I recently had a spirited exchange with someone on LinkedIn about the economics of mental health care.
It started with a familiar question: if early intervention and access to therapy saves money (which they do), why aren’t insurers doing more to cover it?
It’s a fair question on the surface. But the answer exposes something deeper—a structural failure of the insurance system that no amount of data or well-meaning modeling can fix. 
I’ve worked for health insurers directly. I’ve been in the rooms where care pathways, access thresholds, and cost-containment strategies are debated. I’ve seen the actuarial forecasts and trend reports. And here’s the truth:
Insurance companies know that access to mental health care saves money in the long term.
They don’t need more evidence. Some have even published it. Evernorth, the health services arm of Cigna, reported that three timely outpatient therapy sessions saved over $600 per member for the health plan.
And still—coverage delays, denials, narrow networks, and administrative burdens persist.
Why?
Because health insurance is not designed to invest in care. It’s designed to manage risk and minimize payouts during a narrow window of time.
Most insurers know their members churn frequently.
So even if better mental health coverage could reduce hospitalizations, emergency visits, or disability claims, there’s no guarantee the savings will accrue to the same plan footing the bill for therapy today.
Add to that: mental health is still reimbursed at lower rates than medical care. It’s often carved out into separate benefit management systems.
And parity enforcement is weak or inconsistent. Our current administration is considering walking back on federal parity laws – which tells you everything about who or what they aim to support.
Mental health has been structurally deprioritized for decades, not because it’s ineffective, but because it’s seen as a cost center, not a profit driver.
When someone suggests that if cost savings were real, a company would “implement it tomorrow,” I get it. That logic works in other industries. But health insurance is different.
This isn’t just about modeling. It’s about a business model that profits when people don’t use the product they pay for.
Let that sink in: health insurance makes the most money when people don’t access care.
So even when models show that therapy works, even when clients and clinicians report progress—insurers aren’t satisfied.
They delay.
They deflect.
Not because it’s irrational, but because it serves the logic of cost containment and shareholder return.
We can’t assume cost savings equals action.
And we can’t keep blaming clinicians for systems designed to undercut the care and financial value of what they provide.
The failure of progress in mental health access is not due to clinicians’ inability to “adapt” to the system.
It’s due to the system’s inability to recognize, respect, and fund the kind of work that cannot be mass-produced or squeezed into a cost-reduction algorithm.
If we want a different future for mental health care, we have to stop asking clinicians to play nicer in the sandbox.
We have to start asking why the sandbox was built to box us in and who benefits from keeping it that way.
References:
- Milliman Report on Behavioral Health Disparities (2019)
- Evernorth: Behavioral Health Impacts on Total Cost of Care
- NBC News: UnitedHealth Sued by Shareholders
- NAMI: Mental Health Parity Policy Priorities
