When Health is a Game

By Robert Schroeder

The CNN/Tea Party Express Republican Debate September 12 is notorious not for what any of the candidates said, but for an outcry from the audience.

"Let him die!"

That was the response to a question asked by CNN's Wolf Blitzer about how the candidates would accommodate an uninsured 30-year-old needing six months of intensive care. The moment was condemned by most in the media and on the political spectrum, but the fact remains that millions of Americans and government officials are annually faced with literal life-and-death questions like these.  In National Louis University's health leadership program, David Rice, Ph.D., professor in the College of Management and Business, is taking a unique approach to guiding students through these decision-making challenges.

Rice has created a board game that guides students through the options and consequences of treatment paths.  The game is a virtual choose-your-own-adventure model that gives students the safety of experiencing the best and worst of American health care without any repercussions.  The learning model was the subject of a presentation by Rice on "Playing Games in the Classroom" at the regional meeting of the International Assembly for College Business Education Oct. 2-5 in Rensselaer, Ind.

"When playing a game, people express their feelings much more freely and they don't apply their normal social filters," Rice said. "People are very free to say, 'let him die.'

"They would never say that in polite classroom discussion, but it allows them to express feelings held by substantial parts of the population."

The game introduces students to self-pay models, in which the consumer pays for all care, and a collective pay model, similar to a single-payer system.  Students are forced to balance their expenditures between health care they want to spend money on and care they are forced to purchase.  The game requires students to balance their own feelings about providing health care for others; some students may personally refrain from care because of ethical and religious reasons, but the game allows them to explore the consequences of prohibiting care for others.

"When students see others without shared coverage facing a situation of being entirely bankrupt, it changes it from an abstraction to a reality," Rice said. "Students I talk to after a course remember what they had reinforced by the game much more than they remember from things they just learned in a textbook."

Rice has not yet updated his game to reflect changes to the health care system from the Affordable Care and Patient Protection Act of 2010.  Most parts of the law go in effect in 2014, assuming the law stands scrutiny of the courts and a possible vote to repeal.  His game does not yet tackle the specifics of payment structures because of the often-confusing plan options in place.  Ultimately, Rice hopes his game can be a tool for students to rethink their personal approaches to health care systems.

"People are urged to evaluate policies based on things they do expect to pay for, which focuses attention on direct payback," Rice said. "These are things you would be better off for if you were all paying cash and weren't subjected to inflated pricing that allows insurance companies to provide exclusive discounts only available to their customers and not those paying cash, which distorts the whole system."