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In response to growing public criticism of the way health maintenance organizations handle behavioral (mental) health problems, public officials in Philadelphia propose a dramatic initiative: a new public agency to replace what had been a privately-run system, albeit supported by public Medicaid funds. But would this be a better way to ensure that some of the city''s most deeply disturbed residents - many with drug, alcohol, and psychiatric problems, many among the ranks of the homeless - get the care they need? case frames the decision which the City Council must make, as it weighs reports that private health care providers have compromised the quality of care in order to safeguard profits and determines whether such reports are serious enough to replace the private system with an untested public sector alternative. Council members must decide whether the existing public system could be improved through oversight or regulation, and whether a public agency would have the capacity and incentive to manage the challenges of both treating a difficult population and managing the complexities of the public health care financial system.