We must skip over whether Dr Davidson’s “Little ICU” model of part-time intensivists who “fill their non-ICU hours with pulmonary, sleep, and some internal medicine consults” actually are providing the intensivist-led critical care that we think the evidence, such as it is, supports. The only fiscal issue he considers are the physician income and critical care revenue impacts on hospital budgets. These are important barriers to restructuring of critical care, and financial incentives can be a powerful force for good or evil. His argument completely ignores the trade-offs of spending money from a limited medical education budget on intensivist training rather than the hospitalists, palliative care, and family physicians that these communities also, and will increasingly, lack. He ignores the fact that the “Little ICUs” will not be able to find nurses because his model will lead to critical care bed growth that will outstrip the nursing and other health-care worker supply. He has not really addressed that even if there are jobs, intensivists may not choose to work in “Little ICUs.” But these limitations pale compared with the effect that this proposal will have on the overall health-care budget in the United States. Projecting future need for critical care services based on current demand will contribute to financially unsustainable growth in medical care costs. There is no question that an aging population will need more intensivists, and geriatricians, internists, surgeons, nurses, and health-care workers in general. The past two editorials do not ignore the future need for intensivists; they are a plea for our field to consider a broader set of solutions and fiscal realities than the status quo Dr Davidson guards.