—As is typical of for-profit managed care, Dr Cann dismisses the profit motive in the first paragraph and then hides within the citadel of managed care principles for the remainder of his letter. Our Commentary did not attack managed care principles, and we do not advocate wasting resources for any reason, including physician convenience or excessive profit. We fully support thoughtful efforts at continuous improvement of quality and efficiency. With little mention of quality or research, Cann is ready to halve the number of psychotherapy sessions and decrease dramatically inpatient treatment and is at ease with economic credentialing. On what basis are these decisions being made? Patient satisfaction is a valuable driving force for productive change and certainly is essential to marketing, but it is not sufficient to justify curtailing services. Who are the satisfied providers? Are they independent, certified by academic boards, or credentialed by for-profit companies?