INTRODUCTION For intensive care medicine, significant advances in care have been limited in recent years. A wealth of randomized clinical trials and a wide range of new protocols have yielded a wealth of understanding but have not created the next-generation care hoped for. As a result, a “less is more” perspective is growing in the field. This opinion article looks to the field of economics for lessons in how we might consider changing perspective to develop and assess new approaches to care. Current approaches to major forms of care in the intensive care unit (ICU) have stagnated, increasingly complex patients with multiple co-morbidities have resulted in increased use of resources, cost and risk of complications. Growing fear of iatrogenic complications has led to a “less is more” approach to new care (1–3). The major hurdle to overcome is the increase in negative outcomes, which seem to regularly arise with more aggressive approaches to care seen in a range of randomized clinical trials in the last two or more decades. This analysis takes an outside the box approach, with lessons from the field of Economics, to assess the situation and make some bold proposals, in the interest primarily of stimulating “creative tension” in the field as to considering the way forward.