U.S. Healthcare Is So Trash This Game’s Localisation Needed Changing

U.S. Healthcare Is So Trash This Game’s Localisation Needed Changing
Image: Spry Fox

The American healthcare system is so uniquely terrible among developed countries that a localisation team translating a recent indie game had to completely replace a line about crowdfunding an emergency medical procedure because it wouldn’t make sense to players outside of the United States.

Cozy Grove, which launched back in April, is a wonderful little simulation game about setting up camp on a charming, haunted island. At some point, one of the several ghosts that you can meet over the course of the game underlines the importance of making friends with a scary hypothetical: “What if you get sick and need to crowdfund your appendectomy?!”

This scenario is, unfortunately, an all-too real reality for many Americans. Despite living in one of the richest countries in the world, more than 1/4 of the campaigns on crowdfunding site GoFundMe between 2010 and 2018 were related to alleviating healthcare costs in the United States, according to a recent study by the American Medical Association.

Additionally, 18% of Americans have donated to a healthcare-related crowdfunding campaign at some point over the last year, social research organisation NORC at the University of Chicago reported in April. The study also found that almost 40% of these donations come from households that made less than $US60,000 ($76,956) a year.

“People reported that the vast majority of donations were going to campaigns raising money for cancer treatments and accidental injuries,” said Dr. Susan Cahn, a senior research scientist at NORC and co-author of the study. “This information highlights again where gaps in insurance coverage — such as high out-of-pocket costs — may exist and the challenges that Americans with serious illnesses continue to face.”

So when it came time to release Cozy Grove in Spain, a country with public healthcare, a 1:1 translation of the crowdfunding reference wasn’t going to cut it. Instead, the folks at localisation studio Native Prime changed the ghostly NPC’s line to a more innocuous statement about keeping friends around in case you need help moving furniture. Native Prime highlighted the adjustment on Twitter back in May, but it was brought to our attention more recently by Cozy Grove co-writer Kris Ligman, who praised the localisation and rightfully pointed out how terrible it makes the United States healthcare system look.

“The point of game localisation is not just to translate what is said nor ‘erase’ parts of other cultures, but to make players from all countries react the same way a U.S. player would, which in this case is to make them laugh,” Native Prime project manager Isa Gutiérrez explained under the original tweet. “If a Spanish player read, ‘I need friends to pay for my appendectomy,’ they would probably not laugh, they’d be like, ‘Why would I want friends to pay for that?’. That’s why we used a more relatable situation for the Spanish public.”

A rep for Cozy Grove developer Spry Fox told Kotaku via email that the studio gave Native Prime free reign to localise the game as they saw fit.

Since its release, Cozy Grove has attracted both praise in the press and anonymous disparagement for its understandable critiques of capitalism. I’ve yet to play the game much at all myself, but from the little I’ve seen, it’s right on the money when it comes to the woeful inadequacy of American healthcare. This situation serves as another brutal reminder that the modern world has largely solved this problem, and it’s only the United States’ love affair with privatisation that keeps those of us who live here under the constant threat of having to choose between life and insurmountable medical debt.


  • Eeeehhhh, I’m sure spanish gamers are aware of the Yank medical system’s “winner-takes-all” structure.

    • As Australians (I’m assuming) we’re well aware of what a horror the American healthcare system is because we’re saturated with American media (which is also why any health minister saying they admire America’s health care system is such a spine-chilling event). Spanish people wouldn’t have that saturation so there’s a decent chance that a reference to having to pay for a friends appendectomy would make the story less relatable.

      • Spine-chilling indeed. The reason “medicare” cost them so many votes was because no one had any trouble imagining the Liberal party adopting the American model of healthcare.

  • There was a quote floating around sometime ago that really nailed how bad American healthcare is:
    “Every heartwarming human interest story in america is like “he raised $20,000 to keep 200 orphans from being crushed in the orphan-crushing machine” and then never asks why an orphan-crushing machine exists or why you’d need to pay to prevent it from being used.”

  • Ill never understand why Americans think someone choosing between being alive or having a house is an okay thing.

