Saturday, May 15, 2004

Health coverage juggled in game

Dilemma: Demand exceeds budget

By Tim Bonfield
The Cincinnati Enquirer

NORWOOD - It's one thing to say everybody in America should have health insurance. But coming up with a way to pay for it isn't simple at all.

That was the message Greater Cincinnati residents walked away with this week after playing a simulation game that asked them to design a health insurance plan for everybody in the region.

The simulation, called Choosing Healthplans All Together, offers a lesson in the tradeoffs people make when confronted with a limited budget and nearly unlimited demand for health care services.

"It makes me sick to think that in this country there isn't enough money to take care of everybody," said Karen Bell, a nurse who lives in Walnut Hills.

The simulation sessions, held Tuesday and Wednesday in Norwood at the Health Foundation of Greater Cincinnati, were part of several local events marking "Cover the Uninsured Week," a national awareness campaign.

Players were given $6,000 to spend, divided into 50 chips worth $120 each. The amount roughly represents what health insurance premiums cost per person in Ohio.

Raising taxes to get more chips isn't an option, but choosing not to spend some chips to keep as income or savings is allowed.

People play the game in groups of about a dozen each.Here's what happened with a group that played the game Wednesday:

• The group quickly agreed that a community health plan should offer better than bare-bones coverage for hospital, doctor and pharmacy services. Reflecting a distaste for HMOs, players were willing to spend several extra chips to ensure minimal restrictions on choice.

But there was nearly no support for the highest levels of coverage, which charged people nothing for most hospital and doctor services.

• While covering the uninsured was a high priority for most players, the group split over what to give up to pay for it.

Paying to cover all uninsured children cost only one chip, which was widely supported. But paying to cover all uninsured adults cost five more chips.

• The group soundly rejected covering services such as acupuncture or herbal remedies.

• Most players also rejected spending on experimental medicine. In general, players said they were willing to see the pace of medical discovery slow down in return for making money available to cover the uninsured.

• Support for preventive care also was thin. Even though smoking and obesity are major public health issues, players generally agreed that people should pay for their own smoking cessation and weight loss programs.

• Very few people opted to put money into medical saving accounts. Even fewer opted to keep money and just spend less on health care coverage.

How would you solve the problem of the uninsured? For groups interested in playing the Choosing Healthplans Altogether game, contact Judith Warren at the Health Foundation, (513) 458-6615, or e-mail


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