ICU care is expensive and not always successful. In the United States, upward of 0.66% of the gross domestic product is spent on critical care services, and care for those who die in ICUs totals tens of billions of dollars a year.16,59,60 It would seem then that the ICU might be an ideal location for rationing. In our experience, some physicians believe that health-care costs should be substantially reduced by strategies that allow unilateral withdrawal of life support in ICUs when patients do not respond fully to a trial of intensive care. However, Luce and Rubenfeld’s59 analysis of ICU cost structures reveals that the truth is less straightforward. Because > 80% of hospitals’ budgets are independent of the volume of patients treated (ie, fixed—mortgage, maintenance, utilities, and essential personnel salaries), only 20% of costs are modifiable on a per-patient basis (ie, variable—medications, diagnostic and therapeutic equipment, or patient care supplies). The analysis suggests that authorizing unilateral withdrawal of life support when ICU care appears to be failing is unlikely to meaningfully reduce costs. Several empiric studies support this claim.61,62 Limiting the number of ICU beds built—and closing existing ICU beds—presents much greater opportunities for cost savings because both fixed and variable costs would be reduced.