourself up for disappointment
because it's simply not very fun to play with.
I mean, you can't really play it at all.
It's basically a teaching aid with SimCity 2000 graphics on top of it.
And there's nothing wrong with that because that was its purpose.
So it's a lot like eating dry oatmeal or granola.
It might theoretically be good for you,
but unless you're being commanded to partake
or you're just strangely curious,
you probably don't want to have anything to do with it.
[MIDI piano music plays]