(4). clinic
What is the expression—believe nothing you hear, and only half of what you see?
I’ve made references to capitalism throughout these essays, and how I think it’s bad. Big whoop. You might be sympathetic to this worldview, it might make some kind of sense to you. And yet, we continue to labor beneath it, we continue to have to live within it. When you’re trapped in a cage, eventually that cage becomes your entire world, and you don’t even notice the bars anymore. You stop rattling and you start living, resigning.
Alban Viard’s Clinic is about the cage.
I like the word didactic. It means to teach, with some kind of motive. There are lots of didactic games out there. There are games that are meant to tell you how something is bad. Some games cast you as a villain, where the point is to lie or be mean. Some games have you play Nazis, some games have you kill Nazis and feel self-satisfied. One indie game that springs to mind is The Cost, a game where you mine asbestos and decide whether to prioritize profit or kill your workers.
What drives me absolutely insane about this sort of thing is how the game presents players with a sort of false consciousness: Do you want to be a good guy? Do you wanna be bad? Here’s what bad guys do, and here’s what good guys do. The curtain comes up, and people get to pretend.
I think this sort of role-playing is fine, but I’ve seen it repeated so often that it starts to seem a little infantile to me, in the way that a Brad Paisley song with a Volodymyr Zelenskyy feature seems woefully grotesque.
Of course, there are plenty of games that glorify the greed of capital. There are many games that create perfect economic systems that are perfect for exploitation, with perfect amounts of resources and endlessly expendable labor.
Clinic is about the cage.
The premise of the game is an easy satire on its surface. You’re running a clinic. It has doctors. You have little patients, represented by different colored cubes. When you treat patients with the right doctors, you make money, and you make more money the sicker the patients are. Anyone who has spent 35 seconds in the American healthcare system is familiar with its rapaciousness, and if Clinic were simply satire, it wouldn’t be that interesting.
In the game, each player has a board representing their clinic. On their board, they build their clinic in three dimensions, adding entrances, supply closets, treatment rooms, special facilities, and dozens of other options.
The goal is to develop what is essentially a factory. The game has a set number of patients that enter an available pool every round, and players compete to grab the patients they need, storing them in “waiting rooms” until they get sick enough to treat, and then moving them to the right treatment room and the right set of doctors and nurses who can treat them. The less efficiently your clinic treats a patient, a negative resource called “time” stacks up, costing you negative points at the end of the game.
The game is not about having the most money at the end—it’s about having the most points. At the end of each round, players must make a decision to convert the money they made that round to points, which determines how late in turn order they get to act in the next round. Money saved up is meaningless at the end of the game, so this mechanism models taking available capital and “investing” it.
Here’s where the game starts presenting contradictions.
Every tile you add to expand your clinic costs money, you have to pay the wages of your staff, and you have to park everyone’s goddamn cars in a parking lot, which reduces even more of your space. You can build a perfect machine, one that intakes patients swiftly, and treats them effectively, but while you’re doing that, your opponents will be trying to out-compete you for income and points. There are only so many patients, and only so many pieces of equipment available. The game rewards you for building larger and more unwieldy infrastructure because the larger it gets, the more opportunities for exploitation and profit exist.
And the thing is, you can’t really build a perfect machine. Your doctors gradually become stupider and require more and more nurses to help treat sicker patients, which cuts into your bottom line. Everyone is constantly competing to take in more patients, and each time they do, there are fewer and fewer to go around. You race to the bottom, and then the game is over.
Clinic has dozens of small modules that you can add to the game to add additional features. You can add additional employee types, new facilities, new types of patients, geriatric patients that generate income for you every round, and on and on. But, the more of these you play, the more you start to see that none of them are able to change the fundamental core of the game, because the core is a contradiction.
The contradiction is that it is impossible to create fairness, care for human life, or eliminate wastefulness in a system that is predicated upon exploitation. A system that encourages people to get more than they put in can only ever create and reinforce inequity. In a way, Clinic is a satire of liberal interventions into capitalism, a parody of the idea that an exploitative economic system can somehow be made nice, non-violent, or without severe costs. Oh look! New markets! Oh look! A new, fairer process! Oh look! Means testing! Oh look! Better technology!
If, as a premise, a game begins with a simple incentive structure in place: here is a puzzle. Exploit it better than the other players in a specific time frame and you win.
Average all of that exploitation together, and you get one loser: everyone.