ABSTRACT
Chronic pain management remains an elusive and frustrating goal despite growing knowledge about the pathophysiology of pain. Patients seek cure based on physical abnormalities. Employers and the federal government remains the major purchaser of health care. Employees view insurance contributions as a supplement to, rather than a substitute for, cash compensation. Kaiser Permanente is a health maintenance organization largely found in California and is operating under a group model with salaried partner providers. Northern California Kaiser started a cognitive-behavioral approach with group visits for pain management in the late 1970s. Consumer-driven health-care decision making is currently trendy but fraught with problems. Consumers will face significant obstacles in understanding the quality and even the comparative price of health insurance. Transparency will make difficult the pooling of risk from healthy citizens and those who have chronic pain or redistribution of income from rich to poor that otherwise result from the collective purchasing and administration of health insurance.
