Think of the entire health care system as a chess game where the goal is to achieve a healthier population by checkmating against the “darker side,” which represents disease, poor outcomes, inefficiency, and the human suffering of untreated or delayed chronic conditions like pain.

• The patient should be the king: The most important piece. Everything revolves around protecting and empowering them. Without the king (patients), the game does not exist; there is no reason for insurers, providers, or the system. The system was built for patients. It is time we demand it to start acting like it.
• Health care providers (doctors, nurses, specialists like pain management physicians) are the knights and bishops: They have specialized skills to move creatively and directly support the king. They should have the autonomy and resources to deliver timely, effective, patient-centered, multimodal care, including interventional procedures, rehabilitation, psychological support, and judicious treatments tailored to individual needs. However, the patient and the physician, who should be the king and queen on the chessboard, have been reduced to pawns while regulators, administrators, and payers hold the power and act as the king and queen on the board.
• Support pieces (hospitals, pharmacies, labs): Help coordinate the attack on illness.
• Insurance companies and administrators, medical boards, and oversight bodies: Should function like a well-organized backline or rooks who facilitate movement, manage risk, and enable efficient play. But in reality, they have taken over as the self-appointed dominant forces, controlling the board through prior authorizations, step therapy, peer reviews, narrow networks, IPAs, capitation models, and punitive regulatory tactics. They prioritize cost containment, profits, and job security over care, treating patients as disposable and providers as heavily restricted. The result is chaos and massive waste: administrative complexity wastes hundreds of billions nationally; in California, high family premiums (over $28,000), medical debt (more than $10.5 billion owed), and lagging outcomes despite high spending. Everyone watches their back instead of focusing on the patient. “Denials for dollars,” tilted legal systems encouraging “throw mud until something sticks,” and punitive board tactics (accuse first, prove later, especially targeting pain specialists) fuel fear, defensive practice, and reduced access to legitimate care. These misalignments drive physician flight, delay necessary pain management (leading to worse outcomes, ER visits, disease progression, and even increased reliance on street drugs in some cases), and invert priorities away from prevention, longitudinal relationships, and community flourishing. Billions flow to administrative overhead, executive bonuses, and profits while patients wait; providers struggle, and outcomes lag. It is a negative-sum game where the “royal court” (insurers and heavy bureaucracy) wins big, and the king (patient now as a pawn) and frontline pieces lose.

In the current setup, patients get sacrificed for “efficiency.” Providers, as the knights who should move freely to help, face so many rules, prior authorizations, endless documentation, EHR burdens (nearly half their workday), delayed payments, denials (often later overturned), and aggressive board scrutiny that their moves are crippled. They experience burnout, moral injury, defensive medicine, early retirement, or exodus from California to friendlier states. This worsens physician shortages, especially in underserved areas. Insurance-led structures like IPAs (Independent Practice Associations) act as additional layers of control as they contract with selective providers, set tight rules, cap services, and, in some instances, create bureaucratic oversight rather than genuine coordination.

Evidence supporting this picture

This analogy was brought up in my April 12 article, which explicitly uses the king-and-queen-on-the-chessboard imagery to decry how administrative burdens (prior authorizations, etc.) reduce patients and physicians to pawns. On May 14, the article calls for practical fixes like gold card programs, exempting high-performing pain specialists from routine prior authorizations when approval rates are consistently high, to restore autonomy, speed access, reduce burnout, and lower system costs. The May 7 piece laments the gubernatorial race’s lack of a serious health care plan amid physician shortages, regulatory overreach, and misaligned incentives, urging prevention, relational care, tax and regulatory relief, malpractice reform, and smart AI to cut bureaucracy. The April 29 article details how a tilted legal and regulatory environment accelerates doctors leaving California.

This is not just a metaphor; the data lines up closely:

• Administrative waste is enormous: In California, roughly one in four health care dollars (up to $73 billion annually) does not improve care. Administrative costs are a top driver, with estimates around $21 billion yearly in older data. Private insurers and the complexity they create drive a lot of this, things like billing, prior authorizations, denials, and fragmented systems.
• Insurers vs. providers: Insurance administrative costs and profits have grown faster than hospital spending in recent years. Providers (hospitals and doctors’ offices) shoulder heavy burdens, up to 14 to 27 percent of their revenue on billing and insurance-related work, while dealing with narrow networks, delayed payments, and restrictions.
• Patient impact: High deductibles, surprise bills, and access issues persist. Many Californians struggle with costs even when insured. Providers report feeling limited in what they can actually do for patients.
• IPAs and managed care: In California’s dominant managed care environment, IPAs act as intermediaries with their own rules, often under capitation (fixed payments), which incentivizes limiting services to protect margins. This can constrain provider autonomy while adding another bureaucratic layer.

Studies consistently show the U.S. (and California) spends far more on administration than peer countries, with much of it tied to private insurance complexity rather than direct care. This is timely because California’s next governor will inherit a system under strain, which includes, but is not limited to, rising premiums, provider shortages in places, budget pressures, and federal shifts that could cut Medi-Cal funding. The 2026 election (primary June, general November) features candidates with several backing moves toward single-payer or major reform. The core debate fits this analogy perfectly: do we keep the current chessboard where insurers and bureaucracy act as the dominant kings and queens, or reform it so patients are truly central, with providers freer to act? Candidates emphasizing affordability, reducing administrative bloat, prior authorization reforms, and price transparency are essentially arguing to reposition the pieces and protect the patient-king, which gives providers better mobility and curbs the profit-first orchestration of chaos.

Critics of the status quo point to ongoing high costs and insurer margins; defenders of managed care (including IPAs) argue it controls spending. Whoever wins will face big choices on Office of Health Care Affordability rules, Medi-Cal, and responding to federal changes. Voters who care about this should look for candidates focused on real simplification and patient and provider empowerment over layered bureaucracy that benefits the backline at the center’s expense.

Kayvan Haddadan is a physiatrist and pain management physician, and president and medical director of Advanced Pain Diagnostic & Solutions, a multidisciplinary pain management practice in California that he founded in 2012. A physician and surgeon licensed by the Medical Board of California, he is double board-certified in pain medicine and physical medicine and rehabilitation. He is also certified in controlled substance registration through the DEA and serves as a qualified medical examiner through California’s Department of Industrial Relations Division of Workers’ Compensation.

Dr. Haddadan earned his Bachelor of Science degree from the College of Alborz in Tehran, Iran, and his medical degree from Shahid Beheshti University of Medical Sciences. He later received his Educational Commission for Foreign Medical Graduates certification in Philadelphia, completed an internship in medical surgery at Loyola University Medical Center’s Stritch School of Medicine in Illinois, and finished his residency in physical medicine and rehabilitation at the same institution. He completed his fellowship in pain medicine at California Pacific Medical Center’s Pacific Pain Treatment Center and also trained in medical acupuncture for physicians at the University of California, Los Angeles David Geffen School of Medicine.

Dr. Haddadan has contributed to 29 research publications across multiple specialties, including pain management, cardiology, pulmonology, endocrinology, gastroenterology, and infectious disease. His work has examined topics such as hyperlipidemia in high cardiovascular risk patients, hyperuricemia and gout management, type 2 diabetes and hypertension, chronic obstructive pulmonary disease and asthma therapies, influenza treatment, irritable bowel syndrome, and opioid related complications in chronic pain care. His research has also included clinical outcome studies in spinal cord stimulation and award-winning presentations on neuropathic pain management and neuromuscular disorders.