The time has come to stop the federal fun of substituting word games for responsible planning. The advertising and corporation executives brandishing the New Federalism (more executive power, less accountability and responsibility) have had their turn at the wheel. Playing ideological roulette with an imperfect but once encouraging biomedical enterprise, they have successfully evaded serious dialogue about goals. They have substituted pseudomoral platitudes and "free market" economic jargon for the hard work of confronting the practical issues of who supplies, delivers, and pays for reasonable care for the mentally ill. There is no magical option: The patient, third parties, or governments must pay the bill, or mental health skills will be dissipated, available only to the very rich.