These are important questions, but I'm a clinician and researcher, not a managed care administrator or public policy maker. I think I should stick to my area of expertise. But I will offer two comments.First, I am unaware of any other area of health care where decisions about insurance policiy precede consideration of what constitutes good care. Physicians routinely perform unnecessary and expensive procedures, order unnecessary and expensive lab tests, imaging studies, etc. No one second-guesses medical decisions to perform, say, coronary bypass surgery, or orthopedic surgery, even where empirical evidence indicates the procedure is unhelpful and may be harmful. I am not justifying or excusing bad health care policy with respect to medical decision-making. I am pointing out a double standard: there is no other area of health care where people think it is appropriate for discussion of administrative regulations to precede (trump?) discussion about what constitutes good practice. Why is mental health alone singled out for such "special" treatment?Second, research shows that psychotherapy reduces health care costs (because when patients receive appropriate mental health care, unnecessary use of other health care services decreases). This phenomenon is known as the "medical cost offset." For example, the depressed patient I discuss in my blog was spending (or more correctly, his insurance company was spending) nearly $1000 monthly for medications that were not helping. It had gone on for 15 years and could have gone on forever, and no insurer ever questioned it. Weekly psychotherapy was less expensive, far more effective, and ended (successfully) within 18 months. What is the rationale for giving a "free pass" to expensive and often unhelpful (and endless) pharmacological treatments, while singling out psychotherapy alone for special scrutiny?