Many mental health practitioners find it necessary to use the Diagnostic and Statistical Manual of Mental Disorders (DSM) for insurance purposes but are unhappy with its basic assumptions. This raises the question—Would it be possible to devise a new classification system that (1) could be used for insurance purposes and (2) would be based on alternative principles? In the main, this commentary is pessimistic. Through considering the history of attempts to devise alternatives to the DSM, I will argue that it would be extremely difficult to develop an alternative to the DSM that could be used to fund psychotherapy via health care insurance in the United States.