    • In all fairness, I’ve been on a waiting list for 5 years to have a shoulder operation so that I can do basic tasks without pain, bit tough when you’re a cabinet maker lol. And my monthly physiotherapy bills are so expensive that my private health cover (which pays 60% of the bill) only lasts 4 months before I’m paying full price.

      And my 67 yr old mother had been waiting that long for a hip replacement, her other side had deteriorated to the point (because she was forced to overuse it) where she needed that side replaced… For which she was put on a separate waiting list for. Oh… and the one that was replaced… yeah, came in at 2cm too short…

      I’m not saying America’s health system is good, by any means… But I can definitely say that our public system isn’t exactly fantastic.. unless you want a medical cert to wag school…

      • Id take the waitlist over a 100K+ bill for a hospital visit. Keeping yourself healthy should not send you into poverty.

        • Don’t get me wrong… they need to sort out their system.

          But atm, I’ve spent over 20k on physio alone, trying to manage pain, that’s fixed with a simple surgery. Once you factor in other costs associated with mental illness due to chronic pain.. It ramps up… Quality of life isn’t exactly pleasant. I’d rather be 100k in debt and this shoulder be fixed

          Don’t get me wrong, I’ve experienced the good of our system also, on many occasions.

      • US Healthcare doesn’t have waitlists because most people can’t afford the treatment they need so they dont get it.

      • The question with that is “why has our public system become so decrepit?”

        The answer is, of course, successive governments desperately trying to kill off our Universal health system in exchange for one like USA’s.

        Your pain is literally a result of capitalism trying to squeeze money from you.

        • ” Your pain is literally a result of capitalism trying to squeeze money from you.”

          Pretty sure his pain is “Literally” the result of something inside his body. Not capitalism.

          • His pain could have been sorted out in short order if our government had not systematically dismantled the checks and balances that keep our universal healthcare system healthy and efficient. Medicare is strained to breaking point because it’s being starved in order to push people into a US-style private healthcare system. These actions have directly caused his continued pain.

            He could be out of pain if not for capitalism. So yes. Literally. Don’t try to be smug about using “literally” wrong when a) I haven’t and b) you’d rather be grammar police than give any real counterpoint.

  • so if the general public are paying for other peoples health care anyway via crowd sourcing… why not just increase the tax everyone pays and the system will pay for itself? either way the money is coming out of the healthy persons pocket.
    america seems to do everything backwards. like paying hospitality workers pennies and then expecting the customer to pay their wage. just increase the cost of the food and use it to pay your staff a proper wage, the customer still ends up paying the same.

    • America is basically one big battle royale where everyone only cares for themselves. Hard to believe they think their system is fine when they have some of the largest homeless populations in the developed world.

      • It’s fundamentally different approaches to government as well. Australia views government as servants of the people, America views them as a necessary evil. The outcome between the two really is shown in the results, in that even the most politically indifferent Australian is aware of government stupidity, compared to the equivalent American who knows nothing about their own civic system to even see the stupidity.

        • Approach to federalism is wildly different too; when we needed to initiate lockdowns, we’re able to do so. US is much more restrictive there. And even countries like Japan have issues with it; their post-war constitution prevented the government from implementing a full lockdown under health orders, so they had to resort to stimulus packages to get, for instance, small bars to shut down. By 8pm.

          • Our is also one of the oldest constitutions around, yet there was enough forethought back in the day to make allowances for changing future conditions, like States being able to refer powers back to the Federal government (enter the modern healthcare system).

            In American and Japan, it feels like a lot of the measures that were meant to protect the citizens ended up harming them instead because they’re so heavily entrenched and there’s no accounting for unforeseen events.

          • @louie Sorta… a lot of people conveniently forget that ammendments are an actual mechanism to fix or update their constitution provided both sides agree (prohibition is the biggest example here as alchohol is technically illegal in us had it not been for an amendment) The huge problem with America is within the last few years ideologies and politics have been grossly polarised to the point agreeing on anything is practically impossible. Add in thevery many vested interests from both sides of politics to keep their own status quo you’re stuck in a system where nothing is ever fixed..

          • @rock_m the drawn-out political process know as US elections fosters tribalism. You could almost say it encourages it. Even though our systems has its issues, At least its over and done with far quicker.

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